Surgical treatment of the metastatic cervical spine tumours

Česká verzia

Authors: P. Barsa; P. Suchomel
Authors place of work: Neurochirurgické oddělení, Neurocentrum, Krajská nemocnice Liberec
Published in the journal: Cesk Slov Neurol N 2007; 70/103(1): 16-22
Category: Review Article

Summary

A spinal decompression followed by reconstruction and stabilization represents an effective strategy in the management of cervical spinal metastases in selected patients. Various techniques available in armamentarium are discussed in this overview. Because of predominant anterior spinal column metastatic involvement the consideration is given to the vertebral body replacement techniques. In oncological patients, numerous factors play against the optimal surgical result that is the bone fusion facilitated by an autologous bone graft or substitutes. The aim of modern anterior reconstruction is superior primary stability in order to permit an early rehabilitation and ambulation in the rest of life. In patiens with short-term life expectancy, the reconstruction with PMMA supplemented by an appropriate internal fixation achieves immediate stability. Titanium meshed interbody cages represent an alternative to PMMA when mid-term survival is anticipated. The appropriate sizing of the cage to the defect is of paramount importace in order to obtain superior primary stability of the construct. Therefore distractable telescopic spacers seem to be ideal in this indication.

Key words:
metastasis, spine tumour, spinal instrumentation, vertebral body replacement.

Zdroje

1. Greenlee RT, Murray T, Bilden S, Wingo PA. Cancer statistics 2000. CA Cancer J Clin 2000; 50: 7-33.

2. Atanasiu JP, Badartcheff F, Pidhorz L. Metastatic lesions of the cervical spine. A retrospective analysis of 20 cases. Spine 1993; 18:1279-84.

3. Liu JK, Apfelbaum RI, Chiles BW, Schmidt MH. Cervical spinal metastasis: anterior reconstruction and stabilization techniques after tumor resection. Neurosurg Focus 2003; 15: 1-7.

4. Barsa P, Häckel M. Systém „červených praporků“ v diagnostice a terapii bolestí zad. Bolest 2003; 6: 171-6.

5. Constans JP, Dedivitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations: a review of 600 cases. J Neurosurg 1983; 59: 111-8.

6. Coman DR, Delong RP. The role of the vertebral venous systhem in the metastasis of the cancer to the spine. Cancer 1951; 5: 610.

7. Tokuhashi Y, Matsuzaki H, Toriyama S. Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 1990; 115: 1110-13.

8. Häckel M, Stejskal L, Kramář F. Přední krční korpektomie při řešení víceetážových degenerativních stenóz se spondylogenní myelopatií. Zkušenosti s léčbou a přehled literatury. Rozhl Chir 2001; 80(4): 163-9.

9. Whitecloud TS. Anterior surgery for cervical spondylotic myelopathy. Smith-Robinson, Cloward, and vertebrectomy. Spine 1988; 13: 861-3.

10. Scoville WB, Palmer AH, Samra K. The use of acrylic plastic for vertebral replacement or fixation in metastatic disease of the spine: a technical note. J Neurosurg 1967; 27: 274-9.

11. Wilke H-J, Kettler A, Claes L. Stabilizing effect and subsidence tendency of three different cages and bone cement for the fusion of cervical spine segments. Orthopädie 2002; 31: 472-80.

12. Halligan M, Hubschmann OR. Short-term and long-term failures of anterior polymethylmetacrylate construct with esophageal perforation. Spine 1993; 18: 759-61.

13. Merk H, Koch H, Liebau C, Baltzer A, Dragendorf L, Grasshoff H. Implantation of a Harms titanium mesh cylinder for vertebral body replacement in spinal metastase. Z Orthop Ihre Grenzgeb 2000; 138: 169-73.

14. Barsa P, Suchomel P, Buchvald P, Lukáš R, Vaníčková E. Jsou šrouby při přední krční fúzi s bikortikální fixací skutečně bikortikálně zaveden? (Retrospektivní studie). Acta Chir Orthop Traumatol Cech 2002; 69: 35-8.

15. Štulík J, Krbec M, Vyskočil T. Poranění dolní krční páteře-monokortikální technika stabilizace. Acta Chir Orthop Traumatol Cech 2003; 70: 226-32.