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Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors

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Abstract

Single-stage posterior corpectomy for the management of spinal tumors has been well described. Anterior column reconstruction has been accomplished using polymethylmethacrylate (PMMA) or expandable cages (EC). The aim of this retrospective study was to compare PMMA versus ECs in anterior vertebral column reconstruction after posterior corpectomy for tumors in the lumbar and thoracolumbar spine. Between 2006 and 2009 we identified 32 patients that underwent a single-stage posterior extracavitary tumor resection and anterior reconstruction, 16 with PMMA and 16 with EC. There were no baseline differences in regards to age (mean: 58.2 years) or performance status. Differences between groups in terms of survival, estimated blood loss (EBL), kyphosis reduction (decrease in Cobb’s angle), pain, functional outcomes, and performance status were evaluated. Mean overall survival and EBL were 17 months and 1165 ml, respectively. No differences were noted between the study groups in regards to survival (p = 0.5) or EBL (p = 0.8). There was a trend for better Kyphosis reduction in favor of the EC group (10.04 vs. 5.45, p = 0.16). No difference in performance status or VAS improvements was observed (p > 0.05). Seven patients had complications that led to reoperation (5 infections). PMMA or ECs are viable options for reconstruction of the anterior vertebral column following tumor resection and corpectomy. Both approaches allow for correction of the kyphotic deformity, and stabilization of the anterior vertebral column with similar functional and performance status outcomes in the lumbar and thoracolumbar area.

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Abbreviations

ASIA:

American Spinal Injury Association

ECOG:

Eastern Cooperative Oncology Group

KPS:

Karnofsky performance status

ESCC:

Epidural spinal cord compression

PTA:

Posterolateral transpedicular approach

EC:

Expandable cage

PMMA:

Polymethylmethacrylate

VAS:

Visual analog scale

MR:

Magnetic resonance

References

  1. Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH (2000) Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine 25:2240–2249 discussion 2250

    Article  PubMed  CAS  Google Scholar 

  2. Crocker M, Chitnavis B (2007) Total thoracic vertebrectomy with anterior and posterior column reconstruction via single posterior approach. Br J Neurosurg 21:28–31. doi:10.1080/02688690601170676

    Article  PubMed  Google Scholar 

  3. Khan SN, Donthineni R (2006) Surgical management of metastatic spine tumors. Orthop Clin North Am 37:99–104. doi:10.1016/j.ocl.2005.09.002

    Article  PubMed  Google Scholar 

  4. Pateder DB, Kebaish KM, Cascio BM, Neubaeur P, Matusz DM, Kostuik JP (2007) Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults: a radiographic analysis. Spine 32:1551–1554. doi:10.1097/BRS.0b013e318067dc0e

    Article  PubMed  Google Scholar 

  5. Sciubba DM, Gallia GL, McGirt MJ, Woodworth GF, Garonzik IM, Witham T, Gokaslan ZL, Wolinsky JP (2007) Thoracic kyphotic deformity reduction with a distractible titanium cage via an entirely posterior approach. Neurosurgery 60:223–230. doi:10.1227/01.NEU.0000255385.18335.A8 discussion 230–221

    Article  PubMed  Google Scholar 

  6. Deutsch H, Boco T, Lobel J (2008) Minimally invasive transpedicular vertebrectomy for metastatic disease to the thoracic spine. J Spinal Disord Tech 21:101–105. doi:10.1097/BSD.0b013e31805fea01

    Article  PubMed  Google Scholar 

  7. Kamat A, Gilkes C, Barua NU, Patel NR (2008) Single-stage posterior transpedicular approach for circumferential epidural decompression and three-column stabilization using a titanium cage for upper thoracic spine neoplastic disease: a case series and technical note. Br J Neurosurg 22:92–98. doi:10.1080/02688690701671029

    Article  PubMed  CAS  Google Scholar 

  8. Morales Alba NA (2008) Posterior placement of an expandable cage for lumbar vertebral body replacement in oncologic surgery by posterior simple approach: technical note. Spine 33:E901–E905. doi:10.1097/BRS.0b013e31818b8a06

    Article  PubMed  Google Scholar 

  9. Holman PJ, Suki D, McCutcheon I, Wolinsky JP, Rhines LD, Gokaslan ZL (2005) Surgical management of metastatic disease of the lumbar spine: experience with 139 patients. J Neurosurg Spine 2:550–563. doi:10.3171/spi.2005.2.5.0550

