title: Palliative spinal reconstruction using cervical pedicle screws for metastatic lesions of the spine: a retrospective analysis of 32 cases.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To evaluate clinical outcomes of palliative spinal reconstruction using cervical pedicle screws in metastatic spine tumors.
  
  
  BACKGROUND
  No study to date has investigated the effectiveness of cervical pedicle screw fixation in metastatic lesions of the spine.
  
  
  METHODS
  A total of 32 patients with metastatic spine tumors who underwent reconstructive surgery using cervical pedicle screws were reviewed. Four patients presented upper cervical lesions and 28 patients had subaxial lesions. All patients had intractable pain, 29 presented myelopathy, and 18 patients were nonambulatory. Combined anterior column reconstruction was considered in cases of life expectancy more than 2 years and anterior spinal cord compression that could not be solved by posterior decompression and kyphosis correction. Posterior fixation alone was performed in 25 patients, and posterior fixation combined with anterior column reconstruction was performed in 7 patients.
  
  
  RESULTS
  The average postoperative survival period was 12.2 months. Neck pain was improved in all cases. Twenty-four (83%) of the 29 patients with spinal cord lesions presented neurologic improvement. Of 18 patients who were not ambulatory, 16 patients (89%) became ambulatory. Pain relief, neurologic function, and spinal stability were maintained throughout the survival period in 30 of 32 patients (94%).
  
  
  CONCLUSIONS
  Spinal reconstruction using cervical pedicle screws improved spinal stability, pain, and neurologic function. These improvements were maintained throughout the survival period in 94% of the patients. Anterior column reconstruction could be avoided in 78% of the patients in spite of damaged anterior column.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. odaitr@aol.com
authors.forename: Itaru
authors.initials: I
authors.lastname: Oda
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Abumi
authors.forename: Manabu
authors.initials: M
authors.lastname: Ito
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kotani
authors.forename: Takashi
authors.initials: T
authors.lastname: Oya
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D010166:Palliative Care; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome