Acrylic Stabilization of the Cervical Spine for Neoplastic Disease: Evolution of a Technique for Vertebral Body Replacement

The resection of collapsed cervical vertebral bodies affected by malignant lytic lesions often requires innovative methods for stabilization. Over the years, immediate stabilization of the cervical spine has been achieved with acrylic bridges, preformed metallic placement bodies, fibular strut grafts, and other aids. Because acrylic bonds poorly to adjacent bony structures, techniques to assure the adequate fixation of an acrylic bridge between resected vertebral bodies are needed. The possible progression of disease in adjacent bone prompts us to maximize the amount of internal fixation with rods or pins to assure stability. Lasting stability has become more important as the longevity of cancer patients has been increased by multimodality therapy. We report our technique for treating cancer patients with acrylic and pin fixation of the cervical spine after vertebral body excision by the anterior route. Certain modifications of the technique may have advantages over previously reported procedures. Our series of six cases demonstrates the evolution of a technique that allows relatively rapid and easy decompression of the cervical spinal cord and provides immediate stability of the cervical spine. Our indications and contraindications for this procedure are also discussed.