1
|
Mao G, Theodore N. Spinal brachytherapy. Neuro Oncol 2022; 24:S62-S68. [PMID: 36322097 PMCID: PMC9629484 DOI: 10.1093/neuonc/noac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Brachytherapy remains an underrecognized and underutilized radiation therapy modality for the treatment of spinal tumors. This article summarizes the existing body of medical literature on the usage, indications, techniques, and outcomes of brachytherapy for the treatment of spine tumors. The disease pathology most commonly treated with brachytherapy is metastatic spine cancer, rather than primary bone tumors of the spine. Brachytherapy can be used alone, as percutaneous needle injections; however, it is more often used in conjunction with open surgery or cement vertebral body augmentation. Although the data are still relatively sparse, studies show consistent benefit from brachytherapy in terms of improvements in pain, function, local recurrence rate, and overall survival. Brachytherapy is also associated with a favorable complication profile.
Collapse
Affiliation(s)
- Gordon Mao
- Department of Neurological Surgery, The Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicholas Theodore
- Department of Neurological Surgery, The Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Surgical Intervention for Patients With Spinal Metastasis From Lung Cancer: A Retrospective Study of 87 Cases. Clin Spine Surg 2021; 34:E133-E140. [PMID: 32868534 DOI: 10.1097/bsd.0000000000001062] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/24/2020] [Indexed: 12/21/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE Evaluate the prognosis and surgical outcomes of patients with spinal metastasis from lung cancer undergoing surgical treatment. SUMMARY OF BACKGROUND DATA The spine is the most common site of metastatic lesions in patients with lung cancer. There have been a few studies, all small cohorts studying prognosis and surgical outcomes and the results were discordant. MATERIALS AND METHODS A retrospective study on a prospectively collected database was conducted. Data collected were the following: age, tobacco use, tumor histology, American Spinal Injury Association score, revised Tokuhashi score, ambulatory status, perioperative complications, postoperative adjuvant treatment, and survival time. Univariate and multivariate analyses were performed to identify the prognostic factors of survival. RESULTS The authors studied 87 patients with a mean age of 61.3±1.9 years. Median survival was 4.1±0.8 months. Twenty-eight patients (32.2%) lived >6 months and 14 patients (16.1%) lived >12 months. The medical complication rate was 13.8% and the surgical complication rate was 5.7%. The 30-day mortality rate was 4.6%. Univariate analysis showed tobacco use, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy were prognostic factors. There was no significant difference in survival between adenoma lung cancers, nonadenoma lung cancers, and small cell lung cancers (P=0.51). Multivariate analysis revealed tobacco use, revised Tokuhashi score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy affected the survival. CONCLUSIONS This is the largest reported study of patients with spinal metastasis from lung cancer undergoing spinal surgery. It is the first study showing that tobacco use has a negative impact on survival. Spinal surgery improves the quality of life and offers nonambulatory patients a high chance of regaining walking ability with an acceptable risk of complications.
Collapse
|
3
|
Brachytherapy in Spinal Tumors: A Systematic Review. World Neurosurg 2018; 118:e235-e244. [PMID: 29966796 DOI: 10.1016/j.wneu.2018.06.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Conventional external beam radiation and stereotactic radiosurgery are common radiation techniques used to treat spinal tumors. Intraoperative brachytherapy (BT) may serve as an alternative when other options have been exhausted or as an adjunct in combination with other therapies. The objective of this study was to systematically review the literature on BT use in spinal tumor surgery. METHODS PubMed and Embase databases were systematically queried for literature reporting the use of BT in the surgical treatment of spinal tumors. PRISMA guidelines were followed. A meta-analysis was performed. RESULTS Of the 203 initial articles queried, 15 studies were included. Of the 370 total patients described, 78% were treated for spine metastases. Indications for BT included tumors refractory to previous treatments and inability to tolerate chemotherapy, radiation, and/or open surgery. Seed placement was the most common method of delivery (58%) compared with plaques (42%). BT was placed during an open procedure in 52%, and of the remaining percutaneous procedures, 47% were combined with cement augmentation. Tumor recurrence rates varied from 13% to 49%. Seven studies reporting visual analog scale scores reported significant improvement in pain control. CONCLUSIONS BT was used to treat metastatic disease in patients who failed previous therapies and could not tolerate open surgery or further therapy. This review summarizes the major findings in the available literature pertaining to patient background, indications, and outcomes. Spinal BT seems to be a viable option for spine tumor treatment and should be made available at treating centers.
