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Clinical Orthopaedics and Related Research®

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01-03-2011 | Symposium: Current Concepts in Cervical Spine Surgery

Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery

Authors: Vincenzo Denaro, MD, Alberto Di Martino, MD, PhD, Rocco Papalia, MD, PhD, Luca Denaro, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2011

Abstract

Background

Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve better pain relief and improvement of neurologic function.

Questions/purposes

(1) Does tumor removal with reconstruction improve the neurologic status? (2) Is any subset of patients more likely to have neurological recovery from palliative surgery? (3) What is the rate of surgery-related complications?

Patients and Methods

We retrospectively reviewed 46 patients who had palliative surgery for metastatic solid tumor metastases of the subaxial cervical spine. Indications were neurologic deficits, life expectancy longer than 6 months, and a Karnofsky Performance Score of 50 to 70. Surgery consisted of anterior tumor removal and reconstruction with titanium mesh cages and/or tricortical iliac crest allograft plus plate fixation or of a combined procedure with adjunctive posterior decompression and stabilization with lateral mass screw fixation. Postoperatively, neurologic Frankel score grade, Karnofsky Performance Score, and complications were recorded.

Results

Five of 18 nonambulatory patients (Frankel B/C) became ambulatory again (Frankel D). No patients were Frankel Grade E preoperatively, whereas 19 of 46 gained Frankel Grade E after surgery. One patient worsened neurologically and died 4 months after surgery. Patients with neoplastic pachymeningitis had less neurologic recovery than those without. Complications included dural tears (three), wound infection (three), and tumor relapse at the same or an adjacent level (four). Two of these four patients had instrumentation-related complications.

Conclusions

Surgery improved clinical and neurologic status according to Frankel score; patients with neoplastic pachymeningitis are likely to experience less neurologic recovery.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery
Authors: Vincenzo Denaro, MD
Alberto Di Martino, MD, PhD
Rocco Papalia, MD, PhD
Luca Denaro, MD, PhD
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 3/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1617-9

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Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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