Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis

1996 ◽  
Vol 85 (2) ◽  
pp. 211-220 ◽  
Author(s):  
Edward W. Akeyson ◽  
Ian E. McCutcheon
Keyword(s):  
Vertebral Body ◽  
Spinal Metastasis ◽  
Posterior Instrumentation ◽  
Thoracolumbar Spine ◽  
Spinal Metastases ◽  
Radical Resection ◽  
Single Stage ◽  
Surgical Approaches ◽  
Graft Material ◽  
Content Type

✓ The authors present a series of 25 patients who underwent single-stage complete spondylectomy, vertebral body reconstruction, and posterior segmental spinal stabilization for malignant metastatic disease involving multiple columns of the thoracolumbar spine. Patients were selected for this approach primarily because they were poor candidates for a transcavitary or lateral extracavitary approach or because the tumor involved both anterior and posterior columns of the spine. The operative approach used combines radical local resection of tumor via a bilateral transpedicular route, methylmethacrylate vertebral body reconstruction, and Luque rectangle stabilization in a single operation. Following surgery, the majority of patients experienced improvement in their neurological status, reduction in pain, or both. Most patients were functionally improved, or at least no worse, and spinal alignment was maintained in all. There was one local recurrence in a long-term survivor. Complications included cerebrospinal fluid fistulas, migrating graft material, and wound healing problems. The authors conclude that this surgical approach is safe and feasible for the radical resection of vertebral metastasis when combined with reconstruction and stabilization. This technique represents a useful alternative to other commonly used surgical approaches for the treatment of spinal metastases, and it should aid surgeons in selecting the optimum approach for individual patients.

Patterns of failure after single-dose radiosurgery for spinal metastasis

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 402-405 ◽  
Author(s):  
Samuel Ryu ◽  
Jack Rock ◽  
Mark Rosenblum ◽  
Jae Ho Kim
Keyword(s):  
Single Dose ◽  
Pain Control ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Control ◽  
Effective Treatment Option ◽  
Patterns Of Failure ◽  
Content Type ◽  
Spinal Radiosurgery ◽  
Fine Print

Object. Single-dose radiosurgery for solitary spinal metastases can achieve rapid and durable pain control. This study was conducted to determine the patterns of failure after spinal radiosurgery. Methods. Forty-nine patients with 61 solitary spinal metastases underwent radiosurgery between May 2001 and May 2003. Single-dose radiosurgery (10–16 Gy) was delivered only to the involved spinal segments. The authors undertook a retrospective review of clinical notes, including patient questionnaires and radiological studies (computerized tomography or magnetic resonance imaging), to analyze patterns of failure following radiosurgery with regard to the pain and tumor control. Complete and partial pain relief was achieved in 85% of the lesions treated. Relapse of pain at the treated site was noted in 7%. Radiologically, lesions progressively metastasized to the immediately adjacent spines in 5%. These patients also had progressive primary and/or other systemic metastatic diseases. Conclusions. Spine-related pain control/reduction was excellent. Tumor recurrence at the treated segment and progression to the immediately adjacent region were rare. The results support the use of spinal radiosurgery as an effective treatment option for solitary spinal metastasis.

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

2003 ◽  
Vol 15 (5) ◽  
pp. 1-7 ◽  
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.

Intradural extramedullary spinal metastasis

1982 ◽  
Vol 56 (6) ◽  
pp. 835-837 ◽  
Author(s):  
Richard G. Perrin ◽  
Kenneth E. Livingston ◽  
Bizhan Aarabi
Keyword(s):  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Primary Source ◽  
Clinical Syndrome ◽  
Initial Symptom ◽  
Content Type ◽  
High Incidence ◽  
Intradural Extramedullary ◽  
Metastatic Involvement ◽  
Fine Print