Collapse
|
4
|
Folkert MR, Bilsky MH, Cohen GN, Zaider M, Lis E, Krol G, Laufer I, Yamada Y. Intraoperative and percutaneous iridium-192 high-dose-rate brachytherapy for previously irradiated lesions of the spine. Brachytherapy 2013; 12:449-56. [PMID: 23462536 DOI: 10.1016/j.brachy.2013.01.162] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/08/2013] [Accepted: 01/08/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Advances in stereotactic radiosurgery have improved local control of spine metastases, but local failure is still a problem and repeat irradiation is limited by normal tissue tolerance. A novel high-dose-rate (HDR) brachytherapy technique has been developed to treat these previously irradiated lesions. METHODS AND MATERIALS Five patients with progressive disease at previously irradiated sites in the spine who were not amenable to further external beam radiation were treated. Catheters were placed intraoperatively in 2 patients and percutaneously implanted in 3 patients with image-guided techniques. Conformal plans were generated to deliver dose to target tissues and spare critical structures. Patients received single-fraction treatment using HDR iridium-192 brachytherapy. RESULTS Median dose was 14 Gy (range, 12-18 Gy) with a median gross total volume D90 of 75% (range, 31-94%); spinal cord/cauda equina dose constraints were met. At a median followup of 9 months, no local progression of disease has been observed. Four patients had reduction in pain 1-4 weeks after treatment. No brachytherapy-related complications have been observed. CONCLUSIONS Intraoperative and percutaneous iridium-192 HDR spine brachytherapy techniques were not associated with complications or acute toxicity. There has been no local progression at treated sites, and most patients experienced reduction in cancer-related pain.
Collapse
Affiliation(s)
- Michael R Folkert
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Tubbs RS, Loukas M, Callahan JD, Cohen-Gadol AA. A novel approach to the upper anterior thoracic spine: a cadaveric feasibility study. J Neurosurg Spine 2010; 13:346-50. [PMID: 20809728 DOI: 10.3171/2010.3.spine09814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical approaches to the upper anterior thoracic spine can be a challenge. Various techniques such as transsternal routes have been employed but access to the midthoracic vertebrae is limited due to the position of the heart and great vessels. In the present study the authors' goal was to evaluate in cadavers a novel approach to the upper anterior thoracic spine. METHODS In 12 adult cadavers the majority of the left first rib was removed following infraclavicular transection of the attachment of the anterior and middle scalene muscles from this bone. Inferior retraction of the parietal pleura and lung was performed and dissection was carried out inferior to the left subclavian artery and superior and posterior to the aorta, to the anterior aspect of the upper thoracic spine. RESULTS The aforementioned approach and surgical corridor allowed a good access to the anterior aspect of the upper thoracic vertebrae and caudally to the inferior aspect of T-4 vertebral body in all cadavers. No obvious neurovascular injury was identified in any specimen. CONCLUSIONS To the authors' knowledge, the method described herein has not been previously reported. Based on their cadaveric study, they believe such an approach can be used in the patients with pathology in this region of the thoracic spine. Surgical series are now needed to confirm our findings.
