Surgical management of metastatic spinal neoplasms

Vrionis, Frank D.; Small, J. Victor

doi:10.3171/foc.2003.15.5.12

Cited by 83 publications

(42 citation statements)

References 27 publications

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“…Therefore our study demonstrates the need for PM&R teams to elaborate a specific rehabilitation program for patients with metastatic paraplegia different from the one designed for trauma SCI patients. To alleviate back pain, opioids as well as steroidal and nonsteroidal anti-inflammatory drugs are limited by their classic adverse effects (transit disorders, sleepinessy) 13 but are still largely prescribed. In the Guo cohort, 93% of patients were taking opioid drugs at the end of their rehabilitation stay.…”

Section: Associated Symptomsmentioning

confidence: 99%

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Metastatic paraplegia: care management characteristics within a rehabilitation center

Fattal

Gault²,

Leblond³

et al. 2008

Spinal Cord

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Study design: Retrospective study. Objectives: To determine the potential impact of rehabilitation care on associated symptoms and functional improvements of paraplegic patients with metastatic spinal cord compression. Setting: CMN Propara, Montpellier (France). Measures: Demographics, Functional Independence Measure (FIM), Frankel Modified Score and Visual Analog Scale (VAS) for pain, intercurrent adverse medical events and neurological outcome, duration of stay, survival time, rehospitalization in a non-Spinal Cord Injury unit, number of contracts defining the patients rehabilitation goals, number of contracts defining the patients duration of stay within the rehabilitation center. Results: We reviewed the charts of 26 patients. The initial neurological profile was paraplegia or paraparesis for 24 patients and quadriparesis for 2 patients. Regarding functional improvements: four patients demonstrated a poor functional evolution, five patients showed no functional improvements or very slight improvements and all the other patients showed an increase in their overall functional aptitudes. At the end of the stay, 14 patients were urinary independent. Our study reports 52 rehospitalizations in an another unit and 101 outpatient visits during their rehabilitation stay in a physical medicine and rehabilitation (PM&R) center. For the 14 patients who were deceased at the time of data collection, the median survival rate post-paraplegia was 12.7 months. A total of 12 of the 14 patients spent more than a third of their remaining survival time in a rehabilitation center. Discussion: Compared to the patients' life expectancy, their stay in a rehabilitation center is too long and prevents them from spending time with family and loved ones. The occurrence rate of the associated symptoms is high because of both cancer-related disorders and neurological disorders caused by the spinal cord lesion. PM&R professionals are faced with patients affected by chronic pain and fatigue as well as frequent rehospitalizations, short stays and outpatient stays, in the primary oncology unit. This study focuses on the need to privilege the patients' comfort over their functional rehabilitation.

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Section: Associated Symptomsmentioning

confidence: 99%

“…Transdermic patches are even betterFless impact on transit functions. 13 The initial high-dose corticosteroids prescribed to limit the spinal cord edema, 15 should be progressively decreased to moderate-term, low-dose corticosteroids to ensure the necessary additional pain relief. 15 Transit disorders.…”

Section: Associated Symptomsmentioning

confidence: 99%

Metastatic paraplegia: care management characteristics within a rehabilitation center

Fattal

Gault²,

Leblond³

et al. 2008

Spinal Cord

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“…All of these approaches require posterior stabilization, and the exposure is deep and narrow and cannot be used for lesions with significant lateral extension. Postoperatively, there are significant risks of dysphagia, aspiration, and infection with oral flora especially in patients with cancer who will typically need postoperative radiotherapy [2,5,13]. Some of those procedures (transmandibular) require concurrent tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are cases where a posterior approach is indicated due to multilevel disease, previous radiation that makes it hard to retract the trachea and esophagus, poor medical condition precluding circumferential approach, previous failed posterior instrumentation requiring revision, kyphosis and instability needing long segment dorsal fusion and high (C1, C2) or low (cervicothoracic) involvement where the anterior approach may be cumbersome [5,8,13].…”

Section: Introductionmentioning

confidence: 99%

Posterior transpedicular corpectomy for malignant cervical spine tumors

2009

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The goal of this study was to assess surgical clinical and radiographic outcomes of using a posterior transpedicular approach (posterolateral) for ventral malignant tumors of the cervical spine. Access to ventral lesions of the cervical spine can be challenging in patients with malignant tumors. Anterior approaches are the gold standard for ventral pathology in the cervical spine, however, there are cases, where a posterior approach is indicated due to multilevel disease, previous radiation, swallowing difficulty with difficulty in retraction of trachea and esophagus, and in cases where circumferential fusion cannot be done due to patients' poor medical condition. A single approach could provide spinal stabilization and removal of tumor. Eight cases of ventral cervical spine malignant tumors (7 metastatic and 1 chordoma) underwent corpectomy through a posterior transpedicular (posterolateral) approach. Tumors involved C2 (5), C3 (1), C5 (1), and C7 (1). Six cases had anterior reconstruction and three column fusion, and two cases had posterior fusion alone. Gross total resection was achieved in all cases. No hardware failure or worsening of neurological condition was seen (4 patient were neurologically intact and remained intact after surgery and 4 patients improved in their Frankel grade). Pain improved in all patients, mean visual analog scale preoperative was 86 and improved to 22 after surgery. In two patients the vertebral artery was ligated without sequelae. We conclude that cervical spine transpedicular (posterolateral) approach is useful in cases where an anterior approach or a circumferential approach is not an option. It avoids the morbidity of anterior transcervical, transternal, and transoral procedures while providing decompression of neural elements and allowing three column stabilization when needed.

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“…Estas novas técnicas permitem a reconstrução imediata e estabilização da coluna vertebral, mesmo em pacientes com destruição óssea e comprometimento medular causado pelas metástases (FALICOV et al, 2006;JANSSON;BAUER, 2006). Os benefícios trazidos pela descompressão posterior que aborda a ressecção tumoral e a estabilização da coluna vertebral supera a instabilidade iatrogênica decorrente da laminectomia (VRIONIS; SMALL, 2003).…”

Section: Diagnóstico E Tratamentounclassified

Pacientes com metástases vertebrais submetidos à cirurgia - avaliação da qualidade de vida relacionada à saúde

Andrade¹

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Surgical management of metastatic spinal neoplasms

Cited by 83 publications

References 27 publications

Metastatic paraplegia: care management characteristics within a rehabilitation center

Metastatic paraplegia: care management characteristics within a rehabilitation center

Posterior transpedicular corpectomy for malignant cervical spine tumors

Pacientes com metástases vertebrais submetidos à cirurgia - avaliação da qualidade de vida relacionada à saúde

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