Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery.
METHODS
The authors report on anterior vertebral reconstruction following tumor resection with use of fresh-frozen, cortical, long-segment allografts prepared from diaphyseal sections of long bones. A retrospective analysis of clinical outcomes is presented.


OBJECTIVE
To analyze the results following the use of cortical allografts in the treatment of spine tumors.


BACKGROUND
Metastatic disease and primary spinal bone tumors may result in progressive vertebral collapse, instability, deformity, pain, and neurologic deficit. Controversy as to the appropriate type of anterior reconstruction and/or graft material persists.


METHODS
From 1995 until 2001, 30 patients with primary spinal bone tumors or metastases to the spine were treated by anterior vertebral reconstruction with fresh-frozen cortical bone allografts. Grafts were used in combination with anterior and posterior instrumentation.


RESULTS
The median survival was 14 months. Ninety-three percent of all allografts were radiographically incorporated as early as 6 months after surgery in spite of adjuvant chemotherapy and radiation therapy. Fourteen patients (46%) had intraoperative or postoperative complications. Two patients underwent revision surgery for local recurrence. There were no allograft infections, fractures, or collapse.


CONCLUSIONS
Anterior column reconstruction with structural cortical allografts proved to be a reliable technique in patients with spine tumors. Postoperative complications can often be successfully managed.
Lewandrowski
Kai-Uwe
KU
Department of Orthopaedics, Massachusetts General Hospital, Boston, Massachusets, USA. Lewandk@ccf.org
Hecht
Andrew C
AC
DeLaney
Thomas F
TF
Chapman
Peter A
PA
Hornicek
Francis J
FJ
Pedlow
Frank X
FX
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D001915:Braces; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002813:Chondrosarcoma / Q000532:radiotherapy / Q000601:surgery; D002817:Chordoma / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012516:Osteosarcoma / Q000532:radiotherapy / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome