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

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Résumé

La décompression antérieure a été réalisée chez 41 patients porteurs de métastases du corps vertébral. Les complications neurologiques étaient patentes chez 36 patients et latentes chez 5 d'entre eux. On a utilisé pour la reconstruction un cylindre de titane, mis en place après la corporectomie et renforcé par une plaque antérieure. L'implant en titane peut être facilement adapté à la longueur nécessaire sans nécessiter de matériel supplémentaire et onéreux. L'implant est rempli de PMMA avant sa mise en place, ce qui facilite la transfixation nécessaire au verrouillage de la rotation. La mortalité à 30 jours est de 9.7%. La douleur a disparu dans 38 cas sur 41 (92.7%), l'amélioration motrice a été manifeste dans 31 cas sur 35 (88.6%), 6 patients ne présentaient aucun symptôme neurologique ni avant ni après l'opération. Une dégradation neurologique n'a été relevée que dans 1 cas (2.4%). L'efficacité du geste chirurgical a été maintenue jusqu'au décès des patients. Bien que la récidive tumorale à un autre niveau rachidien ait conduit à une chirurgie itérative chez 5 patients, aucun déplacement d'implant n'est survenu durant la période d'observation (recul maximum 44 mois), cela témoignant du caractère mécaniquement faible et sûr du procédé utilisé.

Summary

Anterior decompression in spinal metastases of the corporal type with impending (n=5) or present (n=36) neurological complications was performed in 41 patients. For reconstruction, a titanium cylinder was inserted after spondylectomy and augmented with an anterior plate. The titanium implant can easily be adjusted to the length needed without necessitating expensive additional equipment. Outside the patient the implant is filled with polymethylmetacrylate, facilitating plate transfixation for rotational locking. There was a 30-day mortality of 9.7%. Pain relief was apparent in 38 of 41 patients (92.7%), and motor improvement was manifest in 31 of 35 cases (88.6%). Six patients did not present with any neurological symptoms pre- or postoperatively. Neurological deterioration was registered in only 1 case (2.4%). Surgical efficacy was maintained until the death of the patients. Though tumor recurrence at a different spinal level led to consecutive surgery in 5 patients, no implant dislocation occurred during the observation period (maximum 44 months), characterizing the procedure as a mechanically reliable and safe technique.

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References

  1. Boland PJ, Lane JM, Sundaresan N (1982) Metastatic disease of the spine. Clin Orthop 169:95–102

    Google Scholar 

  2. Bridwell KH, Jenny AB, Saul T, Rich KM, Grubb RL (1988) Posterior segmental spinal instrumentation (PSSI) with posterolateral decompression and debulking for metastatic thoracic and lumbar spine disease. Spine 13:1383–1394

    Google Scholar 

  3. Brihaye J, Ectors P, Lemort M, Van Houtte P (1988) The management of spinal epidural metastases. Adv Techn Stand Neurosurg 16:121–176

    Google Scholar 

  4. Burri C, Claes L, Mutschler W, Wörsdörfer O (1989) Kohlenstoffaser-verstärkte Polysulfon-Implantate für die Tumorchirurgie an der Wirbelsäule. Akt Traumatol 19:297–301

    Google Scholar 

  5. Fidler MW (1986) Anterior decompression and stabilisation of metastatic spinal fractures. J Bone Joint Surg [Br] 68:83–90

    Google Scholar 

  6. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar DH, Vernon JDS, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192

    Google Scholar 

  7. Griss P (1987) Osteosynthesen und Wirbelkörperersatz bei Wirbelsäulentumoren. Orthopäde 16:415–421

    Google Scholar 

  8. Hall AJ, MacKay NNS (1973) The results of laminectomy for compression of the cord or cauda equina by extradural malignant tumour. J Bone Joint Surg 55-B, 497–505

    Google Scholar 

  9. Harms J, Stoltze D, Biedermann L (1990) Wirbelkörperersatz,-platzhalter. Oral presentation, workshop on correction and stabilization of spinal diseases with the Moss-system, Bad Nauheim, FRG, 29 June 1990

  10. Harrington KD (1981) The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. J Bone Joint Surg [Am] 63:36–46

    Google Scholar 

  11. Harrington KD (1984) Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg 61:107–117

    Google Scholar 

  12. Harrington KD (1988) Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop 223:177–197

    Google Scholar 

  13. Hertlein H, Mittlmeier T, Schürmann M, Lob G (1992) Anterior transpedicular instrumentation of the lumbar spine: an anatomical study. J Spinal Disord 5 (in press)

