Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization

Abstract

The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

“…Treatment of metastatic spinal lesions with vertebrectomy and stabilization has been shown to provide significant and sustained improvement in pain control (Table 8) [4,5,20,24,25,35,37,47,50,52]. Similar pain relief was achieved in our series, as evidenced by decreases in VAS and pain medication scale scores that lasted for at least 1 year.…”

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

“…This is in contrast to reports in the literature, that suggest, that breast metastases confined to the skeletal system have a better overall prognosis [6,8,34,43,45]. In our series, which includes patients with and without visceral metastases, the overall median survival from time of surgery was 21 months, which is comparable to some reported series [52] and longer than others [39,46,47,49,53]. Furthermore, the extent of metastatic disease was not associated with the risk of major postoperative complications.…”

Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer

“…[28] Fidlcr [5) O'Neilcta1. [17] Turneret al [29] This scries NS -not stated should be as rigid as possible [4 , 5, 7, 9-12, 15-20,24-31].…”

“…In our series, in 10 patients (24%) a bilateral approach was regarded as necessary. The frequeney of a bilateral approach is qui te variable in the literature, and the criteria for an absolute indication are apparentJy a matter of disellssion [14 , 16J. Si nce autologo us bone grafts alOite requirc severa l monrhs for ineorporation to aehieve adeq uate stabiJity [IOJ without external bracing or immobilization , and this can bc deJayed if irrad iation is appljed, most authors have combined the tech niq ue of acrylic bone cement insertion after spondyleetomy with augmentat ion by a metal im plant l5 , ] 1, [26][27][28]. Apparentl y, the perccntages of neurologicaJ improvement , neurological worsening , morbidity , and 30-day mortality are comparable irrespective of the sped fi c technique used for addition al stabilization (Table 4) [5 , 11, 17, 26, 28 , 29].…”