Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis

Edward W. Akeyson M.D., Ph.D. 1 and Ian E. McCutcheon M.D., F.R.C.S.(C) 1
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  • 1 Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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✓ The authors present a series of 25 patients who underwent single-stage complete spondylectomy, vertebral body reconstruction, and posterior segmental spinal stabilization for malignant metastatic disease involving multiple columns of the thoracolumbar spine. Patients were selected for this approach primarily because they were poor candidates for a transcavitary or lateral extracavitary approach or because the tumor involved both anterior and posterior columns of the spine. The operative approach used combines radical local resection of tumor via a bilateral transpedicular route, methylmethacrylate vertebral body reconstruction, and Luque rectangle stabilization in a single operation. Following surgery, the majority of patients experienced improvement in their neurological status, reduction in pain, or both. Most patients were functionally improved, or at least no worse, and spinal alignment was maintained in all. There was one local recurrence in a long-term survivor. Complications included cerebrospinal fluid fistulas, migrating graft material, and wound healing problems. The authors conclude that this surgical approach is safe and feasible for the radical resection of vertebral metastasis when combined with reconstruction and stabilization. This technique represents a useful alternative to other commonly used surgical approaches for the treatment of spinal metastases, and it should aid surgeons in selecting the optimum approach for individual patients.

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Contributor Notes

Address reprint requests to: Ian E. McCutcheon, M.D., Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 64, Houston, Texas 77030.
  • 1.

    Brenner A, , Roosen K, & Weiss H, et al: Posterior stabilization of the vertebral column in cases of spinal metastasis, in Piotrowski W, , Brock M, & Klinger M (eds): CNS Metastases: Neurosurgery in the Aged. Advances in Neurosurgery, Vol 12. Berlin: Springer-Verlag, 1984, pp 5157 Brenner A, Roosen K, Weiss H, et al: Posterior stabilization of the vertebral column in cases of spinal metastasis, in Piotrowski W, Brock M, Klinger M (eds): CNS Metastases: Neurosurgery in the Aged. Advances in Neurosurgery, Vol 12. Berlin: Springer-Verlag, 1984, pp 51–57

    • Search Google Scholar
    • Export Citation
  • 2.

    Bridwell KH, , Jenny AB, & Saul T, et al: Posterior segmental spinal instrumentation (PSSI) with posterolateral decompression and debulking for metastatic thoracic and lumbar spine disease. Limitations of the technique. Spine 13:13831394, 1988 Bridwell KH, Jenny AB, Saul T, et al: Posterior segmental spinal instrumentation (PSSI) with posterolateral decompression and debulking for metastatic thoracic and lumbar spine disease. Limitations of the technique. Spine 13:1383–1394, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Brunon J, , Sautreaux JL, & Sindou M, et al: Apport de l'ostéosynthèse postérieure dans le traitement des tumeurs du rachis. Neurochirurgie 21:435446, 1975 Brunon J, Sautreaux JL, Sindou M, et al: Apport de l'ostéosynthèse postérieure dans le traitement des tumeurs du rachis. Neurochirurgie 21:435–446, 1975

    • Search Google Scholar
    • Export Citation
  • 4.

    Cooper PR, , Errico TJ, & Martin R, et al: A systematic approach to spinal reconstruction after anterior decompression for neoplastic disease of the thoracic and lumbar spine. Neurosurgery 32:18, 1993 Cooper PR, Errico TJ, Martin R, et al: A systematic approach to spinal reconstruction after anterior decompression for neoplastic disease of the thoracic and lumbar spine. Neurosurgery 32:1–8, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Cross GO, , White HL, & White LP: Acrylic prosthesis of the fifth cervical vertebra in multiple myeloma. Technical note. J Neurosurg 35:112114, 1971 Cross GO, White HL, White LP: Acrylic prosthesis of the fifth cervical vertebra in multiple myeloma. Technical note. J Neurosurg 35:112–114, 1971

    • Search Google Scholar
    • Export Citation
  • 6.

    Cybulski GR, , Stone JL, & Opesanmi O: Spinal cord decompression via a modified costotransversectomy approach combined with posterior instrumentation for management of metastatic neoplasms of the thoracic spine. Surg Neurol 35:280285, 1991 Cybulski GR, Stone JL, Opesanmi O: Spinal cord decompression via a modified costotransversectomy approach combined with posterior instrumentation for management of metastatic neoplasms of the thoracic spine. Surg Neurol 35:280–285, 1991

    • Search Google Scholar
    • Export Citation
  • 7.