    Article  PubMed  Google Scholar 

  10. Lifshutz J, Lidar Z, Maiman D (2004) Evolution of the lateral extracavitary approach to the spine. Neurosurg Focus 16:E12

    PubMed  Google Scholar 

  11. Snell BE, Nasr FF, Wolfla CE (2006) Single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis: surgical technique and results in 15 patients. Neurosurgery 58:ONS-263–ONS-268. doi:10.1227/01.NEU.0000209034.86039.39 discussion ONS-269

    Article  Google Scholar 

  12. Hunt T, Shen FH, Arlet V (2006) Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. Technical note. J Neurosurg Spine 5:271–274. doi:10.3171/spi.2006.5.3.271

    Article  PubMed  Google Scholar 

  13. Vrionis FD, Small J (2003) Surgical management of metastatic spinal neoplasms. Neurosurg Focus 15:E12

    Article  PubMed  Google Scholar 

  14. Liljenqvist U, Lerner T, Halm H, Buerger H, Gosheger G, Winkelmann W (2008) En bloc spondylectomy in malignant tumors of the spine. Eur Spine J 17:600–609. doi:10.1007/s00586-008-0599-8

    Article  PubMed  Google Scholar 

  15. Schmidt MH, Larson SJ, Maiman DJ (2004) The lateral extracavitary approach to the thoracic and lumbar spine. Neurosurg Clin N Am 15:437–441. doi:10.1016/j.nec.2004.04.007

    Article  PubMed  Google Scholar 

  16. Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU (2008) Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am 90:1060–1067. doi:10.2106/JBJS.D.02771

    Article  PubMed  Google Scholar 

  17. Krishnan EC, Nelson C, Neff JR (1986) Thermodynamic considerations of acrylic cement implant at the site of giant cell tumors of the bone. Med Phys 13:233–239

    Article  PubMed  CAS  Google Scholar 

  18. Toksvig-Larsen S, Johnsson R, Stromqvist B (1995) Heat generation and heat protection in methylmethacrylate cementation of vertebral bodies. A cadaver study evaluating different clinical possibilities of dural protection from heat during cement curing. Eur Spine J 4:15–17

    Article  PubMed  CAS  Google Scholar 

  19. Chou D, Wang VY, Gupta N (2009) Transpedicular corpectomy with posterior expandable cage placement for L1 burst fracture. J Clin Neurosci 16:1069–1072. doi:10.1016/j.jocn.2008.12.009

    Article  PubMed  Google Scholar 

  20. Shen FH, Marks I, Shaffrey C, Ouellet J, Arlet V (2008) 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 8:329–339. doi:10.1016/j.spinee.2007.05.002

    Article  PubMed  Google Scholar 

  21. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648. doi:10.1016/S0140-6736(05)66954-1

    Article  PubMed  Google Scholar 

  22. Wang JC, Boland P, Mitra N, Yamada Y, Lis E, Stubblefield M, Bilsky MH (2004) 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 1:287–298. doi:10.3171/spi.2004.1.3.0287

    Article  PubMed  Google Scholar 

  23. Street J, Fisher C, Sparkes J, Boyd M, Kwon B, Paquette S, Dvorak M (2007) Single-stage posterolateral vertebrectomy for the management of metastatic disease of the thoracic and lumbar spine: a prospective study of an evolving surgical technique. J Spinal Disord Tech 20:509–520. doi:10.1097/BSD.0b013e3180335bf7

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program and Department of Neurosurgery, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL, 33647, USA

    Mohammed Eleraky, Ioannis Papanastassiou, Nam D. Tran, Elias Dakwar & Frank D. Vrionis

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  1. Mohammed Eleraky
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  2. Ioannis Papanastassiou
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  3. Nam D. Tran
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  4. Elias Dakwar
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  5. Frank D. Vrionis
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Correspondence to Ioannis Papanastassiou.

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Eleraky, M., Papanastassiou, I., Tran, N.D. et al. 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 20, 1363–1370 (2011). https://doi.org/10.1007/s00586-011-1738-1

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  • DOI: https://doi.org/10.1007/s00586-011-1738-1

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