Collapse
Affiliation(s)
- R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
| | | | | | | |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Pathologic fractures of the spine are extremely painful and cause significant disability and morbidity in patients suffering from metastatic cancer. Often, these patients are not candidates for open surgical procedures and cannot address mechanical instability and radiation therapy can take weeks to become effective. Minimally invasive surgical techniques have been developed over the past several years, offering a simple and effective way of managing painful pathologic fractures. RECENT FINDINGS Vertebroplasty and kyphoplasty offer patients a minimally invasive, percutaneous procedure that dramatically reduces pain related to pathologic spinal fractures almost immediately with very low complication rates. Visual analog scale pain scores, narcotic usage and quality of life scales (SF-36) have all been shown to improve in a durable fashion for over 1 year. Also, these procedures can be performed before, after or concurrently with most radiation and chemotherapy protocols. SUMMARY We recommend vertebroplasty or kyphoplasty in properly selected patients with painful pathologic fractures as early as possible. Newer biomaterials, which are softer than currently used cement, may offer better protection from adjacent level fracturing and lower complication rates.
Collapse
|
7
|
Chen YJ, Chang GC, Chen HT, Yang TY, Kuo BIT, Hsu HC, Yang HW, Lee TS. Surgical results of metastatic spinal cord compression secondary to non-small cell lung cancer. Spine (Phila Pa 1976) 2007; 32:E413-8. [PMID: 17621197 DOI: 10.1097/brs.0b013e318074d6c7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The results for 37 surgical interventions in 31 consecutive patients with non-small cell lung cancer (NSCLC) with symptomatic spinal cord compression were reviewed retrospectively. OBJECTIVES To evaluate postoperative outcomes and survival rates of NSCLC patients surgically treated for symptomatic spinal metastasis. SUMMARY OF BACKGROUND DATA For patients with spinal cord compression secondary to lung cancer, the prognosis is usually poor. However, with the development of new chemotherapeutic drugs and targeted therapeutic agents, the survival rate may be better. METHODS From November 2000 to March 2005, 31 patients with symptomatic metastatic spinal cord compression secondary to NSCLC underwent palliative surgery using a posterolateral transpedicular approach (PTA) or combined posterior and anterior procedures. The indication for surgery was neurologic progression due to spinal cord compression. RESULTS The patients ranged in age from 20 to 81 years (mean, 61.4 years). Twenty-eight patients (90%) underwent PTA, and 3 patients had combined posterior and anterior procedures. Neurologic improvement by at least one Frankel grade was noted in 25 of 31 cases (80%). Overall, 74% of patients (23 of 31) were able to walk after surgery. There was no case of intraoperative mortality, but two deaths occurred in the postoperative period. Median survival time was 8.8 months. CONCLUSIONS Even though lung cancer is considered an aggressive tumor, it is justifiable to aggressively treat patients with symptomatic spinal cord compression. Surgery by PTA can lead to good results in these patients.
Collapse
Affiliation(s)
- Yen-Jen Chen
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
North RB, LaRocca VR, Schwartz J, North CA, Zahurak M, Davis RF, McAfee PC. Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience. J Neurosurg Spine 2005; 2:564-73. [PMID: 15945430 DOI: 10.3171/spi.2005.2.5.0564] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECT Refinement of surgical techniques, especially anterior approaches, for the management of spinal metastases has improved patient outcomes, despite the fact that a complete analysis of the prognostic factors that would inform patient selection has not been undertaken. The authors sought to identify such prognostic factors for neurological outcome and life expectancy in patients with spinal metastases. METHODS The authors used Kaplan-Meier techniques, log-rank comparisons, and a multivariate model stratified by tumor type to identify prognostic factors for duration of ability to walk and survival in patients who underwent surgical treatment for spinal metastases during a decade when all current treatment options were available. Preoperatively, 53 (87%) of the 61 patients in the study population suffered neurological symptoms (for example, weakness) and 52 (85%) were ambulatory. Postoperatively, 59 (97%) were ambulatory. Most patients who survived 6 months (81%) remained ambulatory, as did 66% of those alive at 1.6 years. The median postoperative survival was 10 months. The risk factors for loss of ambulation were preoperative loss of ambulatory ability, recurrent or persistent disease after primary radiotherapy of the operative site, a procedure other than corpectomy, and tumor type other than breast cancer. Prognostic factors for reduced survival were surgical intervention extending over two or more spinal segments, recurrent or persistent disease after primary radiotherapy involving the operative site, diagnosis other than breast cancer, and a cervical spinal procedure. CONCLUSIONS The results of this analysis allowed the authors to create a simple prognostic factor scoring system that can be applied to individual patients. The positive experience derived from this study supports an expanded role for the surgical treatment of metastatic spinal disease.
Collapse
Affiliation(s)
- Richard B North
- Department of Neurosurgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland 21287-7881, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Weigel B, Maghsudi M, Neumann C, Kretschmer R, Müller FJ, Nerlich M. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976) 1999; 24:2240-6. [PMID: 10562991 DOI: 10.1097/00007632-199911010-00012] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Eighty-six surgical interventions in 76 consecutive patients with symptomatic spinal metastases were reviewed retrospectively. OBJECTIVES To evaluate the postoperative outcome and quality of life of patients surgically treated for symptomatic spinal metastases. SUMMARY OF BACKGROUND DATA The standard surgical treatment for patients with symptomatic spinal metastases is anterior spinal cord decompression with stabilization. However, because therapy is only palliative, satisfactory quality of life and high patient acceptance are essential. METHODS The medical records of all patients were reviewed retrospectively. Furthermore, all surviving patients or the next of kin of deceased patients were interviewed by telephone, and the family doctors or the care-providing physicians of external institutions were contacted. RESULTS First-choice surgical treatment was anterior spinal cord decompression with stabilization. Postoperative mean survival was 13.1 months, and mean time at home after spinal surgery was 11.1 months. Neurologic improvement with regard to Frankel classification was observed in 58% of the patients, and 93% were able to walk postoperatively. Pain relief was noted in 89%. Overall, 67% of the patients achieved moderate or good general health as shown by the Karnofsky Index, and 80% were satisfied or very satisfied with the surgical intervention. Moreover, 19% of the surgical interventions were associated with complications, local tumor recurrence developed in 22% of the patients, and paraplegia ultimately developed in 18% of patients. CONCLUSIONS Surgical management of symptomatic spinal metastases, in particular anterior decompression, is of benefit in most metastatic lesions in terms of satisfactory postoperative outcome and quality of life. However, in patients with melanoma or lung carcinoma, the authors advocate spinal surgery only in very exceptional cases.
Collapse
Affiliation(s)
- B Weigel
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany
| | | | | | | | | | | |
Collapse
|
10
|
Taghavi S, Klepetko W, Birsan T. Erweiterte Resektionen bei nichtkleinzelligem Bronchuskarzinom. Eur Surg 1998. [DOI: 10.1007/bf02620128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Comey CH, McLaughlin MR, Moossy J. Anterior thoracic corpectomy without sternotomy: a strategy for malignant disease of the upper thoracic spine. Acta Neurochir (Wien) 1997; 139:712-8. [PMID: 9309285 DOI: 10.1007/bf01420043] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal metastases. While no region of the spine is easily treated, the upper thoracic spine is perhaps the least accessible. Traditional approaches to this region involve either thoracotomy or at least limited sternotomy. The authors present an approach to anterior pathology of the upper thoracic spine that obviates the need for sternotomy. METHODS Within the past two years, two patients with cervicothoracic metastases underwent anterior decompression and fusion without sternotomy. In both patients, the bodies of C7, T1, and T2 were removed. While both patients were prepared and draped for sternotomy, each required a neck dissection only. In both patients, left-sided incisions were made along the leading edge of the sternocleidomastoid. The platysma was divided with the overlying skin. With further dissection, the strap muscles were tagged and divided approximately one centimeter above their sternal attachments. The loose areolar tissue of the superior mediastinum was then bluntly dissected. Along the entire length of the incision, the vascular plane medial to the carotid sheath was developed to facilitate exposure of the anterior spine. A Farley-Thompson retractor system was then employed to retract and protect the superior mediastinal structures. With this exposure, corpectomies were carried out using a high speed drill. Fusion was accomplished through insertion of Steinmann pins into the adjacent intact bodies above and below. This was followed by application of methyl methacrylate. Both patients had immediate postoperative stability with preservation of spinal cord function. Both patients subsequently underwent removal of dorsally located tumor with posterior fusion. CONCLUSIONS The goal of cancer surgery is to provide for increased functional survival without undue morbidity. The authors feel that when possible, the pain of sternal and clavicular osteotomies should be avoided. The described approach works well in conjunction with a methyl methacrylate/Steinmann pin construct. Because of the intact sternum, the surgeon has a downward angle to access the superior endplate of T3. With adequate soft tissue dissection and retraction as described, however, T3 and perhaps even T4 are easily accessible. While this downward angle would likely not permit an anterior plating procedure, it lends itself nicely to Steinmann pin/methyl methacrylate fusion and spares the patient the pain and potential morbidity of sternotomy.
Collapse
MESH Headings
- Breast Neoplasms/diagnosis
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/surgery
- Cervical Vertebrae/pathology
- Cervical Vertebrae/surgery
- Decompression, Surgical/methods
- Female
- Follow-Up Studies
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/surgery
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Postoperative Complications/diagnosis
- Spinal Cord Compression/surgery
- Spinal Fusion/methods
- Spinal Neoplasms/diagnosis
- Spinal Neoplasms/secondary
- Spinal Neoplasms/surgery
- Thoracic Vertebrae/pathology
- Thoracic Vertebrae/surgery
Collapse
Affiliation(s)
- C H Comey
- Department of Neurosurgery, University of Pittsburgh, PA, USA
| | | | | |
Collapse
|
12
|
Abstract
BACKGROUND AND PURPOSE Central nervous system (CNS) metastasis occurs in at least 30% of patients with breast cancer. Standard treatment is the same as in other solid tumors, though clinical behavior, and sensitivity to radiation therapy (RT) and to chemotherapy may differ considerably. Most of these patients die within a few months, but a substantial subgroup may survive a year or more. The last decade has given rise to new diagnostic methods, new surgical and radiotherapeutic techniques, and the clinical evidence of a chemotherapy permissive blood-brain barrier in CNS metastases. The literature was reviewed to assess the clinical impact of early diagnosis, recognition of prognostic factors, and of the recently developed therapeutic approaches. MATERIAL AND METHODS Review of the literature on CNS involvement in breast cancer focusing on clinical studies on early diagnosis, new modes of treatment, and factors influencing outcome. RESULTS Although randomized studies are still awaited, systemic chemotherapy seems a valuable alternative for RT of brain metastases in selected cases. In meningeal carcinomatosis, long survival may be independent of intraventricular chemotherapy. Neurotoxicity of intensive intraventricular treatment is considerable. In epidural metastasis, early diagnosis with prompt start of treatment remains the crucial factor for outcome. Radiation therapy is the mainstay of treatment of epidural metastasis, but new surgical techniques and even systemic chemotherapy should be considered in selected cases. CONCLUSIONS Recognition of prognostic factors combined with appropriate use of various recently developed therapeutic possibilities will improve the clinical outcome including better local tumor control and less treatment-induced neurotoxicity in a considerable number of patients with CNS metastasis from breast cancer.
