Anterior Spinal Arthrodesis With Structural Cortical Allografts and Instrumentation for Spine Tumor Surgery

Lewandrowski, Kai‐Uwe; Hecht, Andrew C.; DeLaney, Thomas F.; Chapman, P. A.; Hornicek, Francis J.; Pedlow, Frank X.

doi:10.1097/00007632-200405150-00019

Cited by 44 publications

(22 citation statements)

References 47 publications

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“…The evidence level was III in 2 articles, 19,25 and IV in 25 studies. [7][8][9]14,16,21,22,27,31,34,35,[38][39][40][41][42]45,48,54,55,67,[69][70][71]74 The mean number of levels of tumor involvement ranged from 1 to 4.4, and 5 studies 25,34,35,54,74 did not report this information. The number of articles reporting data on primary tumors, metastatic tumors, and both, were 9, 4, and 14, respectively.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

“…In Table 2, bone graft options and fusion outcomes are summarized. Thirteen studies 10,14,16,19,22,25,31,34,35,39,40,55,71 used bone grafts solely for anterior fusion, whereas two studies 41,74 solely performed posterior fusion. The other 12 studies 7,8,21,27,38,42,45,48,54,67,69,70 included patients who underwent either anterior fusion, posterior fusion, or both, and were thus substantially heterogeneous.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

“…Regarding graft options, 7 studies 16,19,39,42,55,70,71 used cages filled with morselized bone graft or other bone graft extenders, whereas 4 studies, 27,41,48,67 included patients with vascularized autogenic bone grafts either with or without vascular pedicles. Regarding adjunctive therapy, 18 studies, 7,8,14,16,21,22,25,35,[38][39][40][41][42]45,48,67,70,74 clearly stated the percentage of patients who underwent RT, which substan- Meta-Analysis and Meta-regression Analysis Overall, fusion rates varied widely from 36.0% to 100.0%, with a pooled fusion rate (PFR) of 85.7% (95% CI 80.6%-89.6%). The I 2 value was 36.4, which suggested moderate heterogeneity (Fig.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

“…However, the use of local bone grafts such as laminae, facets, pedicles, and/or vertebrae is often avoided for patients with spinal column tumors due to potential microscopic invasion of tumor cells into adjacent areas, which limits the potential bone graft options. 8,9,27,31,40 Additionally, although controversial, the application of bone morphogenetic protein-2 (BMP-2) to patients with tumors is generally contraindicated due to several prior studies that suggested an increased incidence of tumors in patients who received BMP-2. 58,62,63,66 Because of these issues, it is unclear what bone graft options should be selected in patients with spinal column tumors.…”

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Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

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OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

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Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

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“…These include motion measurement on lateral flexion and exten-sion radiographs, progressive measurement of lost lordotic angle correction, graft collapse and resorption and percentage radiolucency surrounding the graft. The most direct method is by assessment of trabecular continuity between the graft and the adjacent native vertebra [2,15,17,23]. This method relies on assessment by perpendicular radiographic images of the spine and may be subject to overestimation of fusion status in keeping with variation in radiographic quality and reproducibility, overlying visceral artefact and the three-dimensional nature of the subject fusion.…”

Section: Introductionmentioning

confidence: 99%

CT-based classification of long spinal allograft fusion

et al. 2007

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Anterior column reconstruction of the thoracolumbar spine by structural allograft has an increased potential for biological fusion when compared to synthetic reconstructive options. Estimation of cortical union and trabecular in-growth is, however, traditionally based on plain radiography, a technique lacking in sensitivity. A new assessment method of bony union using high-speed spiral CT imaging is proposed which reflects the gradually increasing biological stability of the construct. Grade I (complete fusion) implies cortical union of the allograft and central trabecular continuity. Grade II (partial fusion) implies cortical union of the structural allograft with partial trabecular incorporation. Grade III (unipolar pseudarthrosis) denotes superior or inferior cortical non-union of the central allograft with partial trabecular discontinuity centrally and Grade IV (bipolar pseudarthrosis) suggests both superior and inferior cortical non-union with a complete lack of central trabecular continuity. Twenty-five patients underwent anterior spinal reconstruction for a single level burst fracture between T4 and L5. At a minimum of two years follow up the subjects underwent high-speed spiral CT scanning through the reconstructed region of the thoracolumbar spine. The classification showed satisfactory interobserver (kappa score = 0.91) and intraobserver (kappa score = 0.95) reliability. The use of high-speed CT imaging in the assessment of structural allograft union may allow a more accurate assessment of union. The classification system presented allows a reproducible categorization of allograft incorporation with implications for treatment.

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Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas

et al. 2014

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Anterior Spinal Arthrodesis With Structural Cortical Allografts and Instrumentation for Spine Tumor Surgery

Abstract: 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.

Cited by 44 publications

References 47 publications

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

CT-based classification of long spinal allograft fusion

Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas

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