Cervical spine metastases: techniques for anterior reconstruction and stabilization

Objective. To analyze the results of surgical treatment of chronic infectious cervical spondylitis and literature data.Material and Methods. Design: retrospective monocentric cohort study for 2017–2020. The study included medical history and clinical and instrumental data of 25 patients who underwent 28 reconstructive surgeries on the suboccipital (n1 = 3) and subaxial (n2 = 25) spine. The average follow-up period was 1 year 2 months ± 4 months. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 22.0.Results. The effect of the duration of the therapeutic pause (p = 0.043) and the T1 slope (T1S) (p = 0.022) on the intensity of vertebrogenic pain syndrome was established. When assessing the parameters of the sagittal balance a direct relationship between the age of patients and the value of cervical sagittal vertical axis (CSVA) (p = 0.035) was revealed, while CSVA (p = 0.514) and neck tilt angle (NTA) (p = 0.617) did not significantly affect the intensity of vertebral pain syndrome. The extent of vertebral destruction did not affect either the intensity of vertebral pain (p = 0.872) or the indices of the sagittal balance: CSVA (p = 0.116), T1S (p = 0.154), and NTA (p = 0.562). A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more (p = 0.027) according to the Charlson scale.Conclusion. The leading predictors of complications of surgical treatment of cervical infectious spondylitis are the Charlson comorbidity index (7 points or more) and the variant of anterior reconstruction (the use of a blocked extraspinal plate). The factors influencing the intensity of vertebrogenic pain syndrome in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of infectious spondylitis provides a correction of the sagittal balance parameters, with the possibility of long-term maintaining the achieved values.

Download Full-text

Surgical management of metastatic tumors of the cervical spine

Folia Medica ◽

10.2478/folmed-2013-0026 ◽

2013 ◽

Vol 55 (3-4) ◽

pp. 39-45 ◽

Cited By ~ 2

Author(s):

Atanas N. Davarski ◽

Borislav D. Kitov ◽

Christo B. Zhelyazkov ◽

Stefan D. Raykov ◽

Ivo I. Kehayov ◽

...

Keyword(s):

Cervical Spine ◽

Tumor Resection ◽

Pain Syndrome ◽

University Hospital ◽

X Rays ◽

Stabilization System ◽

Spine Metastases ◽

Anterior Corpectomy ◽

Nerve Root Decompression ◽

Postoperative State

ABSTRACT OBJECTIVE: To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. PATIENTS AND METHODS: The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre- and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classification. RESULTS: Seven patients had only one affected vertebra, 4 patients - two vertebrae, one patient - three vertebrae, 2 patients - four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient - three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial - in 2 patients. Anterior stabilization system ADD plus® (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient - posterior cervical stabilization system. CONCLUSIONS: Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justified. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

Download Full-text

Cervical spinal metastasis: anterior reconstruction and stabilization techniques after tumor resection

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.5.2 ◽

2003 ◽

Vol 15 (5) ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

James K. Liu ◽

Ronald I. Apfelbaum ◽

Bennie W. Chiles ◽

Meic H. Schmidt

Keyword(s):

Cervical Spine ◽

Spinal Metastasis ◽

Posterior Instrumentation ◽

Tumor Resection ◽

Spinal Metastases ◽

Metastatic Tumor ◽

Subaxial Cervical Spine ◽

Bone Autograft ◽

Anterior Reconstruction ◽

Anterior Cervical Corpectomy

Object In a review of the literature, the authors provide an overview of various techniques that have evolved for reconstruction and stabilization after resection for metastatic disease in the subaxial cervical spine. Methods Reconstruction and stabilization of the cervical spine after vertebral body (VB) resection for metastatic tumor is an important goal in the surgical management of spinal metastasis. Generally, the VB defect is reconstructed with bone autograft or allograft, polymethylmethacrylate (PMMA), interbody spacers, and/or cages. In cases of PMMA-assisted reconstruction, internal devices are used to augment the fixation of PMMA. Stabilization is then achieved with anterior instrumentation, usually an anterior cervical locking plate. In some cases, posterior instrumentation may be necessary to supplement the anterior construct. Conclusions Anterior cervical corpectomy followed by reconstruction and stabilization is an effective strategy in the management of spinal metastases in patients.

Download Full-text

Surgery of cervical spine metastases: A retrospective study

European Spine Journal ◽

10.1007/bf02221444 ◽

1994 ◽

Vol 3 (2) ◽

pp. 76-83 ◽

Cited By ~ 52

Author(s):

B. Jónsson ◽

H. Jónsson ◽

G. Karlstróm ◽

L. Sjöström

Keyword(s):

Cervical Spine ◽

Retrospective Study ◽

Spine Metastases

Download Full-text

Instrumentation Surgery of Anterior Reconstruction of the Cervical Spine

Spinal Surgery ◽

10.2531/spinalsurg.15.105 ◽

2001 ◽

Vol 15 (2) ◽

pp. 105-110 ◽

Cited By ~ 3

Author(s):

Yuki Ida ◽

Tetsuya Morimoto ◽

Hiroyuki Nakase ◽

Toshisuke Sakaki

Keyword(s):

Cervical Spine ◽

Anterior Reconstruction

Download Full-text

Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort

Global Spine Journal ◽

10.1177/2192568219839407 ◽

2019 ◽

Vol 10 (1) ◽

pp. 21-29

Author(s):

Michael R. Bond ◽

Anne L. Versteeg ◽

Arjun Sahgal ◽

Laurence D. Rhines ◽

Daniel M. Sciubba ◽

...

Keyword(s):

Cervical Spine ◽

Study Design ◽

Rating Scale ◽

Surgical Intervention ◽

Numerical Rating Scale ◽

Spinal Instability ◽

Cervical Metastases ◽

Spine Metastases ◽

Radiotherapy Alone ◽

The Impact

Study Design: Ambispective cohort study design. Objectives: Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours. Methods: Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention. Results: Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group ( P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group. Conclusions: Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.

Download Full-text