Treatment of Neoplastic Spinal Cord Compression: Results of a Prospective Study

Sundaresan, Narayan; DiGiacinto, George V.; Hughes, James E. O.; Cafferty, Maureen; Vallejo, A. Ramírez De

doi:10.1227/00006123-199111000-00001

Cited by 218 publications

(101 citation statements)

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“…This has led to the development of alternative posterolateral techniques. 23,28,31,51,53,60,63,[66][67][68] Many authors have described techniques for resection of spinal metastasis that do not require a transcavitary approach. 5,[12][13][14]18,34,35,41,43,44,57,59,64 Costotransversectomy was first described by Menard 48 in 1894 for drainage of tuberculous abscesses in patients with Pott paraplegia.…”

Section: Discussionmentioning

confidence: 99%

“…They reported wound-related complications in 4% and death in 8%, with hardware failure in 5% of their patients. In a more recent article, Sundaresan and colleagues 66 reported 110 patients in whom MMA or bone and instrumentation reconstruction was performed. They reported wound-related complications in 16%, hardware-related failure in 11%, and death in 5%.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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Object Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach–related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome. Methods Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, pre-operative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups. Conclusions Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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“…For this reason, aggressive surgical intervention is often considered in patients with metastatic spine disease who can tolerate surgery [5,19,24,33,38,39,47,48,53,54]. Recently, Ogihara et al [36] reviewed patients with lung cancer metastatic to the spine in attempt to identify prognostic factors that may aid in stratifying patients towards medical or surgical treatment.…”

Section: Indications For Surgerymentioning

confidence: 99%

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

et al. 2007

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The histology of the primary tumor in metastatic spine disease plays an important role in its treatment and prognosis. However, there is paucity in the literature of histology-specific analysis of spinal metastases. In this study, prognostic variables were reviewed for patients who underwent surgery for breast metastases to the spinal column. Respective chart review was done to first identify all patients with breast cancer over an 8-year period at a major cancer center and then to select all those with symptomatic metastatic disease to the spine who underwent spinal surgery. Univariate and multivariate analyses were used to assess several prognostic variables. Presence of visceral metastases, multiplicity of bony lesions, presence of estrogen receptors (ER), and segment of spine (cervical, thoracic, lumbar, sacral) in which metastases arose were compared with patient survival. Eighty-seven patients underwent 125 spinal surgeries. Those with estrogen receptor (ER) positivity had a longer median survival after surgery compared to those with estrogen receptor negativity. Patients with cervical location of metastasis had a shorter median survival compared with those having metastases in other areas of the spine. The presence of visceral metastases or a multiplicity of bony lesions did not have prognostic value. In patients with spinal metastases from breast cancer, aggressive surgical management may be an option for providing significant pain relief and preservation/improvement of neurological function. Interestingly, in patients undergoing such surgery, cervical location of metastasis is a negative prognostic variable, and ER-positivity is associated with better survival, while presence of visceral or multiple bony lesions does not significantly alter survival.

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“…In the past, the aims of surgery for spinal metastases were largely confined in decompression for the compressed spinal cord and/or nerve roots [4,7,17]. Other common indications for surgery include intractable pain, pathologic fracture, and spinal instability caused by the lesion [8].…”

Section: Introductionmentioning

confidence: 99%

Outcome of excisional surgeries for the patients with spinal metastases

Gasbarrini

Cappuccio

et al. 2009

Eur Spine J

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To evaluate the outcome of the excisional surgeries (en bloc/debulking) in spinal metastatic treatment in 10 years. A total of 131 patients (134 lesions) with spinal metastases were studied. The postoperative survival time and the local recurrence rate were calculated statistically. The comparison of the two procedures on the survival time, local recurrence rate, and neurologic change were made. The median survival time of the en bloc surgery and the debulking surgery was 40.93 and 24.73 months, respectively, with no significant difference. The significant difference was shown in the local recurrence rate comparison, but not in neurological change comparison. 19.85% patients combined with surgical complications. The en bloc surgery can achieve a lower local recurrence rate than the debulking surgery, while was similar in survival outcome, neurological salvage, and incidence of complications. The risk of the excisional surgeries is high, however, good outcomes could be expected.

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Treatment of Neoplastic Spinal Cord Compression: Results of a Prospective Study

Cited by 218 publications

References 0 publications

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

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

Outcome of excisional surgeries for the patients with spinal metastases

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