A population-based study of surgery for spinal metastases

Finkelstein, Joel; Zaveri, Gautam; Wai, Eugene K.; Vidmar, Marjan; Kreder, Hans J.; Chow, Edward

doi:10.1302/0301-620x.85b7.14201

Cited by 127 publications

(127 citation statements)

References 24 publications

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“…In case of spinal metastases, the rate of SSI is reported from 6.8% to 20% [4,5,9,10,14]. Similarly, the rate of SSI without iodine-supported spinal instruments was 12.5% (7/56 cases) in this study.…”

Section: Few Reports Have Been Published Regarding the Difference In supporting

confidence: 60%

Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology

Hayashi¹,

Murakami²,

Demura³

et al. 2015

The Spine Journal

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Section: Few Reports Have Been Published Regarding the Difference In supporting

confidence: 60%

Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology

Hayashi¹,

Murakami²,

Demura³

et al. 2015

The Spine Journal

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“…The overall rate of complications from surgical procedures for metastatic spine disease has been reported as being as high as 20-30%, with wound infection being the most frequent complication and ranging from 5 to 30% [8,13,22,25,27,28,31,[33][34][35][36][37][38]. The complication rate in our series was 26%, with the wound infection or breakdown rate being 7% and all occurring in posterior procedures.…”

Section: Discussionmentioning

confidence: 52%

Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

Quan

Vital²,

Aurouer³

et al. 2011

Eur Spine J

140

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Purpose There are few prospective studies on surgical outcomes and survival in patients with metastatic disease to the spine. The magnitude and duration of effect of surgery on pain relief and quality of life remains uncertain. Therefore, the aim of this clinical study was to prospectively evaluate clinical, functional, quality of life and survival outcomes after palliative surgery for vertebral metastases. Methods 118 consecutive patients who underwent spinal surgery for symptomatic vertebral metastases were prospectively followed up for 12 months or until death. Clinical data and data from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire were obtained pre-and post-operatively and at regular follow-up intervals. Results Surgery was effective in achieving rapid improvement in axial and radicular pain, neurological deficit, sphincteric dysfunction and ambulatory status, with a complication rate of 26% and a 12 month mortality rate of 48%. Almost 50% of patients had complete resolution of back pain, radiculopathy and neurological deficit. Of the patients who were non-ambulant and incontinent, over 50% regained ambulatory ability and recovered urinary continence. The overall incidence of wound infection or breakdown was 6.8% and the local recurrence rate was 8.5%. There was a highly significant improvement in physical, role, cognitive and emotional functioning and global health status post-operatively. Greatest improvement in pain, function and overall quality of life occurred in the early post-operative period and was maintained until death or during the 12 month prospective follow-up period. Conclusion The potential for immediate and prolonged improvement in pain, function and quality of life in patients with symptomatic vertebral metastases should be considered during the decision-making process when selecting and counselling patients for surgery.

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“…Therefore, an intralesional corpectomy by piecemeal resection was considered as the only feasible surgery [12,22,23,26,33,54,64,68] followed by anterior-posterior stabilization of the resulting segmental spinal defect. However, the overwhelming majority of these intralesional resection patients have shown a poor oncological outcome [17,44,64]. Their elevated mortality rates were in fact caused by the intralesional procedure, which causes tumor-derived blood loss, local and systemic dissemination of tumor cells with substantially increased risk for local recurrence and further metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

et al. 2008

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Wide surgical margins make en bloc spondylectomy and stabilization a referred treatment for certain tumoral lesions. With a total resection of a vertebra, the removal of the segment's stabilizing structures is complete and the instrumentation guidelines derived from a thoracolumbar corpectomy may not apply. The influence of one or two adjacent segment instrumentation, adjunct anterior plate stabilization and vertebral body replacement (VBR) designs on post-implantational stability was investigated in an in-vitro en bloc spondylectomy model. Biomechanical in-vitro testing was performed in a six degrees of freedom spine simulator using six human thoracolumbar spinal specimens with an age at death of 64 (±20) years. Following en bloc spondylectomy eight stabilization techniques were performed using long and short posterior instrumentation, two VBR systems [(1) an expandable titanium cage; (2) a connected long carbon fiber reinforced composite VBR pedicle screw system)] and an adjunct anterior plate. Testsequences were loaded with pure moments (±7.5 Nm) in the three planes of motion. Intersegmental motion was measured between Th12 and L2, using an ultrasound based analysis system. In flexion/extension, long posterior fixations showed significantly less range of motion (ROM) than the short posterior fixations. In axial rotation and extension, the ROM of short posterior fixation was equivalent or higher when compared to the intact state. There were only small, nonsignificant ROM differences between the long carbon fiber VBR and the expandable system. Antero-lateral plating stabilized short posterior fixations, but did not markedly effect long construct stability. Following thoracolumbar en bloc spondylectomy, it is the posterior fixation of more than one adjacent segment that determines stability. In contrast, short posterior fixation does not sufficiently restore stability, even with an antero-lateral plate. Expandable verses nonexpandable VBR system design does not markedly affect stability.

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A population-based study of surgery for spinal metastases

Cited by 127 publications

References 24 publications

Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology

Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology

Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

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