Complications in Surgical Management of Cervical Spinal Metastases

  • Giuseppe Tonini
  • Bruno Vincenzi
  • Chiara Spoto
  • Daniele Santini

Bone is the third most frequent metastatic site. The vertebral column is the most common site for bone metastases, with an incidence of 30–70% in patients with stage IV cancer [1]. Among patients with cancer, in 12–20%, the initial clinical presentation is spinal column metastases [2]. Furthermore, metastases are the most frequent spinal column cancer in the United States, with approximately 18,000 new cases diagnosed annually. Multiple lesions at noncontiguous levels occur in 10–40% of the cases. Breast, lung, and prostate cancers have been the most common malignancies with secondary spine involvement [3]. These are followed by renal cancer, gastrointestinal cancer, thyroid cancer, sarcoma, and the lympophoreticular malig-nances: lymphoma and multiple myeloma. Metastases from prostate cancer, breast cancer, melanoma, and lung cancer commonly cause spinal metastases in 90.5, 74.3, 54.5, and 44.9% of patients, respectively.


Intensity Modulate Radiation Therapy Spinal Cord Compression Spinal Metastasis Percutaneous Vertebroplasty Hypervascular Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wong DA, Fornasier VL, MacNab I (1990) Spinal metastases: the obvious, the occult, and the impostors. Spine 15:1–4PubMedCrossRefGoogle Scholar
  2. 2.
    Schick U, Marquardt G, Lorenz R (2001) Intradural and extradural spinal metastases. Neurosurg Rev 24:1–5PubMedCrossRefGoogle Scholar
  3. 3.
    Jacobs WB, Perrin RG (2001) Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11:1–11CrossRefGoogle Scholar
  4. 4.
    Arguello F, Baggs RB, Duerst RE et al (1990) Pathogenesis of vertebral metastasis and epidural spinal cord compression. Cancer 65:98–106PubMedCrossRefGoogle Scholar
  5. 5.
    Constans JP, de Devitis E, Conzelli R et al (1983) Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 59:111–118PubMedCrossRefGoogle Scholar
  6. 6.
    Schaberg J, Gainor BJ (1985) A profile of metastatic carci-noma of the spine. Spine 10:19–20PubMedCrossRefGoogle Scholar
  7. 7.
    Brice J, McKissock W (1965) Surgical treatment of malig-nant extradural spinal tumours. BMJ 1:1341–1344PubMedCrossRefGoogle Scholar
  8. 8.
    Karnofsky DA, Burchenal JH (1949) Clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 199–205Google Scholar
  9. 9.
    Jenis LG, Dunn EJ, An HS (1999) Metastatic disease of the cervical spine. Clin Orthop 359:89–103PubMedCrossRefGoogle Scholar
  10. 10.
    Rao S, Babini K, Schldhauer T et al (1992) Metastatic malignancy of the cervical spine. A nonoperative history. Spine 17:407–412CrossRefGoogle Scholar
  11. 11.
    Atanasiu J, Badatcgeff F, Pidhorz L (1993) Metastatic lesions of the cervical spine. Spine 18:1279–1284PubMedCrossRefGoogle Scholar
  12. 12.
    Ono K, Ebara T, Fuji K et al (1987) Myelopathy hand – new clinical signs of cervical cord damage. J Bone Joint Surg 69B:215–219Google Scholar
  13. 13.
    Boriani S, Biagini R, De Iure F et al (1996) EN bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients. Spine 21:1927–1931PubMedCrossRefGoogle Scholar
  14. 14.
    Post YRF, EM KGA (1980) Treatment of spinal epidural metastases. Randomized prospective comparison of lamine-ctomy and radiotherapy. J Neurosurg 53:741–748PubMedCrossRefGoogle Scholar
  15. 15.
    Klimo P, Thompson CJ, Kestle JRW et al (2005) A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol 7:64–76PubMedCrossRefGoogle Scholar
  16. 16.
    Patchell RA, Tibbs PA, Regine WF et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet 366:643–648PubMedCrossRefGoogle Scholar
  17. 17.
    Byrne TN (1992) Spinal cord compression from epidural metastases. N Engl J Med 327:614–619PubMedCrossRefGoogle Scholar
  18. 18.
    Byrne TN (2004) Metastatic epidural cord compression. Curr Neurol Neurosci Rep 4:191–195PubMedCrossRefGoogle Scholar
  19. 19.
    Harrington KD (1986) Metastatic disease of the spine. J Bone Joint Surg 68A:1110–1115Google Scholar
  20. 20.
    Harrington KD (1988) Anterior decompression and stabili-zation of the spine as treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop 233:177–197PubMedGoogle Scholar
  21. 21.
    Bauer HC (1997) Posterior decompression and stabilization for spinal metastases. Analysis of sixty-seven consecutivec-patients. J Bone Joint Surg Am 79:514–522PubMedGoogle Scholar
  22. 22.
