The use of expandable cages in patients undergoing multilevel corpectomies for metastatic tumors in the cervical spine.
ABSTRACT Expandable cages have been used successfully to reconstruct the anterior spinal column in the treatment of traumatic, neoplastic, infectious, and degenerative spine disease. To the best of our knowledge, no studies report the results of the use of expandable cages in patients undergoing multilevel corpectomies for cervical spine metastatic disease. We report our experience with the use of expandable cages in this subgroup of patients.From August 2006 to May 2008, 5 patients presenting with myelopathy, pain, and/or radiculopathy secondary to metastatic disease of the cervical spine underwent multilevel cervical corpectomies and placement of expandable cages in our institution. All procedures were supplemented with an anterior cervical plate and with posterior instrumentation to achieve a 360 degrees fusion. A visual analog scale (VAS), Nurick grade, Frankel grade, American Spinal Injuries Association (ASIA) grade, and Ranawat grade were used to evaluate patients pre- and postoperatively. The mean follow-up period was 13.2 months. Three patients underwent a 2-level corpectomy, 1 a 3-level corpectomy, and 1 a 4-level corpectomy. Postoperative imaging studies showed that all patients had correction of preoperative kyphosis. The mean VAS score was reduced from 6.4 to 1. All other indices of spinal cord injury measured improved postoperatively or were stabilized. Postoperative imaging studies showed stable constructs in 4 patients.The use of expandable cages in multilevel corpectomies for the treatment of metastatic cervical spine disease appears to be a safe and effective way to reconstruct the anterior column of the cervical spine, preventing further neurologic deterioration.
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ABSTRACT: OBJECT Recently, aggressive surgical techniques and a push toward en bloc resections of certain tumors have resulted in a need for creative spinal column reconstruction. Iatrogenic instability following these resections requires a thoughtful approach to adequately transfer load-bearing forces from the skull and upper cervical spine to the subaxial spine. METHODS The authors present a series of 7 cases in which lateral mass reconstruction with a cage or fibular strut graft was used to provide load-bearing support, including 1 case of bilateral cage placement. RESULTS The authors discuss the surgical nuances of en bloc resection of high cervical tumors and explain their technique for lateral mass cage placement. Additionally, they provide their rationale for the use of these constructs throughout the craniocervical junction and subaxial spine. CONCLUSIONS Lateral mass reconstruction provides a potential alternative or adjuvant method of restoring the load-bearing capabilities of the cervical spine.Journal of Neurosurgery Spine 11/2014; · 2.36 Impact Factor
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ABSTRACT: A prospective cohort study of 60 consecutive patients with spinal metastases treated with expandable cages. To determine long-term outcome for reconstruction of the spine with expandable cages after single and multilevel corpectomies for spinal metastases. Summary of Background Data. Expandable cages are widely used to reconstruct the spine after the removal of vertebral metastases. Long-term results however are lacking and there is little information on reconstruction after multi-level corpectomies. All patients were prospectively followed with regular clinical and radiographic evaluation. Outcome measures were the Frankel score, patients' self reported recovery, radiological alignment of the spine, and neurological plus biomechanical complications. Sixty patients were treated with expandable cages in our hospital in a five-year period with a maximum follow-up of six years. Single level reconstruction was performed in 48 cases, 2-level reconstruction in 8 cases, and 3-level reconstruction in 4 cases. Postoperatively, the Frankel score had improved significantly (P = 0.03), the segment height had increased (P = 0.02), and, in severe cases of kyphosis (>20 degrees), the regional angulation had been corrected compared to preoperatively (P < 0.001). Complication rate however was high (36.7%), in particular after multilevel reconstruction, in which 3 cases had to be re-operated years after the initial surgery; reasons for this were hardware failure, progressive kyphosis and bronchial perforation. Good recovery was reported in 70% of all patients. Expandable cages can be used successfully in reconstruction of the spine after single and multilevel corpectomies for spinal metastases. However, long-term complication rate is high. Promotion of bony fusion, prevention of soft tissue damage, adequate posterior stabilization, and careful patient selection may reduce these complications.The spine journal: official journal of the North American Spine Society 01/2014; · 2.90 Impact Factor
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ABSTRACT: Assessing the prognosis before treatment for metastatic spine tumor is extremely important in therapy selection. Therefore, we review some prognostic scoring systems and their outcomes. Articles with combinations of two keywords among "metastatic spine tumor" and "prognosis", "score", "scoring system", "predicting", or "life expectancy" were searched for in PubMed. As a result, 236 articles were extracted. Those referring to representative scoring systems about predicting the survival of patients with metastatic spine tumors were used. The significance and limits of these scoring systems, and the future perspectives were described. Tokuhashi score, Tomita score, Baur score, Linden score, Rades score, and Katagiri score were introduced. They are all scoring systems prepared by combining factors that affect prognosis. The primary site of cancer and visceral metastasis were common factors in all of these scoring systems. Other factors selected to influence the prognosis varied. They were useful to roughly predict the survival period, such as, "more than one year or not" or "more than six months or not". In particular, they were utilized for decision-making about operative indications and avoidance of excessive medical treatment. Because the function depended on the survival period in the patients with metastatic spine tumor, it was also utilized in assessing functional prognosis. However, no scoring system had more than 90% consistency between the predicted and actual survival periods. Future perspectives should adopt more oncological viewpoints with adjustment of the process of treatment for metastatic spine tumor.World journal of orthopedics. 07/2014; 5(3):262-71.