Palliative surgery for cervical spine metastasis

Abstract

INTRODUCTIONThe present study aimed to assess the immediate/early clinical outcomes and surgical results of 11 consecutive patients who underwent palliative cervical spine surgery for symptomatic spinal metastases. METHODSThis single-surgeon retrospective case series analysed 12 surgical procedures that were performed for symptomatic cervical spinal metastasis in 11 consecutive patients. All surgeries were carried out at Singapore General Hospital, Singapore, from 2007 to 2013. Preoperative medical oncological assessment/staging was performed on each patient -all patients presented with either axial neck pain or neurological deficits, and had no bladder or bowel symptoms. The primary outcomes analysed were postoperative neurological power and improvement in neck pain.RESULTS Anterior (n = 5), posterior (n = 4) and combined (n = 2) surgical approaches were used for decompression and stabilisation. Comparing between pre-and postoperative pain scores (scored according to the visual analog scale), and pre-and postoperative limb power scores (scored according to the Medical Research Council scale for muscle strength), we found that all patients showed improvement in their symptoms. Postoperatively, patients had either improvement or preservation of neurological power, and all patients had a decrease in axial neck pain after surgery. Although there was one case of minor pedicle screw instrumentation malplacement, this did not result in any neurological symptoms. Median survival for the patients was 108 (range 7-1,095) days.CONCLUSION Palliative surgery for cervical spine metastasis is safe with good neurological results, low complication rates, and improvement in neck pain. A multidisciplinary approach involving surgeons, medical oncologists and radiotherapists is needed to optimise patient care and outcome.

Minimally invasive cervical pedicle screw fixation via the posterolateral approach for metastatic cervical spinal tumors

“…One patient was alive at the final follow-up (34 months); we followed up 17 of the 18 patients until death. The average fusion area was 4.9 vertebrae (range, [3][4][5][6][7][8].…”

“…The surgical procedure for treating cervical spinal tumors involves two main steps, namely, "neural decompression" and "stabilization." Stabilization with instrumentation is effective for pain relief and for preventing cervical myelopathy secondary to vertebral collapse [3][4][5] . Surgical options for treatment of cervical metastases include anterior and posterior approaches as well as a combined approach [2][3][4][5] .…”

Treatment of spine metastases in cancer: a review

“…41,[52][53][54][55][56] Surgery remains the standard treatment for patients with rapidly progressive spinal cord compression or patients with a high risk of fracture, but it can cause postoperative complications and delay the initiation of other anticancer therapies. 28,31,57 Minimally-invasive techniques can improve spine stabilization and reduce the morbidity of spine metastases. 1,30,34,[58][59][60][61][62][63][64] It is clear that there are several treatments available for spine metastases but not every method is suitable for every patient.…”

Underwater-treadmill training attenuates blood-spinal cord barrier disruption by promoting angiogenesis and inhibiting MMP-2/9 expression following spinal cord injury

“…Spinal cord injury (SCI) places a heavy burden on society and the economy [1]. Currently, it can only be relieved by surgery, but it cannot be cured [2]. The basement membrane, pericytes and the terminal foot process of astrocytes constitute the barrier of the BSCB, which protects and regulates the parenchyma of the spinal cord [3,4].…”