Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures.
OBJECTIVE
Few reports are available on the use of pedicle screw fixation for cancer-related spinal instability. The authors present their experience with pedicle screw fixation in the management of malignant spinal column tumors.


METHODS
Records for patients with malignant spinal tumors who underwent pedicle screw fixation at the authors' institution between September 1994 and December 1999 were retrospectively reviewed.


RESULTS
Ninety-five patients with malignant spinal tumors underwent 100 surgeries involving pedicle screw fixation: metastatic spinal disease was present in 81 patients, and locally invasive tumors were demonstrated in 14 patients. Indications for surgery were pain (98%) and/or neurological dysfunction (80%). A posterior (48%) or a combined anterior-posterior (52%) approach was performed depending on the extent of tumor and the patient's condition. At the mean follow up of 8.2 months, 43 patients (45%) had died; median survival, as determined by Kaplan-Meier analysis, was 14.8 months. At I month postsurgery, self-reported pain had improved in 87% of cases (p < 0.001), which is a finding substantiated by reductions in analgesic use, and 29 (47%) of 62 patients with preoperative neurological impairments were functionally improved (p < 0.001). Postoperative complications were associated only with preoperative radiation therapy (p = 0.002) and with preexisting serious medical conditions (p = 0.04). In two patients asymptomatic violation of the lateral wall of the pedicle was revealed on postoperative radiography. The 30-day mortality rate was 1%.


CONCLUSIONS
For selected patients with malignant spinal tumors, pedicle screw fixation after tumor resection may provide considerable pain relief and restore or preserve ambulation with acceptable rates of morbidity and mortality.
Fourney
D R
DR
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston 77030, USA.
Abi-Said
D
D
Lang
F F
FF
McCutcheon
I E
IE
Gokaslan
Z L
ZL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology; D011183:Postoperative Complications; D011184:Postoperative Period; D011300:Preoperative Care / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome