Preliminary experience of titanium mesh cages for pathological fracture of middle and lower cervical vertebrae

Chuang, Hao Che; Wei, Sung Tai; Lee, Han Chung; Chen, Chun-Chung; Lee, Wen Yuen; Cho, Der Yang

doi:10.1016/j.jocn.2007.11.011

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…In our series, the average survival time of the 38 (except the perioperative death) patients was 22 months, longer than that of other studies of cervical metastases with a mean survival of 6–19 months [1, 4, 7, 8, 10, 19, 21–23]. Yet, Kirchner et al [5] reviewed all the metastases to the cranio-cervical junction with a mean survival time of 6.44 months.…”

Section: Discussioncontrasting

confidence: 54%

Surgical treatment of upper cervical spine metastases: a retrospective study of 39 cases

et al. 2017

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BackgroundThe surgical treatment of upper cervical spine metastases are controversial up to now. By summarizing and analyzing the clinical data of the upper cervical spine involved metastases treated surgically in our center, we mainly aimed to investigate the surgical decisions and outcomes so as to provide more references for the clinical treatment of this special and complex spine metastasis.MethodsWe evaluated the patients’ pre- and post-operative neck pain and neurologic function with paired t test, followed by the statistics of the selection of surgical approaches, ways of reconstruction, and related complications. Moreover, the Kaplan–Meier survival analysis was adopted to analyze the patients’ survival according to different growth group (rapid, moderate, and slow).ResultsThere were 39 patients with atlantoaxial metastases in this study. The most common symptom (94.87%) was occipital-cervical pain, which relieved greatly after surgical interventions (p < 0.01). The metastases mainly resulted from lung cancer and nasopharyngeal cancer with an incidence of 38.46 and 10.26%, respectively. As to different growth group, the rapid-growth tumors accounted for 69.23% in all atlantoaxial metastases. Tumor resection and stabilization were performed mainly via the combined anterior and posterior approach (66.67%). The 1-, 2-, and 3-year overall survival rate at the last follow-up was 58.5, 40, and 28.3%, respectively, with a median survival time of 18 months. The rate of complications associated with the surgical intervention was 12.82% (5/39), which is lower than that of the previous reports and generally controllable.ConclusionsRelatively radical interventions with surgery for upper cervical spine metastases offered satisfactory outcomes with a low mortality. Together with adjuvant therapy, surgical treatment benefits patients with atlantoaxial metastases by relieving regional pain, restoring or improving the neurologic function, stabilizing the quality of life, and prolonging the survival time of such patients.

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Section: Discussioncontrasting

confidence: 54%

Surgical treatment of upper cervical spine metastases: a retrospective study of 39 cases

et al. 2017

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“…The evidence level was III in 2 articles, 19,25 and IV in 25 studies. [7][8][9]14,16,21,22,27,31,34,35,[38][39][40][41][42]45,48,54,55,67,[69][70][71]74 The mean number of levels of tumor involvement ranged from 1 to 4.4, and 5 studies 25,34,35,54,74 did not report this information. The number of articles reporting data on primary tumors, metastatic tumors, and both, were 9, 4, and 14, respectively.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

“…In Table 2, bone graft options and fusion outcomes are summarized. Thirteen studies 10,14,16,19,22,25,31,34,35,39,40,55,71 used bone grafts solely for anterior fusion, whereas two studies 41,74 solely performed posterior fusion. The other 12 studies 7,8,21,27,38,42,45,48,54,67,69,70 included patients who underwent either anterior fusion, posterior fusion, or both, and were thus substantially heterogeneous.…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

“…The other 12 studies 7,8,21,27,38,42,45,48,54,67,69,70 included patients who underwent either anterior fusion, posterior fusion, or both, and were thus substantially heterogeneous. Regarding graft options, 7 studies 16,19,39,42,55,70,71 used cages filled with morselized bone graft or other bone graft extenders, whereas 4 studies, 27,41,48,67 included patients with vascularized autogenic bone grafts either with or without vascular pedicles. Regarding adjunctive therapy, 18 studies, 7,8,14,16,21,22,25,35,[38][39][40][41][42]45,48,67,70,74 clearly stated the percentage of patients who underwent RT, which substan- Meta-Analysis and Meta-regression Analysis Overall, fusion rates varied widely from 36.0% to 100.0%, with a pooled fusion rate (PFR) of 85.7% (95% CI 80.6%-89.6%).…”

Section: Results Overview Of the Included Studiesmentioning

confidence: 99%

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Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

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OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

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“…The few radiographic fusion studies of these patients are small, lack criteria for fusion assessment, and vary widely in their fusion estimates, ranging from 17.6% to 100%. [22][23][24][25][26][27] While traumatic thoracolumbar burst fractures have been successfully managed with percutaneous fixation without fusion, the studies often ex-clude patients with neurological deficits requiring direct decompression. [28][29][30][31] In contrast, the circumferential decompression employed in oncological patients is almost invariably destabilizing.…”

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confidence: 99%

Survival, fusion, and hardware failure after surgery for spinal metastatic disease

Yee¹,

Saadeh²,

Strong³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEDecompression with instrumented fusion is commonly employed for spinal metastatic disease. Arthrodesis is typically sought despite limited knowledge of fusion outcomes, high procedural morbidity, and poor prognosis. This study aimed to describe survival, fusion, and hardware failure after decompression and fusion for spinal metastatic disease.METHODSThe authors retrospectively examined a prospectively collected, single-institution database of adult patients undergoing decompression and instrumented fusion for spinal metastases. Patients were followed clinically until death or loss to follow-up. Fusion was assessed using CT when performed for oncological surveillance at 6-month intervals through 24 months postoperatively. Estimated cumulative incidences for fusion and hardware failure accounted for the competing risk of death. Potential risk factors were analyzed with univariate Fine and Gray proportional subdistribution hazard models.RESULTSOne hundred sixty-four patients were identified. The mean age ± SD was 62.2 ± 10.8 years, 61.6% of patients were male, 98.8% received allograft and/or autograft, and 89.6% received postoperative radiotherapy. The Kaplan-Meier estimate of median survival was 11.0 months (IQR 3.5–37.8 months). The estimated cumulative incidences of any fusion and of complete fusion were 28.8% (95% CI 21.3%–36.7%) and 8.2% (95% CI 4.1%–13.9%). Of patients surviving 6 and 12 months, complete fusion was observed in 12.5% and 16.1%, respectively. The estimated cumulative incidence of hardware failure was 4.2% (95% CI 1.5–9.3%). Increasing age predicted hardware failure (HR 1.2, p = 0.003).CONCLUSIONSLow rates of complete fusion and hardware failure were observed due to the high competing risk of death. Further prospective, case-control studies incorporating nonfusion instrumentation techniques may be warranted.

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Preliminary experience of titanium mesh cages for pathological fracture of middle and lower cervical vertebrae

Cited by 8 publications

References 35 publications

Surgical treatment of upper cervical spine metastases: a retrospective study of 39 cases

Surgical treatment of upper cervical spine metastases: a retrospective study of 39 cases

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Survival, fusion, and hardware failure after surgery for spinal metastatic disease

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