Anterolateral kyphoplasty in the management of cervical spinal metastasis

Blondel, Benjamin; Adetchessi, T.; Demakakos, Jason; Pech-Gourg, G.; Dufour, Henry; Fuentès, S.

doi:10.1016/j.otsr.2012.01.004

Cited by 25 publications

(20 citation statements)

References 18 publications

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“…The preoperative pain value of 6.0/10 on the VAS was comparable to scores in other published studies, as were the postoperative values (2.9/10) at Day 2 after surgery and at the follow-up (0.5/10). 5,18,32,37,45 We showed that this significant reduction in neck pain occurred despite having performed in the cervical spine additional dorsal procedures in 2 cases and additional ventral procedures in 5 cases.…”

Section: Discussionmentioning

confidence: 85%

Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

Stangenberg

Viezens²,

Eicker

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe treatment of cervical spinal metastases represents a controversial issue regarding the type, extent, and invasiveness of interventions. In the lumbar and thoracic spine, kypho- and vertebroplasties have been established as minimally invasive procedures for patients with metastases to the vertebral bodies and without neurological deficit. These procedures show good results with respect to pain reduction and low complication rates. However, limited data are available for kypho- and vertebroplasties for cervical spinal metastases. In an effort to add to existing data, the authors here present a case series of 14 patients who were treated for osteolytic metastases of the cervical spine using vertebroplasty alone or in addition to another surgical procedure involving the cervical spine in a palliative setting to reduce pain and restore stability.METHODSFourteen patients consisting of 8 males and 6 females, with a mean age of 64.7 years (range 44–85 years), were treated with vertebroplasty at the authors’ clinic between January 2015 and November 2016. In total, 25 vertebrae were treated with vertebroplasty: 10 C-2, 5 C-3, 2 C-4, 2 C-5, 3 C-6, and 3 C-7. Two patients had an additional posterior stabilization and 5 patients an additional anterior stabilization. In 13 cases, the surgical approach was a modified Smith-Robinson approach; in 1 case, the cement was injected into the corpus axis from posteriorly. Patients with osteolytic defects of the posterior wall of the vertebral body did not undergo surgery, nor did patients with neurological deficits. Preoperatively, on the 2nd day after surgery, and at the follow-up, neck pain was rated using the visual analog scale (VAS).RESULTSTwelve patients were examined at follow-up (mean 9 months). Neck pain was rated as a mean of 6.0 (range 3–8) preoperatively, 2.9 on Day 2 after surgery (range 0–5), and 0.5 at the follow-up (range 0–4), according to the VAS. The mean Neck Disability Index at follow-up was 3.6% (range 0%–18%).CONCLUSIONSAnterior vertebroplasty of the cervical spine via an anterolateral approach represents a safe and minimally invasive procedure with a low complication rate and appears suitable for reducing pain and restoring stability in cases of cervical spinal metastases. Vertebroplasties can be combined with other anterior and posterior operations of the cervical spine and, in the axis vertebra, can be performed transpedicularly from posteriorly. Thus, in cases in which the posterior wall of the vertebral body is intact, vertebroplasty represents a less invasive alternative to vertebral replacement in oncological surgery. Prospective randomized trials with a longer follow-up period and a larger patient cohort are needed to confirm the encouraging results of this case series.

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Section: Discussionmentioning

confidence: 85%

Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

Stangenberg

Viezens²,

Eicker

et al. 2017

Neurosurgical Focus

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“…In the upper cervical spine, this procedure is challenging for the surgeon to control using the anterolateral, posterolateral, translateral, and direct transoral approaches. 43 – 48 Indications for kyphoplasty include painful vertebral metastases without spinal instability, and spinal cord and spinal nerve root compression. Therefore, the purpose of the operation is to stabilize the cervical spine and relieve intractable pain.…”

Section: Discussionmentioning

confidence: 99%

Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine

Ye²,

Pu³

et al. 2016

Medicine

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Increased incidence of upper cervical metastases and higher life expectancy resulted in higher operative rates in patients. The purpose of this study was to explore the methods and the clinical outcomes of palliative surgery for cervical spinal metastases.A systematic review of a 15-case series of upper cervical metastases treated with palliative surgery was performed. All cases underwent palliative surgery, including anterior tumor resection and internal fixation in 3 cases, posterior tumor resection and internal fixation in 10 cases, and combined anterior and posterior tumor resection and internal fixation in 2 cases. Patients were followed-up clinically and radiologically after the operation, and visual analog scale (VAS) and activities of daily living scores were calculated. In addition, a literature review was performed and patients with upper cervical spine metastases were analyzed.The mean follow-up period was 12.5 months (range, 3–26 months) in this consecutive case series. The pain was substantially relieved in 93.3% (14/15) of the patients after the operation. The VAS and Japanese Orthopedic Association scores showed improved clinical outcomes, from 7.86 ± 1.72 and 11.13 ± 2.19 preoperatively to 2.13 ± 1.40 and 14.26 ± 3.03 postoperatively, respectively. The mean survival time was 9.5 months (range, 5–26 months). Dural tear occurred in 1 patient. Wound infections, instrumentation failure, and postoperative death were not observed. Among our cases and other cases reported in the literature, 72% of the patients were treated with simple anterior or posterior operation, and only 12% of the patients (3/25) underwent complex combined anterior and posterior operation.Metastatic upper cervical spine disease is not a rare occurrence. Balancing the perspective of patients on palliative surgery concerning the clinical benefits of operation versus its operative risks can assist the decision for surgery.

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“…Case series and reports suggest that vertebroplasty and kyphoplasty in the cervical spine can be used to treat painful metastatic deposits. 3 7 This is usually advocated through a minimal anterior approach to minimize the risks of percutaneous trocar insertion.…”

Section: Discussionmentioning

confidence: 99%

“…Although cement leak is a reported complication of this technique, it is most often not clinically significant. 3 …”

Section: Introductionmentioning

confidence: 99%

Corpectomy with Adjacent-Level Kyphoplasty to Treat Metastatic Lung Cancer in Three Contiguous Cervical Vertebrae Causing Focal Neurologic Compromise

Bateman

Way

2014

Global Spine Journal

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Study Design Case report. Objectives Decompression of metastatic spinal cord compression has been shown to improve quality of life and prolong ambulation in patients undergoing palliative treatment. We report a case of metastatic cervical myelopathy treated with a combined approach using corpectomy and stabilization together with balloon kyphoplasty to allow adequate decompression and immediate stability in a patient with significant destruction of adjacent vertebral bodies. Methods The cervical spine was approached anteriorly and decompressed with a C7 corpectomy. Subsequent stability was achieved with insertion of a trabecular metal cage. Balloon kyphoplasty was used to treat lytic lesions within the posterior body of the adjacent vertebrae for pain relief and increased stability. Additional stability was achieved through the application of an anterior plate. Results Full limited decompression and stabilization were successfully achieved. The patient had no further neurologic deterioration and made modest improvements that allowed a return to independent ambulation. Conclusion This limited approach may be an option for patients with metastatic spinal cord compression, lytic destruction of adjacent vertebral bodies, and limited life expectancy.

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Anterolateral kyphoplasty in the management of cervical spinal metastasis

Cited by 25 publications

References 18 publications

Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: outcome in 14 cases

Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine

Corpectomy with Adjacent-Level Kyphoplasty to Treat Metastatic Lung Cancer in Three Contiguous Cervical Vertebrae Causing Focal Neurologic Compromise

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