title: Posterior stabilisation of a malignant cervico-thoracic vertebral bone defect.
abstract: Oesophageal cancer is frequently complicated by malignant fistulae. Necrosis of the tumour following radiotherapy or chemotherapy may lead to the development of fistulae between the oesophagus and adjacent tissues and organs. We report the expansion of an extra-luminal oesophageal cancer after resection, invading the cervico-thoracic spine, fortunately without neurological deficit, and leading to instability and formation of a malignant fistula linking the tracheo-bronchial tree to the subarachnoidal space. To prevent imminent paraplegia and to alleviate severe pain, we rigidly stabilised the spine at the cervico-thoracic junction using an angle-stable system through a single posterior approach. Further postoperative follow-up revealed no signs of neurological deterioration. Cervico-thoracic stability was preserved until the patient died nearly five months postoperatively. This case shows that posterior stabilisation and decompression may be a palliative option for patients with imminent paraplegia and severe pain due to advanced tumour infiltration of the cervico-thoracic spine.
authors.affiliation: Department of Orthopedic Surgery and Spinal Cord Injury, University of Ulm, Germany. benjamin.ulmar@rku.de
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ulmar
authors.forename: Balkan
authors.initials: B
authors.lastname: Cakir
authors.forename: Klaus
authors.initials: K
authors.lastname: Huch
authors.forename: Wolfhart
authors.initials: W
authors.lastname: Puhl
authors.forename: Marcus
authors.initials: M
authors.lastname: Richter
mesh_terms: D001863:Bone Screws; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000628:therapy; D002574:Cervical Vertebrae; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000379:methods; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D016268:Internal Fixators; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D018570:Risk Assessment; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure