[Implantation of a Harms titanium mesh cylinder for vertebral body replacement in spinal metastases].
OBJECTIVE
Vertebral metastases are quiet common and may result in vertebral collapse, spinal instability, and progressive neurological compromise. An anterior approach is the accepted method for decompression and stabilization by vertebral replacement. There is still need for discussion regarding the material of the replacement device. Here, the authors report on Harms' titanium cage (DePuy-Motech) for vertebral replacement.


METHODS
From 1992 until 1995 17 patients with spinal metastases were treated by anterior vertebral replacement at the Orthopaedic Department, University of Magdeburg. Indications for the procedure were single metastases and respectively, progressive neurological deficit with vertebral destruction seen radiologically. Implantation of the cage was performed solely or in combination with anterior or posterior instrumentation. Pre- and postoperative assessments were evaluated by clinical scores.


RESULTS
Mean follow-up was 9.3 months. At the end of our study 11 patients had died (mean survival 6.7 months). Mean follow-up of the surviving 6 was 9.8 months. Patient's daily activity (Karnofsky) improved in 8 cases, became worse in 4 cases, and did not change in 5 cases. Neurologically (Frankel) there was improvement in 3 patients, deterioration in 4 patients, and no change in 10 patients. Walking ability showed improvement in 6 cases, deterioration in 3 cases and no change in 8 cases. Relief of pain (Moskowitz) was reported by 12 patients, no patient complained of increasing pain, 5 patients reported no change, and 10 patients were pain-free.


CONCLUSIONS
In most cases with spinal metastases, the quality of life may be improved by vertebral replacement with Harms' titanium cage. Amelioration of clinical symptoms such as neurological deficit, pain, and tack of walking ability occurred in most patients.
Merk
H
H
Orthopädische Klinik, Otto-von-Guerricke-Universität, Magdeburg.
Koch
H
H
Liebau
C
C
Baltzer
A
A
Dragendorf
L
L
Grasshoff
H
H
D000328:Adult; D000368:Aged; D000497:Alloys; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D014025:Titanium
D000497:Alloys; C031462:titanium alloy (TiAl6V4); D014025:Titanium