Transthoracic vertebrectomy for metastatic spinal tumors

Abstract

<jats:p>Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region.</jats:p> <jats:p>Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p &lt; 0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p &lt; 0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%.</jats:p> <jats:p>These results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.</jats:p>

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

“…Treatment of metastatic spinal lesions with vertebrectomy and stabilization has been shown to provide significant and sustained improvement in pain control (Table 8) [4,5,20,24,25,35,37,47,50,52]. Similar pain relief was achieved in our series, as evidenced by decreases in VAS and pain medication scale scores that lasted for at least 1 year.…”

“…Data collected regarding the primary breast cancer included dates of initial diagnosis, surgery, radiation and/or chemotherapy/hormonal therapy and the presence of other metastases at the time of spinal surgery. Clinical data collected regarding the spinal metastases included the presenting neurological signs and symptoms as quantified by the Frankel grading system [15,20]. Also, the severity Fig.…”

“…1 Proposed algorithm for treatment of patients with symptomatic spinal metastases from breast cancer of pain was assessed using a numerical pain rating scale (0-10), which is a modification of the visual analog scale (VAS) [10,42]. The type of pain medication used was classified from 1 to 5, as previously reported by the senior author (Table 1) [20].…”

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

“…Nevertheless, intralesional surgery predisposes the patient to local recurrences and poor prognosis. To reduce the surgery-induced tumor cell dissemination, decrease local recurrence rates and to improve survival times, different techniques [8,15,16,20,23,25,26,32] for wide resections at the spine, involving either en bloc total [32] or hemilaminectomy [18] followed by en bloc corporectomy and dorso-ventral stabilization have been developed. In early 1980, Stener and Roy-Camille were the first to describe en bloc spondylectomy via a posterior approach after complete resection of the dorsal vertebral structures, i.e., both laminae, spinous process and parts of the pedicles, resulting in an oncological adequate resection for primary bone tumor locations not extending beyond the vertebral body [23,26].…”

Thoracoscopic assisted en bloc resection of a spine tumor

“…These are due to improvement in the pain, maintenance of function, decrease in the recurrence and potential for improvement in the neurological status [7]. A complete wide resection of the vertebral lesion is not possible due to spinal canal and its contents, although if the tumor was localized to the body or the anterior elements, such a resection can achieve a negative margin [1,8].…”