Evidence-based review of the surgical management of vertebral column metastatic disease

Ryken, Timothy C.; Eichholz, Kurt M.; Gerszten, Peter C.; Welch, William C.; Gokaslan, Ziya L.; Resnick, Daniel K.

doi:10.3171/foc.2003.15.5.11

Cited by 66 publications

(36 citation statements)

References 66 publications

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“…Due to the improvement of the surgical techniques, more and more aggressive surgeries were adopted in spinal metastatic treatment [11,18,22]. Nowadays, the superiority of surgery in management of spinal metastases has been supported by a number of documentaries, in spite of the long-existing controversies [9,11,15].…”

Section: Introductionmentioning

confidence: 99%

Outcome of excisional surgeries for the patients with spinal metastases

Gasbarrini

Cappuccio

et al. 2009

Eur Spine J

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To evaluate the outcome of the excisional surgeries (en bloc/debulking) in spinal metastatic treatment in 10 years. A total of 131 patients (134 lesions) with spinal metastases were studied. The postoperative survival time and the local recurrence rate were calculated statistically. The comparison of the two procedures on the survival time, local recurrence rate, and neurologic change were made. The median survival time of the en bloc surgery and the debulking surgery was 40.93 and 24.73 months, respectively, with no significant difference. The significant difference was shown in the local recurrence rate comparison, but not in neurological change comparison. 19.85% patients combined with surgical complications. The en bloc surgery can achieve a lower local recurrence rate than the debulking surgery, while was similar in survival outcome, neurological salvage, and incidence of complications. The risk of the excisional surgeries is high, however, good outcomes could be expected.

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Section: Introductionmentioning

confidence: 99%

Outcome of excisional surgeries for the patients with spinal metastases

Gasbarrini

Cappuccio

et al. 2009

Eur Spine J

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“…While less than 5% of all primary musculoskeletal tumors are located at the spine, 5-10% of all cancer patients develop metastatic spinal lesions during the course of their disease [2,5,24,47,53,69]. For this patient group, apart from a few special cases, the chance of a curative treatment is primarily limited by the disseminated stage of disease and further tumoral spread.…”

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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“…The following data were tabulated: age, primary tumor, sex, location of the metastasis, preoperative neurological state according to the Frankel scale (Box 1), improvement in pain after the operation using a visual analogue pain scale ( Figure 1) and the final evolution of the case (survival or death). indicated in the following cases of vertebral metastatic lesion: spinal cord compression with myelopathy; vertebral instability with intractable mechanical pain; dislocated fractures of the spine; radiculopathy with progressive or uncontrollable symptoms; tumor growth even after radiotherapy; and direct extension of the primary tumor in the spine, for example in cases of Pancoast tumor (4,5) .…”

Section: Methodsmentioning

confidence: 99%

Estudo da aplicabilidade do escore de Tokuhashi modificado nos pacientes tratados cirurgicamente de metástases vertebrais

Mattana¹,

Freitas²,

Mello³

et al. 2011

Rev. bras. ortop.

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Objective: To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain Rev Bras Ortop. 2011;46(4):424-30

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Evidence-based review of the surgical management of vertebral column metastatic disease

Cited by 66 publications

References 66 publications

Outcome of excisional surgeries for the patients with spinal metastases

Outcome of excisional surgeries for the patients with spinal metastases

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Estudo da aplicabilidade do escore de Tokuhashi modificado nos pacientes tratados cirurgicamente de metástases vertebrais

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