Collapse
Affiliation(s)
- W Boogerd
- Department of Neuro-Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoekhuis, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Rosenthal D, Marquardt G, Lorenz R, Nichtweiss M. Anterior decompression and stabilization using a microsurgical endoscopic technique for metastatic tumors of the thoracic spine. J Neurosurg 1996; 84:565-72. [PMID: 8613847 DOI: 10.3171/jns.1996.84.4.0565] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
It is well accepted that the treatment of spinal tumors that threaten neurological integrity comprises resection, vertebral body reconstruction, and stabilization if the patient's condition is suitable. In spite of the excellent results reported using thoracotomy, the majority of investigators recommend posterolateral techniques because of lower morbidity, shorter hospitalization time, and the possibility of performing dorsal stabilization via the same incision. To overcome some of the disadvantages of thoracotomy, the authors developed an anterior procedure that permits vertebrectomy, reconstruction, and stabilization to be performed entirely by endoscopic technique. Microsurgical endoscopy and stabilization were performed in four patients with metastatic disease of the thoracic spine. All were ambulatory after surgery and at follow up; preoperative neurological and neurophysiological deficits improved as well. No complications occurred in this small series. Microsurgical endoscopy achieves a substantial reduction in trauma, use of analgesic medications, and hospitalization time. Early results seem to indicate that adequate decompression, stabilization and reduction of surgical morbidity can be achieved with this technique.
Collapse
Affiliation(s)
- D Rosenthal
- Department of Neurosurgery, Klinikum der Johann Wolfgang Goethe-Universitat, Frankfurt am Main, Germany
| | | | | | | |
Collapse
|
14
|
Clavel Escribano M, Clavel Laria P. Paraplejia secundaria a expansión vertebral metastásica. Caso clínico. Neurocirugia (Astur) 1996. [DOI: 10.1016/s1130-1473(96)70755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
15
|
Makris A, Kunkler IH. Controversies in the management of metastatic spinal cord compression. Clin Oncol (R Coll Radiol) 1995; 7:77-81. [PMID: 7619768 DOI: 10.1016/s0936-6555(05)80805-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Makris
- Royal Marsden Hospital, Sutton, UK
| | | |
Collapse
|
16
|
Boogerd W, van der Sande JJ. Diagnosis and treatment of spinal cord compression in malignant disease. Cancer Treat Rev 1993; 19:129-50. [PMID: 8481926 DOI: 10.1016/0305-7372(93)90031-l] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- W Boogerd
- Department of Neurology, The Netherlands Cancer Institute (Antoni van Leeuwenhoekziekenhuis), Amsterdam
| | | |
Collapse
|
17
|
Cooper PR, Errico TJ, Martin R, Crawford B, DiBartolo T. A systematic approach to spinal reconstruction after anterior decompression for neoplastic disease of the thoracic and lumbar spine. Neurosurgery 1993; 32:1-8. [PMID: 8421537 DOI: 10.1227/00006123-199301000-00001] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The anterior approach to the thoracic and lumbar spine for neoplastic disease is now a well-accepted procedure, with results, for the most part, superior to those achieved with laminectomy. However, the specific indications for anterior decompression and the selection of reconstruction techniques based on the location and extent of bony destruction have received surprisingly little attention. The authors report their experience with the operative management of 33 patients with benign and malignant tumors of the thoracic and lumbar spine, using the anterior transthoracic or retroperitoneal approach. The role of stabilization and the relative indications for anterior or posterior instrumentation are emphasized. The mean age of patients was 58 years. Twenty-three patients were male. Five patients had benign tumors, and the remainder had a variety of metastatic lesions. Twenty-nine patients had lower extremity motor deficits, although 25 were ambulatory preoperatively. Thirty-seven noncontiguous resections were performed in 33 patients. In 13 patients, the resected vertebral body was replaced with acrylic or bone without instrumentation; in 18, the acrylic was supplemented with anterior instrumentation; and in 6, both anterior and posterior instrumentation were used. Above T11, vertebral reconstruction techniques were used to restore stability after decompression. Between T11 and L4, anterior instrumentation was used to supplement vertebral reconstruction in all patients. Supplemental posterior instrumentation was used for three-column involvement. Motor function was stabilized or improved in 94% of patients, and 88% of patients were ambulatory postoperatively. Of 28 patients with malignant disease, 23 died after a mean survival of 10.2 months (range, 2-51 mo) and 5 are alive a mean of 34.4 months since their operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P R Cooper