    Cybulski GR, , Von Roenn KA, & D'Angelo CM, et al: Luque rod stabilization for metastatic disease of the spine. Surg Neurol 28:277283, 1987 Cybulski GR, Von Roenn KA, D'Angelo CM, et al: Luque rod stabilization for metastatic disease of the spine. Surg Neurol 28:277–283, 1987

    • Search Google Scholar
    • Export Citation
  • 8.

    DeWald RL, , Bridwell KH, & Prodromas C, et al: Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine 10:2126, 1985 DeWald RL, Bridwell KH, Prodromas C, et al: Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine 10:21–26, 1985

    • Search Google Scholar
    • Export Citation
  • 9.

    Faccioli F, , Lima J, & Bricolo A: One-stage decompression and stabilization in the treatment of spinal tumors. J Neurosurg Sci 29:199205, 1985 Faccioli F, Lima J, Bricolo A: One-stage decompression and stabilization in the treatment of spinal tumors. J Neurosurg Sci 29:199–205, 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Fidler MW: Posterior instrumentation of the spine. An experimental comparison of various possible techniques. Spine 11:367372, 1986 Fidler MW: Posterior instrumentation of the spine. An experimental comparison of various possible techniques. Spine 11:367–372, 1986

    • Search Google Scholar
    • Export Citation
  • 11.

    Flatley TJ, , Anderson MH, & Anast GT: Spinal instability due to malignant disease. Treatment by segmental spinal stabilization. J Bone Joint Surg (Am) 66:4752, 1984 Flatley TJ, Anderson MH, Anast GT: Spinal instability due to malignant disease. Treatment by segmental spinal stabilization. J Bone Joint Surg (Am) 66:47–52, 1984

    • Search Google Scholar
    • Export Citation
  • 12.

    Harrington KD: Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg 61:107117, 1984 Harrington KD: Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg 61:107–117, 1984

    • Search Google Scholar
    • Export Citation
  • 13.

    Harrington KD: Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop 233:177197, 1988 Harrington KD: Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop 233:177–197, 1988

    • Search Google Scholar
    • Export Citation
  • 14.

    Harrington KD: The use of methylmethacryate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. J Bone Joint Surg (Am) 63:3646, 1981 Harrington KD: The use of methylmethacryate 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, 1981

    • Search Google Scholar
    • Export Citation
  • 15.

    Heller JG, , Zdeblick TA, & Kunz DA, et al: Spinal instrumentation for metastatic disease: in vitro biomechanical analysis. J Spinal Disord 6:1722, 1993 Heller JG, Zdeblick TA, Kunz DA, et al: Spinal instrumentation for metastatic disease: in vitro biomechanical analysis. J Spinal Disord 6:17–22, 1993

    • Search Google Scholar
    • Export Citation
  • 16.

    Heller M, , McBroom RJ, & MacNab T, et al: Treatment of metastatic disease of the spine with posterolateral decompression and Luque instrumentation. Neuro-Orthopedics 2:7074, 1986 Heller M, McBroom RJ, MacNab T, et al: Treatment of metastatic disease of the spine with posterolateral decompression and Luque instrumentation. Neuro-Orthopedics 2:70–74, 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Jelsma RK, & Kirsh PT: The treatment of malignancy of a vertebral body. Surg Neurol 13:189195, 1980 Jelsma RK, Kirsh PT: The treatment of malignancy of a vertebral body. Surg Neurol 13:189–195, 1980

    • Search Google Scholar
    • Export Citation
  • 18.

    Johnston FG, , Uttley D, & Marsh HT: Synchronous vertebral decompression and posterior stabilization in the treatment of spinal malignancy. Neurosurgery 25:872876, 1989 Johnston FG, Uttley D, Marsh HT: Synchronous vertebral decompression and posterior stabilization in the treatment of spinal malignancy. Neurosurgery 25:872–876, 1989

    • Search Google Scholar
    • Export Citation
  • 19.