✓ The management of 10 patients with symptomatic localized intradural extramedullary spinal metastasis is reviewed. The single most common primary source was carcinoma of the breast (four cases). The initial symptom in nine patients was pain, with five patients reporting a characteristically severe cramping discomfort with radicular distribution. All patients underwent laminectomy decompression. At the time of surgery, six of the patients were weak but ambulatory and four were bedridden. Following surgery, four patients enjoyed some measure of pain relief, seven patients became ambulatory, and three remained bedridden. Two patients achieved a “satisfactory” result, and were walking and continent 6 months after surgery. Secondary brain tumors were demonstrated or implicated in nine patients, supporting the concept that the spinal metastases represented tertiary deposits following dissemination via the cerebrospinal fluid. Symptomatic intradural extramedullary spinal metastasis causes a virulent clinical syndrome with poor prognosis and disappointing outcome after treatment. Given the high incidence of associated cerebral metastatic involvement, total neuraxis radiation and/or chemotherapy should be considered when symptomatic spinal metastasis is discovered to be intradural and extramedullary.

Unilateral posterolateral decompression without stabilization for neurological palliation of symptomatic spinal metastasis in debilitated patients

1995 ◽  
Vol 82 (5) ◽  
pp. 739-744 ◽  
Author(s):  
Simcha J. Weller ◽  
Eugene Rossitch
Keyword(s):  
Life Expectancy ◽  
Average Length ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Entire Group ◽  
Limited Life Expectancy ◽  
Content Type ◽  
Limited Life ◽  
Limited Surgery ◽  
Fine Print

✓ Patients with symptomatic spinal metastases and limited life expectancy are often too debilitated to withstand anterior or posterolateral spinal cord decompression and segmental stabilization. More limited surgery aiming solely at preservation or restoration of neurological function and relief from pain offers the potential for significant improvement in the quality of remaining life without incurring undue perioperative morbidity and mortality. Eight patients with spinal metastases and limited life expectancy underwent a unilateral transpedicular decompression procedure on their most symptomatic side and/or the side of maximum tumor involvement. All patients were neurologically improved within the 1st postoperative week; all were ambulatory and continent postoperatively. Postoperatively, all five patients with preoperative motor deficits demonstrated increased motor strength, and the three patients with predominant radicular pain reported marked improvement. There were no perioperative deaths and two transient perioperative complications. The average length of hospitalization was 6 days for patients without complications and 10 days for the entire group. Unilateral transpedicular decompression without stabilization is an effective and safe method for palliating symptomatic spinal metastases in debilitated patients with widespread malignancy and limited life expectancy. This therapeutic option should be considered in select cases as an alternative to either nonoperative management or anterior or posterolateral decompression and segmental stabilization.

Patterns of failure after single-dose radiosurgery for spinal metastasis

2004 ◽  
pp. 402-405 ◽  
Author(s):  
Samuel Ryu ◽  
Jack Rock ◽  
Mark Rosenblum ◽  
Jae Ho Kim
Keyword(s):  
Single Dose ◽  
Pain Control ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Control ◽  
Effective Treatment Option ◽  
Patterns Of Failure ◽  
Content Type ◽  
Spinal Radiosurgery ◽  
Fine Print

Object. Single-dose radiosurgery for solitary spinal metastases can achieve rapid and durable pain control. This study was conducted to determine the patterns of failure after spinal radiosurgery. Methods. Forty-nine patients with 61 solitary spinal metastases underwent radiosurgery between May 2001 and May 2003. Single-dose radiosurgery (10–16 Gy) was delivered only to the involved spinal segments. The authors undertook a retrospective review of clinical notes, including patient questionnaires and radiological studies (computerized tomography or magnetic resonance imaging), to analyze patterns of failure following radiosurgery with regard to the pain and tumor control. Complete and partial pain relief was achieved in 85% of the lesions treated. Relapse of pain at the treated site was noted in 7%. Radiologically, lesions progressively metastasized to the immediately adjacent spines in 5%. These patients also had progressive primary and/or other systemic metastatic diseases. Conclusions. Spine-related pain control/reduction was excellent. Tumor recurrence at the treated segment and progression to the immediately adjacent region were rare. The results support the use of spinal radiosurgery as an effective treatment option for solitary spinal metastasis.

