Lumbar vertebral body resection and replacement for metastatic lesions

Summary

Objectives

Resection of metastases of lumbar vertebrae and replacement with an expandable implant of modular design.

Indications

Imminent instability secondary to bony destruction. Instability already present.

Neurologic deficit with or without pain due to destruction of vertebral body.

Contraindications

Poor prognosis due to multiple metastases

Paraplegia.

Life expectancy < 3 months.

Destruction of more than 2 neighbouring vertebrae.

Surgical Technique

Anterior extraperitoneal approach. Resection of the involved vertebral body. Insertion of an appropriate prosthesis, restoration of height and alignment with the help of an extraction spindle. Additional fixation with the Universal Spinal Instrumentation System or third tubular plates, covered either with bone cement, autogenous or allogenic bone.

Results

Eighteen lumbar body replacements (9 women, 9 men, average age: 56.1 years). Length of follow-up: 3 to 42 months. At the time of the follow-up only 5 patients were alive. Out of the 18 patients 12 had a neurological deficit preoperatively, 2 of whom were paraplegic. Postoperative improvement of the neurological deficit in 7 patients. Preoperative assessment of the patients using the Frankel classification showed: A=0, B=0, C=2, D=10, E=6. Postoperatively: A=0, B=0, C=1, D=4, E=13.