Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> To assess clinical outcome and survival in patients with cervical vertebral spinal neoplasms after they have undergone anterior decompression and cervical plate stabilization (ACPS) by using either autologous bone graft or polymethylmethacrylate (PMMA) as the anterior load-bearing support structure.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> This was a retrospective case study composed of 30 patients harboring cervical spinal vertebral neoplasms who underwent anterior cervical decompression and (ACPS) within a 7-year period. Postoperative immobilization included treatment in a halo brace in two cases and in a hard cervical collar for the remaining patients. Postoperatively most patients underwent radio- and/or chemotherapy. All patients except one benefited from a significantly improved quality of life with decreased pain and/or improved neurological status. The mean Kaplan—Meier survivoral estimate was 35.8 months (range 8 days–11.3 years, with 10 patients alive at most recent follow-up contact). Patients achieved long-term or lifelong mechanical stability in the cervical spine, and only one patient required a repeated posterior stabilization procedure. No hardware-related complications occurred. One patient died 8 days postoperatively of pneumonia. A nonsignificant difference in survival (p = 0.2164) was observed between patients harboring metastatic neoplasms (26.8 months) and those harboring lymphomatous and multiple myeloma neoplasms (54 months).</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Favorable clinical outcome of both neurological symptoms and pain can be achieved using ACPS after surgery for neoplasms in the cervical vertebrae. Furthermore, long-term or lifelong cervical spine mechanical stability with bone fusion is achieved using this technique even when radiation therapy is delivered to the site of the bone graft.</jats:p>

Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection

“…2,6,30,40 Various techniques have been described in the literature for reconstruction of the cervical and cervicothoracic spine following corpectomy. 3,6,7,9,11,13,24,32,36,40,42,48,49 In patients with degenerative spinal disease, autologous bone (commonly harvested from the iliac crest) or bone allograft has been a well-accepted replacement material for use after vertebral body removal, with or without additional placement of a plate fixation system. 9,15,38,46 The successful use of this type of reconstruction in conjunction with plate fixation in patients with metastatic disease has also been reported recently by Caspar.…”

Multiple Vertebral Metastases from Malignant Cardiac Pheochromocytoma-Case Report-

“…Immediate and persistent stability was achieved even after radiation therapy was performed. 4) Our patient presented with a pathological fracture of the C-4 vertebral body. Surgical treatment had to be carefully chosen considering the multiple systemic metastases already discovered at the time of diagnosis.…”

“…11) Anterior corpectomy, reconstruction with autologous bone or polymethylmethacrylate, and fixation are generally accepted as surgical options for vertebral body tumors. 4,9) However, the optimum material needed to reconstruct the vertebral body defect has not been established. Whether autologous bone graft can be incorporated into an irradiated vertebral bone bed is still not clear.…”

“…Whether autologous bone graft can be incorporated into an irradiated vertebral bone bed is still not clear. 4,9) Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae was used in 26 patients who underwent corpectomy of the pathological vertebrae, reconstruction with autologous bone graft, and anterior cervical plating. Immediate and persistent stability was achieved even after radiation therapy was performed.…”

Neck and back pain in the elderly

“…In cases involving tumor resection from the cervical spine, anterior decompression and cervical plate stabilization using bone graft achieves satisfactory mechanical stability, even in the setting of postoperative radiation therapy [26]. This procedure does not require postoperative halo vest immobilization, and, in fact, results in favorable neurologic outcomes and the prompt alleviation of pain for most patients presenting with tumor-related spinal cord compression.…”