Medulloblastoma: is the 5-year survival rate improving?

1997 ◽  
Vol 86 (1) ◽  
pp. 13-21 ◽  
Author(s):  
Karoly M. David ◽  
Adrian T. H. Casey ◽  
Richard D. Hayward ◽  
William F. J. Harkness ◽  
Kim Phipps ◽  
...  
Keyword(s):  
Survival Rate ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Extent Of Resection ◽  
Biological Behavior ◽  
Duration Of Symptoms ◽  
Street Hospital ◽  
Content Type ◽  
Cerebrospinal Fluid Diversion ◽  
Fine Print

✓ A series of 80 cases of medulloblastomas in children undergoing operation and postoperatively followed between 1980 and 1990 at Great Ormond Street Hospital for Children (GOSH) has been reviewed and compared to an earlier series reported from the same institution by McIntosh. The overall 5-year survival rate for the present series was 50%, although three patients died after surviving 5 years. The operative mortality rate was 5%. Survival analysis revealed that the presence or absence of spinal metastases and the necessity for some form of cerebrospinal fluid diversion within 30 days of the operation independently significantly affected survival in this series. Those patients with no spinal metastasis and total tumor removal had a 5-year survival rate of 73%, making this the most favorable subgroup in the series. Patient age and gender, duration of symptoms, Chang T stages, tumor volume, extent of resection, and postoperative chemotherapy were not significant variables. Although these results are better than those reported in the earlier GOSH series, they are not significantly different from the results of the second 5-year cohort of patients described in that article. Radiotherapy remains the greatest advance in treatment, although it is hoped that further improvement will result from the various chemotherapy protocols now being studied and from increasing knowledge of the biological behavior of these tumors.

Spinal metastases with neurological manifestations

1983 ◽  
Vol 59 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Jean Paul Constans ◽  
Enrico de Divitiis ◽  
Renato Donzelli ◽  
Renato Spaziante ◽  
Jean Francois Meder ◽  
...  
Keyword(s):  
Spinal Metastasis ◽  
Combined Treatment ◽  
Spinal Metastases ◽  
General Rule ◽  
Short Term ◽  
Primary Tumor Site ◽  
Content Type ◽  
Neurological Syndrome ◽  
Results Of Treatment ◽  
Treatment Surgery

✓ The authors have studied 600 cases of spinal metastasis causing a neurological syndrome. The most significant statistical data are reviewed. The cases are examined according to clinical characteristics, type of primary tumor, site of lesion, and survival. Each of these factors influenced the choice and results of treatment. As a general rule, combined treatment (surgery and radiotherapy) was used. Preliminary surgery was performed as an emergency, designed to halt progression of the neurological syndrome and to prevent its more serious manifestations. The technique and usefulness of surgery are discussed for different situations and the short-term results of treatment are related to the various factors involved.

scholarly journals Posterior approaches for symptomatic metastatic spinal cord compression

2016 ◽  
Vol 41 (2) ◽  
pp. E11 ◽  
Author(s):  
Camilo Molina ◽  
C. Rory Goodwin ◽  
Nancy Abu-Bonsrah ◽  
Benjamin D. Elder ◽  
Rafael De la Garza Ramos ◽  
...  
Keyword(s):  
Case Reports ◽  
Spinal Metastasis ◽  
Controlled Trial ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Surgical Approaches ◽  
Retrospective Case ◽  
Surgical Interventions ◽  
Posterior Laminectomy

