Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis.
The authors present a series of 25 patients who underwent single-stage complete spondylectomy, vertebral body reconstruction, and posterior segmental spinal stabilization for malignant metastatic disease involving multiple columns of the thoracolumbar spine. Patients were selected for this approach primarily because they were poor candidates for a transcavitary or lateral extracavitary approach or because the tumor involved both anterior and posterior columns of the spine. The operative approach used combines radical local resection of tumor via a bilateral transpedicular route, methylmethacrylate vertebral body reconstruction, and Luque rectangle stabilization in a single operation. Following surgery, the majority of patients experienced improvement in their neurological status, reduction in pain, or both. Most patients were functionally improved, or at least no worse, and spinal alignment was maintained in all. There was one local recurrence in a long-term survivor. Complications included cerebrospinal fluid fistulas, migrating graft material, and wound healing problems. The authors conclude that this surgical approach is safe and feasible for the radical resection of vertebral metastasis when combined with reconstruction and stabilization. This technique represents a useful alternative to other commonly used surgical approaches for the treatment of spinal metastases, and it should aid surgeons in selecting the optimum approach for individual patients.
Akeyson
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EW
Department of Neurosurgery, University of Texas M.D Anderson Cancer Center, Houston, USA.
McCutcheon
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IE
D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D020366:Methylmethacrylate; D008768:Methylmethacrylates / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D011183:Postoperative Complications; D011184:Postoperative Period; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome
D001843:Bone Cements; D008768:Methylmethacrylates; D020366:Methylmethacrylate