Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2015

Open Access 01-12-2015 | Research article

Palliative transpedicular partial corpectomy without anterior vertebral reconstruction in lower thoracic and thoracolumbar junction spinal metastases

Authors: Chien-Chun Chang, Yen-Jen Chen, Da-Fu Lo, Hsien-Te Chen, Horng-Chaung Hsu, Ruey-Mo Lin

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

Login to get access

Abstract

Background

The thoracolumbar junction is the transition from a stiff (thoracic spine) to a mobile zone (lumbar spine) and is relatively unstable compared with the thoracic and lumbar portions of the spine. The need for anterior reconstruction after a corpectomy has been emphasized by several authors. However, for patients with a relatively short life expectancy, anterior reconstruction may be unnecessary. Posterior instrumentation alone may be sufficient to provide pain relief and stability for such patients. The goal of this study was to assess the postoperative outcomes and survival rates of patients with tumor metastases of the lower thoracic spine and thoracolumbar junction (T10–L1) who underwent transpedicular partial corpectomy without anterior vertebral reconstruction.

Methods

From November 2001 to February 2015, 29 patients diagnosed with symptomatic spinal cord compression caused by tumor metastasis involving T10 to L1 underwent palliative surgery that involved a posterolateral transpedicular partial corpectomy without anterior reconstruction. The surgical indication was neurologic progression. A follow-up was conducted for all of the patients, including reviewing medical records and performing an examination in the outpatient department.

Results

The patients ranged in age from 33 to 83 years (mean, 61.6 years). Neurologic improvement by at least one Frankel grade was noted in 75.9 % of the patients (N = 22). Neither intraoperative mortality nor implant failure was reported. The median survival rate was 7.43 months (range, 0.47–28 months).