    Kostiuk JP, , Errico TJ, & Gleason TF, et al: Spinal stabilization of vertebral column tumors. Spine 13:250256, 1988 Kostiuk JP, Errico TJ, Gleason TF, et al: Spinal stabilization of vertebral column tumors. Spine 13:250–256, 1988

    • Search Google Scholar
    • Export Citation
  • 20.

    Lesoin F, , Kabbaj K, & Debout J, et al: The use of Harrington's rods in metastatic tumour with spinal cord compression. Acta Neurochir 65:175181, 1982 Lesoin F, Kabbaj K, Debout J, et al: The use of Harrington's rods in metastatic tumour with spinal cord compression. Acta Neurochir 65:175–181, 1982

    • Search Google Scholar
    • Export Citation
  • 21.

    Lesoin F, , Rousseaux M, & Lozes G: Posterolateral approach to tumours of the dorsolumbar spine. Acta Neurochir 81:4044, 1986 Lesoin F, Rousseaux M, Lozes G: Posterolateral approach to tumours of the dorsolumbar spine. Acta Neurochir 81:40–44, 1986

    • Search Google Scholar
    • Export Citation
  • 22.

    Lievre JA, , Darcy M, & Pradat P: Tumeur à cellules géantes du rachis lombaire; spondylectomie totale en deux temps. Rev Rhum 35:125130, 1968 Lievre JA, Darcy M, Pradat P: Tumeur à cellules géantes du rachis lombaire; spondylectomie totale en deux temps. Rev Rhum 35:125–130, 1968

    • Search Google Scholar
    • Export Citation
  • 23.

    Lozes G, , Fawaz A, & Devos P, et al: Operative treatment of thoraco-lumbar metastases, using methylmetacrylate and Kempf's rods for vertebral replacement and stabilization. Report of 15 cases. Acta Neurochir 84:118123, 1987 Lozes G, Fawaz A, Devos P, et al: Operative treatment of thoraco-lumbar metastases, using methylmetacrylate and Kempf's rods for vertebral replacement and stabilization. Report of 15 cases. Acta Neurochir 84:118–123, 1987

    • Search Google Scholar
    • Export Citation
  • 24.

    Magerl F, & Coscia MF: Total posterior vertebrectomy of the thoracic or lumbar spine. Clin Orthop 232:6269, 1988 Magerl F, Coscia MF: Total posterior vertebrectomy of the thoracic or lumbar spine. Clin Orthop 232:62–69, 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    McAfee PC, , Bohlman HH, & Ducker T, et al: Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases. J Bone Joint Surg (Am) 68:11451157, 1986 McAfee PC, Bohlman HH, Ducker T, et al: Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases. J Bone Joint Surg (Am) 68:1145–1157, 1986

    • Search Google Scholar
    • Export Citation
  • 26.

    Miles J, , Banks AJ, & Dervin E, et al: Stabilisation of the spine affected by malignancy. J Neurol Neurosurg Psychiatry 47:897904, 1984 Miles J, Banks AJ, Dervin E, et al: Stabilisation of the spine affected by malignancy. J Neurol Neurosurg Psychiatry 47:897–904, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    O'Neil J, , Gardner V, & Armstrong G: Treatment of tumors of the thoracic and lumbar spinal column. Clin Orthop 227:103112, 1988 O'Neil J, Gardner V, Armstrong G: Treatment of tumors of the thoracic and lumbar spinal column. Clin Orthop 227:103–112, 1988

    • Search Google Scholar
    • Export Citation
  • 28.

    Onimus M, , Schraub S, & Bertin D, et al: Surgical treatment of vertebral metastasis. Spine 11:883891, 1986 Onimus M, Schraub S, Bertin D, et al: Surgical treatment of vertebral metastasis. Spine 11:883–891, 1986

    • Search Google Scholar
    • Export Citation
  • 29.

    Perrin RG, & McBroom RJ: Anterior versus posterior decompression for symptomatic spinal metastasis. Can J Neurol Sci 14:7580, 1987 Perrin RG, McBroom RJ: Anterior versus posterior decompression for symptomatic spinal metastasis. Can J Neurol Sci 14:75–80, 1987

    • Search Google Scholar
    • Export Citation
  • 30.

