Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer

Hertlein, H.; Mittlmeier, Thomas; Piltz, Stefan; Schürmann, Martin; Kauschke, Thomas; Lob, G.

doi:10.1007/bf00300940

Cited by 23 publications

(7 citation statements)

References 28 publications

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“…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. Local recurrence occurred in 8.4% in our study after an appropriate approach, and was identical for anterior and posterior approaches.…”

Section: Discussionmentioning

confidence: 97%

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: 97%

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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“…However, the designes of such implants still require nowadays extensive surgeries (24,35,36,37,38). Furthermore, these constructions have to be completed by an additional stabilizing implant except the prosthesis discussed by MACMILAN et al (35).…”

Section: Discussionmentioning

confidence: 98%

A Newly Designed Vertebral Replacement Implant to Reconstruct the Thoracolumbar Spine Anteriorly

Vanderschot¹,

Schepers

Vanschoonwinkel

et al. 2002

Acta Chirurgica Belgica

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Calcium phosphate compounds are becoming of increasingly great importance in the field of biomaterials and, in particular, as bone substitutes. In this way donor-side morbidity can be avoided. A type A lesion of the vertebral body can be the reason of a neurological deficit, requiring a corpectomy by means of an anterior approach, tricortical bone grafting and internal stabilization to get a fusion over time. It is our aim to introduce in this study a newly designed vertebral replacement device, tested in an animal model, using domestic pigs. Two biomaterials, Cementek and Biobon were primarily macroscopically and microscopically evaluated, using a critically sized bone defect of a vertebral body and compared with autologous bone grafts. The final tests consisted of two groups of four animals. A corpectomy at the level of L4 was created and stabilized by means of the newly designed vertebral replacement implant. Autologous bone grafts were applied in one group of animals and Cementek in the other to fill the remaining space. Fusion was studied using anteroposterior and lateral radiographs, followed by a computer tomography. The biocompatibility of the biomaterials and autologous bone grafts were in order of: Cementek > autologous bone grafts > Biobon. In the final tests after a six months period, a fusion was diagnosed in four cases, two delayed unions, and two obvious non-unions. An analysis of the failures in this animal study can possibly clarify the shortcomings of this concept. Perhaps, subtle changes of the design combined with other synthetic bone substitutes can possibly improve the fusion rate in the near future.

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“…Alternative techniques have been described by: SALZER et a!. (1988), TuRNER et al (1988),MANABE et al (1989, MOORE and UTTLEY (1989), CYBULSKI (1989), GALASKO (1991), KANEDA (1991) Fidler et al (1991), HARMS (1992), HERTLEIN et al (1992), COOPER eta!' (1985), SIEGAL (1985, 1990), HARRINGTON (1986), ONIMUS et al (1986) , STEFFEE et al (1986) MA et al (1987, KOSTUIK et al (1988), MAGERL and COSCIA (1988), ONO et a!.…”

Section: Surgical Techniques For Metastases At Various Spinal Levelsmentioning

confidence: 99%

Diagnosis and Therapy of Spinal Tumors

Algra¹,

Valk²,

Heimans³

1998

Medical Radiology

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The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.Product liability: The publishers cannot guarantee the accuracy of anr information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: de'blik, Berlin Typesetting: Verlagsservice Teichmann, Mauer SPIN,10111594 21/3135 -5 4 3 210 -Printed on acid-free paper ForewordSpinal Tumors are relatively rare conditions, but they present distinct and specific clinical and radiological features.Modern radiological imaging techniques, especially the new cross-sectional methods such as CT and magnetic resonance imaging, allows us nowadays to depict the exact localization and extent of these lesions more clearly. Moreover, the specific findings of these different morphological diagnostic modalities yield deeper insight into the exact nature of these tumors and their differential diagnosis.During the past few years, important progress in the therapy of spinal tumors has been achieved. Information about these new developments, however, is disseminated throughout the medical literature and scattered across the different medical disciplines. Furthermore, opinions regarding the best diagnostic approach and/or therapy are not always concordant.The editors of this book should be congratulated to bringing together several international authorities with particular expertise in the diagnosis and the treatment of spinal tumors.Together, these authors provide a complete overview of the currently prevailing diagnostic algorithms and therapeutic strategies for spinal tumors.The book will therefore suit excellently the needs of all physicans involved in the management of patients which such tumors: neurologists, neurosurgeons, orthopedic surgeons and radiologists. It will be of particular interest to radiologists, who are nowadays responsible not only for the diagnosis of these tumors but also, in some cases, for their non-surgical treatment.Leuven ALBERT L. BAERT PrefaceMany different opinions exist on the diagnostic workup and, particularly, on the therapy of spinal tumors. For instance, there is no consensus on the optimal treatment of spinal compression caused by vertebral metastases.With the advent of new imaging techniques (MRI) and therapeutic regimens, an up-to-date reference work is needed. This book is the first of its kind in that it offers an overview of the opinions of internationally renowned specialists. The editors hope this publication will help to establish rational imaging and therapy protocols for spinal tumors.Alkmaar Amsterdam Amsterdam

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Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer

Cited by 23 publications

References 28 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

A Newly Designed Vertebral Replacement Implant to Reconstruct the Thoracolumbar Spine Anteriorly

Diagnosis and Therapy of Spinal Tumors

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