Surgical interventions for spinal metastasis are commonly performed for mechanical stabilization, pain relief, preservation of neurological function, and local tumor reduction. Although multiple surgical approaches can be used for the treatment of metastatic spinal lesions, posterior approaches are commonly performed. In this study, the role of posterior surgical procedures in the treatment of spinal metastases was reviewed, including posterior laminectomy with and without instrumentation for stabilization, transpedicular corpectomy, and costotransversectomy. A review of the literature from 1980 to 2015 was performed using Medline, as was a review of the bibliographies of articles meeting preset inclusion criteria, to identify studies on the role of these posterior approaches among adults with spinal metastasis. Thirty-four articles were ultimately analyzed, including 1 randomized controlled trial, 6 prospective cohort studies, and 27 retrospective case reports and/or series. Some of the reviewed articles had Level II evidence indicating that laminectomy with stabilization can be recommended for improvement in neurological outcome and reduction of pain in selected patients. However, the use of laminectomy alone should be carefully considered. Additionally, transpedicular corpectomy and costotransversectomy can be recommended with the expectation of improving neurological outcomes and reducing pain in properly selected patients with spinal metastases. With improvements in the treatment paradigms for patients with spinal metastasis, as well as survival, surgical therapy will continue to play an important role in the management of spinal metastasis. While this review presents a window into determining the utility of posterior approaches, future prospective studies will provide essential data to better define the roles of the various options now available to surgeons in treating spinal metastases.

scholarly journals Transthoracic vertebrectomy for metastatic spinal tumors

1998 ◽  
Vol 5 (2) ◽  
pp. E2 ◽  
Author(s):  
Ziya L. Gokaslan ◽  
Julie E. York ◽  
Garrett L. Walsh ◽  
Ian E. McCutcheon ◽  
Frederick F. Lang ◽  
...  
Keyword(s):  
Spinal Metastasis ◽  
Posterior Instrumentation ◽  
Spinal Metastases ◽  
Neurological Dysfunction ◽  
Spinal Tumors ◽  
Cancer Center ◽  
Primary Tumors ◽  
Entire Study ◽  
Lower Extremity Weakness ◽  
Presenting Symptoms

Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region. Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p < 0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p < 0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%. These results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.

Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients

2004 ◽  
Vol 1 (3) ◽  
pp. 287-298 ◽  
Author(s):  
Jeremy C. Wang ◽  
Patrick Boland ◽  
Nandita Mitra ◽  
Yoshiya Yamada ◽  
Eric Lis ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Eastern Cooperative Oncology Group ◽  
Single Stage ◽  
Wound Complications ◽  
Preoperative Radiation ◽  
High Grade ◽  
Content Type ◽  
Spine Tumors ◽  
Transpedicular Approach ◽  
Fine Print

Object. Patients with metastatic spine tumors often have multicolumn involvement and high-grade epidural compression, requiring circumferential decompression and instrumentation. Secondary medical and oncological issues add morbidity to combined approaches. The authors present their experience in using the single-stage posterolateral transpedicular approach (PTA) to decompress the spine circumferentially and to place instrumentation. Methods. From September 1997 to February 2004, 140 patients with spine metastases underwent the PTA. Magnetic resonance imaging revealed high-grade spinal cord compression in 120 patients (86%) and lytic vertebral body destruction in all patients. Preoperatively 84 patients (60%) received radiotherapy directed to the involved level and 42 (30%) underwent tumor embolization. Following circumferential decompression, all patients underwent anterior reconstruction with polymethylmethacrylate and Steinmann pins, and posterior segmental fixation. The median operative time was 5.1 hours, the median blood loss was 1500 ml, and the median hospital stay was 9 days. Ninety-six percent of the patients experienced postoperative pain improvement and improvement in or stabilization of neurological status. In 51 nonambulatory patients with poor Eastern Cooperative Oncology Group grades, 75% regained the ability to walk. One month postoperatively 90% of patients achieved good-to-excellent performance scores. The overall median patient survival time was 7.7 months. Patients with colon and lung carcinomas had significantly shorter survival times. Major operative complications occurred in 20 patients (14.3%). Wound complications occurred in 16 patients (11.4%), but this was not correlated with preoperative radiation treatment. Conclusions. The PTA allows circumferential epidural tumor decompression and the placement of anterior and posterior spinal column instrumention. Immediate spinal stability is achieved without the use of brace therapy. This technique achieved a high success rate for pain palliation, neurological preservation, and functional improvement, while avoiding the morbidity associated with combined approaches.

Sign in / Sign up

Export Citation Format

Share Document