title: Evidence-Based Review and Survey of Expert Opinion of Reconstruction of Metastatic Spine Tumors.
abstract: METHODS
  Systematic review and consensus expert opinion.
  
  
  OBJECTIVE
  To provide surgeons and other health care professionals with guidelines for surgical reconstruction of metastatic spine disease based on evidence and expert opinion.
  
  
  BACKGROUND
  The surgical treatment of spinal metastases is controversial. Specifically two aspects of surgical reconstruction are addressed in this study: (i) choice of bone graft used during surgery for metastatic spine tumors and (ii) the design of reconstruction or construct to stabilize.
  
  
  METHODS
  A systematic review of the available medical literature from 1980 to 2015 was conducted, and combined with consensus expert opinion from a recent survey of spine surgeons who treat metastatic spine tumors.
  
  
  RESULTS
  There is very little evidence in the literature to provide guidance on the use of bone graft in metastatic tumor reconstruction. There is little evidence in the literature to support the preferential use of one graft type over the other. Approximately, 41% of respondents said they used bone graft or bone graft substitutes to accomplish fusion. There were 17 studies that described the use of a prefabricated prosthetic, 10 studies describing the use of polymethyl methacrylate (PMMA) bone cement, and only three studies describing the use of bone graft for anterior column reconstruction. The use of structural allograft was most popular among the experts for anterior reconstruction, followed by cage reconstruction, and PMMA bone cement.
  
  
  CONCLUSIONS
  Achieving bony union may be of importance for the maintenance of spinal stability in the long term after reconstruction. Whether bony union is required for patients with shorter life expectancies is debatable. The literature supports the use of anterior reconstruction with either a prefabricated prosthetic or PMMA bone cement. It also supports the use of an anterior construct reinforced with bilateral posterior instrumentation when performing a three-column reconstruction.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Orthopedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Farhaan
authors.initials: F
authors.lastname: Altaf
authors.affiliation: Division of Surgery, McGill University and Montreal General Hospital, Montreal, Québec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dea
authors.affiliation: Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
authors.affiliation: Department of Neurosurgery, University of California-San Francisco Medical Center, San Francisco, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
authors.affiliation: Department of Orthopedics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jorrit-Jan
authors.initials: JJ
authors.lastname: Verlaan
authors.affiliation: Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Department of Orthopedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
mesh_terms: D016025:Bone Transplantation / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000601:surgery*