  14. Johnston FG, Uttley D, Marsh HT (1989) Synchronous vertebral decompression and posterior stabilization in the treatment of spinal malignancy. Neurosurgery 25:872–876

    Google Scholar 

  15. Lee CK, Rosa R, Fernand R (1986) Surgical treatment of tumors of the spine. Spine 11:201–208

    Google Scholar 

  16. Manabe S, Tateishi A, Abe M, Ohno T (1989) Surgical treatment of metastatic tumors of the spine. Spine 14:41–47

    Google Scholar 

  17. O'Neil J, Gardner V, Armstrong G (1988) Treatment of tumors of the thoracic and lumbar spinal column. Clin Orthop 227:103–112

    Google Scholar 

  18. Onimus M, Schraub S, Bosset JF, Guidet M (1986) Surgical treatment of vertebral metastasis. Spine 11:883–891

    Google Scholar 

  19. Ono K, Yonenobu K, Ebara S, Fujiwara K, Yamashita K, Fuji T, Dunn EJ (1988) Prosthetic replacement surgery for cervical spine metastasis. Spine 13:817–822

    Google Scholar 

  20. Polster J, Wuisman P, Matthiaß HH, Brinckmann P (1989) Die ventrale Stabilisierung von primären Tumoren und Metastasen der Wirbelsäule mit dem Wirbelkörperimplantat und Palacos. Z Orthop 127:414–417

    Google Scholar 

  21. Roy-Camille R, Saillant G, Lapresle P, Mazel C, Mariambourg G (1985) Traitement chirurgical des métastases du rachis par stabilisation à l'aide de plaques postérieures vissées dans les pédicules vertébraux. Rev Chir Orthop 71:483–492

    Google Scholar 

  22. Schaberg J, Gainor BJ (1985) A profile of metastatic carcinoma of the spine. Spine 10:19–20

    Google Scholar 

  23. Schwarzenbach O, Boos N, Aebi M (1990) Metastasen und durch Metastasen bedingt pathologische Frakturen der Wirbelsäule. Unfallchirung 93:457–466

    Google Scholar 

  24. Sherk HH, Nolan JP Jr, Mooar PA (1988) Treatment of tumors of the cervical spine. Clin Orthop 233:163–167

    Google Scholar 

  25. Shirakusa T, Motonaga R, Yoshimine K, Takada S, Ueda H, Yamasaki S, Takachi T, Yoh S (1989) Anterior rib strut grafting for the treatment of malignant lesions in the thoracic spine. Arch Orthop Trauma Surg 108:268–272

    Google Scholar 

  26. Siegal T, Siegal T (1985) Vertebral body resection for epidural compression by malignant tumors. J Bone Joint Surg [Am] 67:375–382

    Google Scholar 

  27. Sundaresan N, Galicich JH (1984) Treatment of spinal metastases by vertebral body resection. Cancer Invest 2:383–397

    Google Scholar 

  28. Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P (1985) Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 63:676–684

    Google Scholar 

  29. Turner PL, Prince HG, Webb JK, Sokal MPJW (1988) Surgery for malignant extradural tumours of the spine. J Bone Joint Surg [Br] 70:451–456

    Google Scholar 

  30. Waisbrod H (1988) Treatment of metastatic disease of the spine with anterior resection and stabilization by means of a new cancellous metal construct. Arch Orthop Trauma Surg 107:222–225

    Google Scholar 

  31. Wuisman P, Polster J, Härle A, Matthiaß HH, Brinckmann P (1989) Das Wirbelkörperimplantat als Behandlungsprinzip bei Tumoren und Metastasen der thorakalen und lumbalen Wirbelsäule. Z Orthop 127:25–31

    Google Scholar 

  32. Young RF, Post EM, King GA (1980) Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 53:741–748

    Google Scholar 

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Authors and Affiliations

  1. Klinikum Großhadern, Unfallchirurgie, Chirurgische Klinik und Poliklinik der Universität München, Marchioninistrasse 15, W-8000, München 70, Federal Republic of Germany

    Hans Hertlein, Thomas Mittlmeier, Stefan Piltz, Matthias Schürmann, Thomas Kauschke & Günter Lob

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  1. Hans Hertlein
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  2. Thomas Mittlmeier
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  3. Stefan Piltz
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  4. Matthias Schürmann
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  5. Thomas Kauschke
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  6. Günter Lob
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Hertlein, H., Mittlmeier, T., Piltz, S. et al. Spinal stabilization for patients with metastatic lesions of the spine using a titanium spacer. Eur Spine J 1, 131–136 (1992). https://doi.org/10.1007/BF00300940

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