    Rompe JD, , Eysel P, & Hopf C, et al: Decompression/stabilization of the metastatic spine. Cotrel-Dubousset instrumentation in 50 patients. Acta Orthop Scand 64:38, 1993 Rompe JD, Eysel P, Hopf C, et al: Decompression/stabilization of the metastatic spine. Cotrel-Dubousset instrumentation in 50 patients. Acta Orthop Scand 64:3–8, 1993

    • Search Google Scholar
    • Export Citation
  • 31.

    Shaw B, , Mansfield FL, & Borges L: One stage posterolateral decompression and stabilization for primary and metastatic vertebral tumors in the thoracic and lumbar spine. J Neurosurg 70:405410, 1989 Shaw B, Mansfield FL, Borges L: One stage posterolateral decompression and stabilization for primary and metastatic vertebral tumors in the thoracic and lumbar spine. J Neurosurg 70:405–410, 1989

    • Search Google Scholar
    • Export Citation
  • 32.

    Sherman RMP, & Waddell JP: Laminectomy for metastatic epidural spinal cord tumors. Posterior stabilization, radiotherapy and preoperative assessment. Clin Orthop 207:5563, 1986 Sherman RMP, Waddell JP: Laminectomy for metastatic epidural spinal cord tumors. Posterior stabilization, radiotherapy and preoperative assessment. Clin Orthop 207:55–63, 1986

    • Search Google Scholar
    • Export Citation
  • 33.

    Siegal T, & Siegal T: Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery 17:424432, 1985 Siegal T, Siegal T: Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery 17:424–432, 1985

    • Search Google Scholar
    • Export Citation
  • 34.

    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) 67:375382, 1985 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) 67:375–382, 1985

    • Search Google Scholar
    • Export Citation
  • 35.

    Slatkin NE, & Posner JB: Management of spinal epidural metastases. Clin Neurosurg 30:698716, 1982 Slatkin NE, Posner JB: Management of spinal epidural metastases. Clin Neurosurg 30:698–716, 1982

    • Search Google Scholar
    • Export Citation
  • 36.

    Solini A, , Paschero B, & Orsini G, et al: The surgical treatment of metastatic tumours of the lumbar spine. Ital J Orthop Traumatol 11:427442, 1985 Solini A, Paschero B, Orsini G, et al: The surgical treatment of metastatic tumours of the lumbar spine. Ital J Orthop Traumatol 11:427–442, 1985

    • Search Google Scholar
    • Export Citation
  • 37.

    Steffee AD, , Sitkowski DJ, & Topham LS: Total vertebral body and pedicle arthroplasty. Clin Orthop 203:203208, 1986 Steffee AD, Sitkowski DJ, Topham LS: Total vertebral body and pedicle arthroplasty. Clin Orthop 203:203–208, 1986

    • Search Google Scholar
    • Export Citation
  • 38.

    Stener B: Total spondylectomy for removal of a giant-cell tumor in the eleventh thoracic vertebra. Spine 2:197201, 1977 Stener B: Total spondylectomy for removal of a giant-cell tumor in the eleventh thoracic vertebra. Spine 2:197–201, 1977

    • Search Google Scholar
    • Export Citation
  • 39.

    Stener B: Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg (Br) 53:288295, 1971 Stener B: Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg (Br) 53:288–295, 1971

    • Search Google Scholar
    • Export Citation
  • 40.

    Stener B, , Henriksson C, & Johansson S: Surgical removal of bone and muscle metastases of renal cancer. Acta Orthop Scand 55:491500, 1984 Stener B, Henriksson C, Johansson S: Surgical removal of bone and muscle metastases of renal cancer. Acta Orthop Scand 55:491–500, 1984

    • Search Google Scholar
    • Export Citation
  • 41.

    Stener B, & Johnsen OE: Complete removal of three vertebrae for giant-cell tumour. J Bone Joint Surg (Br) 53:278287, 1971 Stener B, Johnsen OE: Complete removal of three vertebrae for giant-cell tumour. J Bone Joint Surg (Br) 53:278–287, 1971

    • Search Google Scholar
    • Export Citation
  • 42.