- Department of Neurosurgery, New York University Medical Center, New York
| | | | | | | | | |
Collapse
|
18
|
A Systematic Approach to Spinal Reconstruction after Anterior Decompression for Neoplastic Disease of the Thoracic and Lumbar Spine. Neurosurgery 1993. [DOI: 10.1097/00006123-199301000-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
19
|
|
20
|
Acikgoz B, Akkurt C, Erbengi A, Bertan V, Ozgen T, Ozcan O. Metastatic spinal cord tumours. PARAPLEGIA 1989; 27:359-63. [PMID: 2601985 DOI: 10.1038/sc.1989.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this report 84 patients who had surgical intervention for metastatic spinal cord tumours are presented. The primary tumours were mainly from lungs, breast or of haematological origin, and were commonest in the thoracic region. In all but 2 patients laminectomy was performed. Surgical decompression permitted diagnosis, and there was neurological improvement in nearly half of the patients.
Collapse
Affiliation(s)
- B Acikgoz
- Kahramanmaras State Hospital, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
The physician must have a high index of suspicion to detect SCC early in patients with malignancy. Back pain is the first symptom in almost all patients, and the diagnosis should be considered for all older patients with back pain. Asking about back pain should be a routine part of the review of systems, especially for patients with known malignancies. Clinically, it is impossible to tell whether or not a patient who has back pain and cancer has epidural SCC. Patients may be stratified as to the likelihood of SCC using the history and physical examination, but the diagnosis relies on radiographic visualization of the spinal cord. It may be acceptable to closely follow patients with normal neurologic examinations and normal plain films, but even this is controversial and includes only a minority of patients. Myelography remains the test of choice. MRI will play an increasingly important role in the future, but has not yet been systematically evaluated. The best therapeutic approach is not clear, but standard treatment is only about 50% effective in all cases. At present, radiation therapy is the treatment of choice for many patients, in particular those who are ambulatory at diagnosis. Anterior resection with vertebral body reconstruction is an exciting approach and may substantially improve the prognosis for patients who are paraparetic or paraplegic. It is important to attempt to choose for each patient the diagnostic and therapeutic options offering the best chance for comfort and preservation of function. The decision of how or even whether to treat is multifactorial and is more complicated than the determination of simply whether or not compression is present.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- D W Bates
- Department of Medicine, Oregon Health Sciences University, Portland 97201
| | | |
Collapse
|
22
|
|
23
|
Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P. Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 1985; 63:676-84. [PMID: 4056870 DOI: 10.3171/jns.1985.63.5.0676] [Citation(s) in RCA: 208] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients), and a variety of others (35 patients). Of the 101 patients, 23 received surgery de novo; the remaining 78 patients had undergone previous therapy. Sites of involvement included the cervical region in 13 patients, the thoracic region in 68 patients, and the lumbar region in 20 patients. Prior to surgery, severe pain was noted in 90% of the patients, and 45% were non-ambulatory. Using an anterolateral surgical exposure, the vertebral body was resected along with all epidural tumor. Immediate stabilization was achieved with methyl methacrylate and Steinmann pins. Following surgery, the overall ambulation rate was 78%, and 85% of patients experienced pain relief. Of the 23 patients who had received no prior therapy, 90% continued to be ambulatory at their last follow-up examination or until death. The authors believe that surgery prior to irradiation is indicated in selected patients with neoplastic cord compression. In patients with solitary osseous metastasis to the spine, potentially curative resection can be undertaken if surgery is performed when the tumor is still confined to the vertebral body.
Collapse
|