Spinal stabilization of vertebral column tumors.
An analysis of indications, techniques, results of stabilization and decompression of 100 consecutive spinal tumour cases was carried out. Localized metastatic disease is best operated anteriorly. Primary malignancies are best treated with en bloc resection. Pain relief in metastatic disease is achieved by rigid stabilization. The unstable spine secondary to benign or malignant disease often requires stabilization for alleviation of pain; 132 stabilization procedures were performed in 100 patients. There were nine benign and 91 malignant tumors including 71 metastatic. Indications for stabilization were pathological fracture or following decompression. Anterior approaches including implant stabilization were used in those with metastatic disease limited to one to two levels or where significant kyphosis existed. Posterolateral decompression with Luque rod stabilization was indicated where disease was more widespread. In metastatic disease acrylic cement was used both anteriorly and posteriorly together with implant stabilization. Eighty-one percent had good to excellent relief of pain; 68 patients had neurological deficits. Significant neurological return was achieved in 40% of posterior decompressions and 71% of anterior decompressions in metastatic disease. All patients with benign tumors have solid fusions. In malignant disease the use of cement provided stability without loss of fixation in 87 of 91 procedures. Complications were 4% infection and failure of two Harrington rods without wiring, one Luque rod and two anterior constructs. The average longevity of patients treated for metastatic disease was 11.3 months.
Kostuik
J P
JP
Department of Surgery, Toronto General Hospital/Mount Sinai Hospitals, Ontario, Canada.
Errico
T J
TJ
Gleason
T F
TF
Errico
C C
CC
D004868:Equipment Failure; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology / Q000601:surgery; D009984:Orthopedic Fixation Devices / Q000009:adverse effects; D010166:Palliative Care; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications*