Metastatic spinal cord compression: a randomized trial of direct decompressive surgical resection plus radiotherapy vs. radiotherapy alone

Regine, W.F.; Tibbs, Phillip A.; Young, A. Byron; Payne, R. W.; Saris, Stephen C.; Patchell, Roy A.

doi:10.1016/s0360-3016(03)00825-3

Cited by 39 publications

(23 citation statements)

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“…This circumferention reconstruction is often assocaited with significant risks. 12,13,18 In this study, two patients had spinal metastasis underwent preoperative embolization followed by stand alone anterior column reconstruction with neurological improvement.…”

Section: Discussionmentioning

confidence: 98%

Anterior Column Reconstruction Using Titanium Mesh Cages after Thoracolumbar Corpectomy: Clinical and Radiological outcome

Abdeen¹,

Alghazaly²

2012

Egyptian Spine Journal

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Background Data: The optimal treatment of unstable thoracolumbar spine due to trauma, tumors, and tuberculous spondylitis remains controversial. Treatment goals of thoracolumbar corpectomy are: to prevent neurological deterioration; enhance neurological recovery; stabilization, and to prevent late pain and deformity. Purpose: This retrospective study was conducted to determine the safety and efficacy of stabilization using titanium mesh cage reconstruction filled with autogenous bone graft and anterior plating after thoracolumbar corpectomy due to trauma, tumors or tuberculous spondylitis. Study Design: A retrospective clinical case study. Patients and Methods: A series of patients underwent reconstruction of the anterior column after thoracolumbar corpectomy between June 2006 and June 2011 were reviewed. Sixteen patients underwent reconstruction using titanium mesh cages, and retrospectively analyzed data from the medical records and radiographs including immediate postoperative and latest follow up. The etiology due to trauma in ten cases, tuberculosis in three cases, metastasis in two cases and myeloma in one case. An average duration of follow up was 18 months [ 8-58 months ], single level reconstruction done in trauma and tumor cases, two level corpectomy done in tuberculous spondylitis cases. The degree of kyphosis, construct height and the subsidence of the cage in relation to the vertebral endplates were measured preoperatively, early post operative, and at the latest follow up. The surgical approach was thoracoabdominal in 10 cases and retroperitoneal in 6 cases. Results: Neurological recovery in our study; 4 patients were neurologically intact, Frankel grade E on admission , and all of them remains intact postoperatively. Of the 6 patients with Frankel D on admission, all had recovered full motor and sensory function. Of the 6 patients with Frankel C on admission, three improved one grade, the other three improved two grades. The mean construct height of the involved vertebrae before surgery was 41 mm and the mean construct height immediate after surgery and at follow up were 47 and 44 mm respectively. Solid fusion was observed in all patients, there were no hardware failure. The sagittal alignment of the fractured segment was satisfactorily restored immediately after surgery as a significant decrease in the local kyphotic angle. Conclusion: Anterior instrumentation is an effective and safe treatment for thoracolumbar instability by demonstaring satisfactory clinical and radiological outcomes. (2012ESJ028)

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Section: Discussionmentioning

confidence: 98%

Anterior Column Reconstruction Using Titanium Mesh Cages after Thoracolumbar Corpectomy: Clinical and Radiological outcome

Abdeen¹,

Alghazaly²

2012

Egyptian Spine Journal

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“…Local radiotherapy is indicated postoperatively to achieve local tumor control [21,36,46,47,50] and should be initiated as soon as possible (LoE IIa, grade of recommendation A).…”

Section: Radiotherapymentioning

confidence: 99%

“…The immediate (< 24 h, maximum < 48 h) surgical decompression with tumor debulking followed by radiotherapy is the method of choice (with the highest level of evidence [LoE] Ib) [34] in case of vertebral column instability, vertebral compression and/or acute paraplegia [17,24,29,34,37,50]. It has to be considered that laminectomy additionally destabilizes the vertebral column.…”

Section: Surgical Measuresmentioning

confidence: 99%

“…Different fractionation concepts have been evaluated in prospective studies (1 × 8, 5 × 4, 10 × 3, 15 × 2.5, 20 × 2 Gy). However, no regimen proved to be markedly superior [24,30,41,45,47,49,50]. Prolonged fractionation appears to be beneficial as to longer-lasting therapeutic effects and a lower rate of in-field recurrences (and necessity of reirradiation) [39,47].…”

Section: Special Technical Considerations and Dosing In Msccmentioning

confidence: 99%

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DEGRO Practice Guidelines for Palliative Radiotherapy of Metastatic Breast Cancer

et al. 2009

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Bone metastases as well as MSCC should be managed in an interdisciplinary approach mostly as combined-modality treatment according to the specific clinical situation. The present practice guidelines offer criteria and recommendations for different radiooncologic treatment schedules based on the best available levels of evidence. Preferred technique, targeting and different dose schedules are described in detail.

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“…In addition, it is not effective for preventing imminent vertebral body collapse; almost half of patients undergoing radiation therapy subsequently experience vertebral body compression fractures. 11,12 Because of these drawbacks, Regine et al 13 concluded that when patients meet the clinical criteria for surgery, the role of radiation therapy is that of adjuvant therapy. Adding a spine-stabilization procedure to a radiation therapy program is thought to be critical for managing axial pain and providing neurologic recovery.…”

Section: Radiation Therapymentioning

confidence: 99%

Metastatic Spinal Lesions: State-of-the-Art Treatment Options and Future Trends

Georgy¹

2008

AJNR Am J Neuroradiol

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SUMMARY:The purpose of this article is to review the current state of the art for treating symptomatic spinal fractures associated with malignant lesions and to present potential future trends in treatments for this patient population. Epidemiology, clinical presentation, and biomechanical ramifications of these lesions are summarized and treatment regimes, clinical outcomes, and complications and technical issues associated with treatments are presented. Potential future trends and new technologies for performing vertebral body augmentation in patients with metastatic spinal lesions are also discussed. Metastatic bone tumors in the spine are painful and debilitating but are challenging to treat and often require relatively extensive surgery, which many clinicians and patients are reluctant to pursue. Percutaneous approaches for performing vertebral body augmentation for treating metastatic spinal lesions have been developed as good alternatives to open surgery. These types of procedures have evolved immensely over the last 10 years, and the current state of the art has been found to fit neatly into the conventional oncologic treatment algorithm. Epidemiology and Clinical PresentationSpinal metastasis is the most commonly encountered tumor of the spine, 1 occurring in Յ40% of patients with cancer. 2 Each year, 5% of patients with cancer, or approximately 61,000 persons, will develop spinal metastasis. 3 The cancers most often metastasizing to the spine include breast (21%), lung (14%), prostate (8%), renal (5%), gastrointestinal (5%), and thyroid (3%). Two of 3 patients are affected in the thoracic spine, whereas affected areas of the other third of patients are split 1:2 in the cervical and lumbar regions, respectively.2 The posterior half of the vertebral body is usually infiltrated first, with the anterior body, lamina, and pedicles becoming involved later. 4 The treatment regimen for spinal metastasis is generally palliative and consists of a combination of medical therapy (steroids, pain medication, and chemotherapy), radiation therapy, and surgery.The primary goals of treatment are to relieve pain and preserve or restore function when managing patients affected by spinal metastasis. Patients with metastatic spine disease typically present with progressive and unrelenting pain that is not alleviated with rest and is often worse at night. Pain is generally described in at least 1 of 3 ways: 1) constant and localized, 2) radicular, or 3) axial, coinciding with functional disability. Localized pain is generally thought to be a result of periosteal stretch occurring with tumor expansion and is usually treated by using radiation because this therapy is effective in decreasing the tumor size. Radicular pain, most likely due to the tumor pressing against the nerve root, is also addressed by using radiation therapy but can be treated by using nerve root blocks as well. Axial pain, most frequently associated with mechanical instability of the spine or pathologic vertebral body fracture, is worsened with physical act...

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Metastatic spinal cord compression: a randomized trial of direct decompressive surgical resection plus radiotherapy vs. radiotherapy alone

Cited by 39 publications

References 0 publications

Anterior Column Reconstruction Using Titanium Mesh Cages after Thoracolumbar Corpectomy: Clinical and Radiological outcome

Anterior Column Reconstruction Using Titanium Mesh Cages after Thoracolumbar Corpectomy: Clinical and Radiological outcome

DEGRO Practice Guidelines for Palliative Radiotherapy of Metastatic Breast Cancer

Metastatic Spinal Lesions: State-of-the-Art Treatment Options and Future Trends

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