Conclusion

The results of this study suggest that the stability of implants can be maintained up to 28 months with satisfying functional outcome after a palliative posterolateral transpedicular partial corpectomy without anterior reconstruction.
Literature
1.
go back to reference Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.PubMedCrossRef Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.PubMedCrossRef
2.
go back to reference Harrington KD. 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. 1981;63:36–46.PubMed Harrington KD. 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. 1981;63:36–46.PubMed
3.
go back to reference McAfee PC, Bohlman HH, Ducker T, Eismont FJ. Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases. J Bone Joint Surg Am. 1986;68:1145–57.PubMed McAfee PC, Bohlman HH, Ducker T, Eismont FJ. Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases. J Bone Joint Surg Am. 1986;68:1145–57.PubMed
4.
go back to reference Siegal T, Tiqva P, Siegal T. Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive operative procedures. J Bone Joint Surg Am. 1985;67:375–82.PubMed Siegal T, Tiqva P, Siegal T. Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive operative procedures. J Bone Joint Surg Am. 1985;67:375–82.PubMed
5.
go back to reference Chen YJ, Hsu HC, Chen KH, Li TC, Lee TS. Transpedicular partial corpectomy without anterior vertebral reconstruction in thoracic spine metastasis. Spine (Phila Pa 1976). 2007;32:E623–6.CrossRef Chen YJ, Hsu HC, Chen KH, Li TC, Lee TS. Transpedicular partial corpectomy without anterior vertebral reconstruction in thoracic spine metastasis. Spine (Phila Pa 1976). 2007;32:E623–6.CrossRef
6.
go back to reference Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, et al. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J. 2010;19:1657–76.PubMedCentralPubMedCrossRef Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, et al. Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J. 2010;19:1657–76.PubMedCentralPubMedCrossRef
7.
go back to reference Chen HH, Wang WK, Li KC, Chen TH. Biomechanical effects of the body augmenter for reconstruction of the vertebral body. Spine (Phila Pa 1976). 2004;29:E382–7.CrossRef Chen HH, Wang WK, Li KC, Chen TH. Biomechanical effects of the body augmenter for reconstruction of the vertebral body. Spine (Phila Pa 1976). 2004;29:E382–7.CrossRef
8.
go back to reference Wang XY, Dai LY, Xu HZ, Chi YL. Biomechanical effect of the extent of vertebral body fracture on the thoracolumbar spine with pedicle screw fixation: an in vitro study. J Clin Neurosci. 2008;15:286–90.PubMedCrossRef Wang XY, Dai LY, Xu HZ, Chi YL. Biomechanical effect of the extent of vertebral body fracture on the thoracolumbar spine with pedicle screw fixation: an in vitro study. J Clin Neurosci. 2008;15:286–90.PubMedCrossRef
9.
go back to reference Akeyson EW, McCutcheon IE. Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg. 1996;85:211–20.PubMedCrossRef Akeyson EW, McCutcheon IE. Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg. 1996;85:211–20.PubMedCrossRef
10.
go back to reference Wang JC, Boland P, Mitra N, Yamada Y, Lis E, Stubblefield M, et al. Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1:287–98.PubMedCrossRef Wang JC, Boland P, Mitra N, Yamada Y, Lis E, Stubblefield M, et al. Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1:287–98.PubMedCrossRef
11.
go back to reference Eleraky M, Papanastassiou I, Tran ND, Dakwar E, Vrionis FD. Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors. Eur Spine J. 2011;20:1363–70.PubMedCentralPubMedCrossRef Eleraky M, Papanastassiou I, Tran ND, Dakwar E, Vrionis FD. Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors. Eur Spine J. 2011;20:1363–70.PubMedCentralPubMedCrossRef
12.
go back to reference Shen FH, Marks I, Shaffrey C, Ouellet J, Arlet V. The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J. 2008;8:329–39.PubMedCrossRef Shen FH, Marks I, Shaffrey C, Ouellet J, Arlet V. The use of an expandable cage for corpectomy reconstruction of vertebral body tumors through a posterior extracavitary approach: a multicenter consecutive case series of prospectively followed patients. Spine J. 2008;8:329–39.PubMedCrossRef
13.
go back to reference Viswanathan A, Abd-El-Barr MM, Doppenberg E, Suki D, Gokaslan Z, Mendel E, et al. Initial experience with the use of an expandable titanium cage as a vertebral body replacement in patients with tumors of the spinal column: a report of 95 patients. Eur Spine J. 2012;21:84–92.PubMedCentralPubMedCrossRef Viswanathan A, Abd-El-Barr MM, Doppenberg E, Suki D, Gokaslan Z, Mendel E, et al. Initial experience with the use of an expandable titanium cage as a vertebral body replacement in patients with tumors of the spinal column: a report of 95 patients. Eur Spine J. 2012;21:84–92.PubMedCentralPubMedCrossRef
14.
go back to reference Metcalfe S, Gbejuade H, Patel NR. The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors: consecutive case series of 50 patients. Spine (Phila Pa 1976). 2012;37:1375–83.CrossRef Metcalfe S, Gbejuade H, Patel NR. The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors: consecutive case series of 50 patients. Spine (Phila Pa 1976). 2012;37:1375–83.CrossRef
15.
go back to reference McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976). 2006;31:S70–9.CrossRef McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine (Phila Pa 1976). 2006;31:S70–9.CrossRef
16.
go back to reference Oda I, Cunningham BW, Abumi K, Kaneda K, McAfee PC. The stability of reconstruction methods after thoracolumbar total spondylectomy. An in vitro investigation. Spine (Phila Pa 1976). 1999;24:1634–8.CrossRef Oda I, Cunningham BW, Abumi K, Kaneda K, McAfee PC. The stability of reconstruction methods after thoracolumbar total spondylectomy. An in vitro investigation. Spine (Phila Pa 1976). 1999;24:1634–8.CrossRef
17.
go back to reference Bridwell KH, Jenny AB, Rich KM ST, Brubb RL. Posterior segmental spinal instrumentation (PSSI) with posterolateral decompression and debulking for metastatic thoracic and lumbar spine disease. Limitations of the technique. Spine (Phila Pa 1976). 1988;13:1383–94.CrossRef Bridwell KH, Jenny AB, Rich KM ST, Brubb RL. Posterior segmental spinal instrumentation (PSSI) with posterolateral decompression and debulking for metastatic thoracic and lumbar spine disease. Limitations of the technique. Spine (Phila Pa 1976). 1988;13:1383–94.CrossRef
18.
go back to reference Walter J, Reichart R, Waschke A, Kalff R, Ewald C. Palliative considerations in the surgical treatment of spinal metastases: evaluation of posterolateral decompression combined with posterior instrumentation. J Cancer Res Clin Oncol. 2012;138:301–10.PubMedCrossRef Walter J, Reichart R, Waschke A, Kalff R, Ewald C. Palliative considerations in the surgical treatment of spinal metastases: evaluation of posterolateral decompression combined with posterior instrumentation. J Cancer Res Clin Oncol. 2012;138:301–10.PubMedCrossRef
19.
go back to reference Cho DC, Sung JK. Palliative surgery for metastatic thoracic and lumbar tumors using posterolateral transpedicular approach with posterior instrumentation. Surg Neurol. 2009;71:424–33.PubMedCrossRef Cho DC, Sung JK. Palliative surgery for metastatic thoracic and lumbar tumors using posterolateral transpedicular approach with posterior instrumentation. Surg Neurol. 2009;71:424–33.PubMedCrossRef
20.
go back to reference Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine (Phila Pa 1976). 2000;25:2240–9.CrossRef Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine (Phila Pa 1976). 2000;25:2240–9.CrossRef
Metadata
Title
Palliative transpedicular partial corpectomy without anterior vertebral reconstruction in lower thoracic and thoracolumbar junction spinal metastases
Authors
Chien-Chun Chang
Yen-Jen Chen
Da-Fu Lo
Hsien-Te Chen
Horng-Chaung Hsu
Ruey-Mo Lin
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-015-0255-z

Other articles of this Issue 1/2015

Journal of Orthopaedic Surgery and Research 1/2015 Go to the issue