Reconstructive Spinal Surgery as Palliation for Metastatic Malignancies of the Spine

DeWald, Ronald L.; Prodromas, Chadwick; Rodts, Mary Faut

doi:10.1097/00007632-198501000-00004

Cited by 169 publications

(57 citation statements)

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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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Section: Discussionmentioning

confidence: 99%

Experience with wound complications after surgery for sacral tumors

Guo

et al. 2013

Eur Spine J

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“…Other common indications for surgery include intractable pain, pathologic fracture, and spinal instability caused by the lesion [8]. Laminectomy, the most frequently adopted traditional procedure in early time, has been proved to be mediocre in outcome and not more beneficial than radiotherapy alone [3,25].…”

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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“…Prior to the occurrence of a pathologic fracture, pain is the most common symptom of metastatic disease and is potentially a result of mechanical instability created by the lytic destruction of spinal elements [5,10]. Non-operative interventions used to treat spinal metastases are multimodal H. Ahn St. Michael's Hospital, Orthopaedic Surgery, University of Toronto, St. Michael's Orthopaedic Associates, 55 Queen St. East, Suite 800, Toronto, ON, Canada M5C IR6 e-mail: ahnh@smh.toronto.on.ca and include analgesia, corticosteroids, radiation therapy and chemotherapy [29].…”

Section: Introductionmentioning

confidence: 99%

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

et al. 2007

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A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.

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Reconstructive Spinal Surgery as Palliation for Metastatic Malignancies of the Spine

Cited by 169 publications

References 0 publications

Experience with wound complications after surgery for sacral tumors

Experience with wound complications after surgery for sacral tumors

Outcome of excisional surgeries for the patients with spinal metastases

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

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