Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study

Abstract

OBJECTIVE Surgical management of spinal metastases at the cervicothoracic junction (CTJ) is highly complex and relies on case-based decision-making. The aim of this multicentric study was to describe surgical procedures for metastases at the CTJ and provide guidance for clinical and surgical management. METHODS Patients eligible for this study were those with metastases at the CTJ (C7–T2) who had been consecutively treated in 2005–2019 at 7 academic institutions across Europe. The Spine Instability Neoplastic Score, neurological function, clinical status, medical history, and surgical data for each patient were retrospectively assessed. Patients were divided into four surgical groups: 1) posterior decompression only, 2) posterior decompression and fusion, 3) anterior corpectomy and fusion, and 4) anterior corpectomy and 360° fusion. Endpoints were complications, surgical revision rate, and survival. RESULTS Among the 238 patients eligible for inclusion this study, 37 were included in group 1 (15%), 127 in group 2 (53%), 18 in group 3 (8%), and 56 in group 4 (24%). Mechanical pain was the predominant symptom (79%, 189 patients). Surgical complications occurred in 16% (group 1), 20% (group 2), 11% (group 3), and 18% (group 4). Of these, hardware failure (HwF) occurred in 18% and led to surgical revision in 7 of 8 cases. The overall complication rate was 34%. In-hospital mortality was 5%. CONCLUSIONS Posterior fusion and decompression was the most frequently used technique. Care should be taken to choose instrumentation techniques that offer the highest possible biomechanical load-bearing capacity to avoid HwF. Since the overall complication rate is high, the prevention of in-hospital complications seems crucial to reduce in-hospital mortality.

CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy

“…The major reasons of postoperative complications requiring revision surgery were surgical site infections and wound healing disorders, which were regarded not to be attributed to the use of CFR-PEEK. Their number was comparable to the rates of this type of complication of patients treated for SM previously reported by other studies [ 24 , 25 ]. In seven cases (2.2%), revision surgery for screw loosening was performed.…”

“…The preoperative KPS of patients in our study was within the range of other recent studies about surgical treatment for spinal neoplasms [ 24 , 29 ]. A strong association between KPS and survival after surgery for spinal metastases was shown before [ 30 ].…”

Extended salvage surgery after high-dose chemoradiation therapy for tumors in the cervico-thoracic junction with invasion of the chest wall and the spine: a case series

“…Local tumor invasion might destabilize the structural integrity of the vertebral body with resulting imbalance of the sagittal profile of the spine, causing pain and neurological deficits. A recent publication on spinal metastases of the CTJ underlines the challenge for biomechanical stabilization after extended surgical resection [ 20 ]. Surgical treatment options are mainly palliative and aim for minimal perioperative and postoperative morbidity.…”

Navigation accuracy and assessability of carbon fiber-reinforced PEEK instrumentation with multimodal intraoperative imaging in spinal oncology

“…All observers rated iCT image quality higher than rCBCT/CBCT image quality (*p < 0.01) but relevant pedicle breaches were reliably identified with substantial agreement between all observers regardless of the imaging modality. Navigation accuracy for CFRP pedicle screws was considerably lower than expected from reports on titanium implants and CT may be best for reliable assessment of CFRP materials.For patients with spinal oncological disease, posterior pedicle screw fixation with or without circumferential decompression, en-bloc spondylectomy, or anterior cage reconstruction represents an accepted strategy to address tumor burden, cord compression, instability and pain [1][2][3][4][5][6][7] . Against this background, technology in the field of spine surgery has evolved towards the development of new implant materials and computer-assisted image guidance: Carbon fiber reinforced PEEK (CFRP) has been reported to have biomechanical screw properties comparable to standard titanium implants 8 with distinct advantages of reduced imaging artifacts 9 , less perturbation effects 10 and the potential to significantly improve planning, safety and quality of adjuvant radiotherapy and follow-up [10][11][12][13][14][15][16] .…”

“…For patients with spinal oncological disease, posterior pedicle screw fixation with or without circumferential decompression, en-bloc spondylectomy, or anterior cage reconstruction represents an accepted strategy to address tumor burden, cord compression, instability and pain [1][2][3][4][5][6][7] . Against this background, technology in the field of spine surgery has evolved towards the development of new implant materials and computer-assisted image guidance: Carbon fiber reinforced PEEK (CFRP) has been reported to have biomechanical screw properties comparable to standard titanium implants 8 with distinct advantages of reduced imaging artifacts 9 , less perturbation effects 10 and the potential to significantly improve planning, safety and quality of adjuvant radiotherapy and follow-up [10][11][12][13][14][15][16] .…”