    Sundaresan N, , DiGiacinto GV, & Hughes JEO: Surgical approaches to primary and metastatic tumors of the spine, in Schmidek HH, & Sweet WH (eds): Operative Neurosurgical Techniques: Indications, Methods, Results. Orlando, FL: Grune & Stratton, 1988, pp 15251537 Sundaresan N, DiGiacinto GV, Hughes JEO: Surgical approaches to primary and metastatic tumors of the spine, in Schmidek HH, Sweet WH (eds): Operative Neurosurgical Techniques: Indications, Methods, Results. Orlando, FL: Grune & Stratton, 1988, pp 1525–1537

    • Search Google Scholar
    • Export Citation
  • 43.

    Sundaresan N, , DiGiacinto GV, & Hughes JEO, et al: Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery 29:645650, 1991 Sundaresan N, DiGiacinto GV, Hughes JEO, et al: Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery 29:645–650, 1991

    • Search Google Scholar
    • Export Citation
  • 44.

    Sundaresan N, , DiGiacinto GV, & Krol G, et al: Spondylectomy for malignant tumors of the spine. J Clin Oncol 7:14851491, 1989 Sundaresan N, DiGiacinto GV, Krol G, et al: Spondylectomy for malignant tumors of the spine. J Clin Oncol 7:1485–1491, 1989

    • Search Google Scholar
    • Export Citation
  • 45.

    Sundaresan N, , Fraser AB, & Krol G: Surgical stabilization for tumors of the thoracic spine, in Holtzman RNN, , McCormick PC, & Farcy JPC (eds): Spinal Instability. New York: Springer-Verlag, 1994, pp 295317 Sundaresan N, Fraser AB, Krol G: Surgical stabilization for tumors of the thoracic spine, in Holtzman RNN, McCormick PC, Farcy JPC (eds): Spinal Instability. New York: Springer-Verlag, 1994, pp 295–317

    • Search Google Scholar
    • Export Citation
  • 46.

    Sundaresan N, , Galicich JH, & Bains MS, et al: Vertebral body resection in the treatment of cancer involving the spine. Cancer 53:13931396, 1984 Sundaresan N, Galicich JH, Bains MS, et al: Vertebral body resection in the treatment of cancer involving the spine. Cancer 53:1393–1396, 1984

    • Search Google Scholar
    • Export Citation
  • 47.

    Sundaresan N, , Galicich JH, & Lane JM: Harrington rod stabilization for pathological fractures of the spine. J Neurosurg 60:282286, 1984 Sundaresan N, Galicich JH, Lane JM: Harrington rod stabilization for pathological fractures of the spine. J Neurosurg 60:282–286, 1984

    • Search Google Scholar
    • Export Citation
  • 48.

    Sundaresan N, , Galicich JH, & Lane JM, et al: Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 63:676684, 1985 Sundaresan N, Galicich JH, Lane JM, et al: Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 63:676–684, 1985

    • Search Google Scholar
    • Export Citation
  • 49.

    Tomita K, , Kawahara N, & Baba H, et al: Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:291298, 1994 Tomita K, Kawahara N, Baba H, et al: Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:291–298, 1994

    • Search Google Scholar
    • Export Citation
  • 50.

    Weller SJ, & Rossitch E Jr: Unilateral posterolateral decompression without stabilization for neurological palliation of symptomatic spinal metastasis in debilitated patients. J Neurosurg 82:739744, 1995 Weller SJ, Rossitch E Jr: Unilateral posterolateral decompression without stabilization for neurological palliation of symptomatic spinal metastasis in debilitated patients. J Neurosurg 82:739–744, 1995

    • Search Google Scholar
    • Export Citation
  • 51.

    Wenger DR, & Carollo JJ: The mechanics of thoracolumbar fractures stabilized by segmental fixation. Clin Orthop 189:8996, 1984 Wenger DR, Carollo JJ: The mechanics of thoracolumbar fractures stabilized by segmental fixation. Clin Orthop 189:89–96, 1984

    • Search Google Scholar
    • Export Citation
  • 52.

    Wenger DR, , Carollo JJ, & Wilkerson JA Jr, et al: Laboratory testing of segmental spinal instrumentation versus traditional Harrington instrumentation for scoliosis treatment. Spine 7:265269, 1982 Wenger DR, Carollo JJ, Wilkerson JA Jr, et al: Laboratory testing of segmental spinal instrumentation versus traditional Harrington instrumentation for scoliosis treatment. Spine 7:265–269, 1982

    • Search Google Scholar
    • Export Citation

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