Posterior Segmental Spinal Instrumentation (PSSI) with Posterolateral Decompression and Debulking for Metastatic Thoracic and Lumbar Spine Disease

Jenny, Arthur B.; Saul, Thomas G.; Rich, Keith M.; Grubb, Robert L.

doi:10.1097/00007632-198812000-00010

Cited by 105 publications

(46 citation statements)

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“…Surgical treatment should be adapted to the topography of the metastasis. Bridwell et al [2] observed local recurrence in 6 out of 19 cases of spinal metastasis (31.6%) treated by posterior decompression. According to Hertlein et al [5], no local recurrence was observed when surgery was performed according to the metastatic localization.…”

Section: Discussionmentioning

confidence: 98%

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Chataigner

Onimus

2000

European Spine Journal

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IntroductionPain is the most common symptom in patients presenting with spinal metastasis without neural compromise. Surgery, radiotherapy and vertebroplasty are all effective treatments alone or in combination. According to Boland et al. [1], early aggressive treatment may be considered to avoid cord compression. The aim of this study is to determine indications and strategy of surgical treatment related to the length of survival and to the risk of recurrence. Materials and methodsOne hundred and seven patients were operated on for spinal metastasis without spinal cord compression. There were 54 women and 53 men, with a mean age of 58 (range 29-87). Neoplasm was revealed by spinal metastasis in seven cases. In the other cases, neoplasm had been known about for a mean period of 30 months (range 0-288 months). The primary tumour was predominantly lung neoplasm (37 cases), followed by breast neoplasm (30 cases), unknown (9 cases), kidney (8 cases), digestive tract (6 cases), others (17 cases). There were only two cases of primary prostate neoplasm. Back pain was the main symptom in all cases, with radiculopathy in 43 cases. Pyramidal irritation (Babinski sign, hyper-reAbstract Surgery in patients presenting with vertebral metastasis without neural deficit is controversial. A series of 107 patients (54 female, 53 male) were operated on at a mean age of 58. The metastasis was the first manifestation of the cancer in seven cases. In 100 patients, the cancer had been diagnosed 30 months earlier (average). Vertebral pain was present in all cases, with associated radicular pain in 43 cases. Pyramidal irritation without neural deficit was present in seven cases. The mean preoperative Karnofsky index was 64.7%. The mean preoperative Tokuhashi score was 8.6. The surgical approach depended on the topography of the metastasis. Ninety-three patients were dead at review, with a mean survival of 8 months. Seventeen patients underwent further spinal surgery, for local recurrence in nine cases, and for another spinal localization in eight cases, after a mean interval of 8 months. Recurrence occurred at the same level in all seven patients presenting with neural deficit at recurrence. Among ten recurrences without neural deficit, two were observed at the same level and eight were observed on another level. Surgery in vertebral metastasis without neural deficit results in substantial functional improvement, but does not increase the duration of life. For kidney metastasis, total vertebrectomy must be performed because of the risk of recurrence. For thyroid metastasis, total vertebrectomy is a good alternative to increase the efficacy of iodotherapy. In other cases, for patients with good general status, surgery must be adapted to the location of the involvement.

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Section: Discussionmentioning

confidence: 98%

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Chataigner

Onimus

2000

European Spine Journal

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“…Sacral procedures have had historically higher rates of infection than other spinal procedures [5][6][7][8][9][10]. Primary sacral tumors are rare, and experience with postoperative wound complications of these tumors is, therefore, limited to observations on less than 80 patients [2,[11][12][13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Experience with wound complications after surgery for sacral tumors

Guo

et al. 2013

Eur Spine J

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Purpose The aim of this article is to summarize our experience in treating sacral wound complications after sacrectomy. We focus, in particular, on factors associated with wound complications, including surgical site infection (SSI) and wound dehiscence. Methods The definition of SSI devised by Horgan et al. was applied. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI. Between September 1997 and August 2009, 387 patients with a sacral tumor underwent sacrectomy performed by the same team of surgeons and were followed up for C12 months. Potential risk factors were evaluated for univariate associations with SSI and wound complications. Multivariable conditional logistic regression was used to identify the combined effects of several risk factors. Results Of the 387 wounds studied, 274 healed uneventfully, and 113 (29.2 %) broke down because of infection or dehiscence. Fifty-one (13.2 %) patients developed a postoperative SSI, and 62 (16.0 %) patients developed wound dehiscence. Gram-negative bacteria grew in 45 cultures (91.8 %) and included 38 cases of Escherichia coli. Previous radiation, rectum rupture, longer duration of surgery, and cerebrospinal fluid leakage were significantly associated with increased likelihood of developing an SSI. Previous radiation, rectum rupture, age \40 years, history of diabetes mellitus, maximum tumor diameter C10 cm, and instrumentation used were risk factors for wound complications. Conclusions The incidence of wound complications is not so high at a musculoskeletal tumor center with surgeons experienced in treating sacral tumors. Controlling for these risk factors when possible may improve clinical outcomes.

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“…Recently, other authors 18,20,21 with a much smaller number of patients (11, 1 and 25 cases) presented similar strategies in treating tumors on the spine. Especially with regard to the acute development of neurological symptoms, which always requires an immediate action even if the patient is in bad shape, they recommend the posterior procedure as the treatment of choice.…”

Section: Discussionmentioning

confidence: 95%

Strategy for the treatment of patients with spinal neoplasms

1997

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Progress in oncological therapy within the last decade has enhanced the survival time of patients su ering from tumorous osteolyses of the spine. While the necessity of surgical intervention is often settled by acute clinical symptoms, the extent of surgery is certainly codetermined by the patient's expectations and the time of survival to be expected. We therefore developed a speci®c tumor algorithm for operations on the spine with special emphasis on prognosis and the attainable quality of life. The results of 154 patients with tumorous osteolyses of the thoracic and lumbar spine, who were treated according to our algorithm, underline the unequivocal advantages of initially posterior procedures.

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Posterior Segmental Spinal Instrumentation (PSSI) with Posterolateral Decompression and Debulking for Metastatic Thoracic and Lumbar Spine Disease

Cited by 105 publications

References 0 publications

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence

Experience with wound complications after surgery for sacral tumors

Strategy for the treatment of patients with spinal neoplasms

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