    Hirabayashi H, Ebara S, Kinoshita T et al (2003) Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer 97:476–484PubMedCrossRefGoogle Scholar
  23. 23.
    Ibrahim A, Crockard A, Antonietti P et al (2008) Does spinal surgery improve the quality of life for those with extra-dural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves. J Neurosurg Spine 8(3):271–278PubMedCrossRefGoogle Scholar
  24. 24.
    Sioutos PJ, Arbit E, Meshulam CF et al (1995) Spinal metastases from solid tumors: analysis of factors affecting survival. Cancer 76:1453–1459PubMedCrossRefGoogle Scholar
  25. 25.
    Weigel B, Maghsudi M, Neumann C et al (1999) Surgical management of symptomatic spinal metastases: postoperative outcome and quality of life. Spine 24:2240–2246PubMedCrossRefGoogle Scholar
  26. 26.
    Wise JJ, Fischgrund JS, Herkowitz HN et al (1999) Complications, survival rates and risk factors of surgery for metastatic disease of the spine. Spine 24(18):1943–1951PubMedCrossRefGoogle Scholar
  27. 27.
    Patil CG, Lad SP, Santarelli J et al (2007) National inpatient complications and outcomes after surgery for spinal metastasis from 1993–2002. Cancer 110:625–630PubMedCrossRefGoogle Scholar
  28. 28.
    Guzman R, Dubach-Schwizer S, Heini P et al (2005) Preoperative transarterial embolization of vertebral metastases. Eur Spine J 14:263–268PubMedCrossRefGoogle Scholar
  29. 29.
    Prabhu VC, Bilsky MH, Jambhekar K et al (2003) Results of preoperative embolization for metastatic spinal neoplasms. J Neurosurg 98(2 Suppl):156–164PubMedGoogle Scholar
  30. 30.
    Olsen MA, Maysfield J, Lauryssen C et al (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:149–155PubMedGoogle Scholar
  31. 31.
    McPhee IB, Williams RP, Swanson CE (1998) Factors influ-encing wound healing after surgery for metastatic disease of the spine. Spine 23:726–733PubMedCrossRefGoogle Scholar
  32. 32.
    Hentschel SJ, Rhines LD, Wong FC et al (2004) Subarachnoid-pleural fistula after resection of thoracic tumors. J Neurosurg 100:332–336PubMedCrossRefGoogle Scholar
  33. 33.
    Klekamp J, Samii M (1998) Surgical results for spinal metastases. Acta Neurochir 140(9):957–967PubMedCrossRefGoogle Scholar
  34. 34.
    Sundaresan N, Rothman A, Manhart K et al (2002) Surgery for solitary metastases of the spine. Rationale and results of treatment. Spine 27:1802–1806PubMedCrossRefGoogle Scholar
  35. 35.
    Gokaslan ZL, York JE, Walsh GL et al (1998) Transthoracic vertebrestomy for metastatic spinal tumors. J Neurosurg 89:599–609PubMedCrossRefGoogle Scholar
  36. 36.
    McLain RF (2001) Spinal cord decompression: an endo-scopically assisted approach for metastatic tumors. Spinal Cord 39:482–487PubMedCrossRefGoogle Scholar
  37. 37.
    Fourney DR, Schomer DF, Nader R et al (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98(1 suppl):21–30PubMedCrossRefGoogle Scholar
  38. 38.
    Deramond H, Depriester C, Galibert P et al (1998) Percutaneous vertebroplasty with polymethylmethacrylate. Technique indications, and results. Radiol Clin North Am 36:533PubMedCrossRefGoogle Scholar
  39. 39.
    Alvarez L, Perez-Higueras A, Quinones D et al (2003) Vertebroplasty in the treatment of vertebral tumors: postpro-cedural outcome and quality of life. Eur Spine J 12:356–360PubMedCrossRefGoogle Scholar
  40. 40.
    Chiras J, Depriester C, Weill A et al (1997) Percutaneous vertebral surgery. Techniques and indications. J Neuroradiol 24:45–59PubMedGoogle Scholar
  41. 41.
    Tatsui H, Onomura T, Morishita S et al (1996) Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation. Spine 21(8):2143–2148PubMedCrossRefGoogle Scholar
  42. 42.
    Sundaresan N, Scher H, DiGiacinto GV et al (1986) Surgical treatment of spinal cord compression in kidney cancer. J Clin Oncol 4:1851–1856PubMedGoogle Scholar
  43. 43.
    Finkelstein JA, Zaveri G, Wai E et al (2003) A population based study of surgery for spinal metastases survival rates and complications. J Bone Joint Surg (Br) 85B:1045–1050CrossRefGoogle Scholar
  44. 44.
    Argenson C, Cordonnier D, Enkaoua E et al (1997) Place dela chirugie dans la traitment des metastases du rachis. SOF.C.O.T. Reunion Annuelle, Novembre 1996. Rev Chir Orthop 83(Suppl):109–174Google Scholar
  45. 45.
    Yamashita K, Denno K, Ueda T et al (1993) Prognostic sig-nificance of bone metastases in patients with metastatic prostate cancer. Cancer 71:1297–1302PubMedCrossRefGoogle Scholar
  46. 46.
    Ghogawala Z, Mansfield F, Borges L (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine 26:818–824PubMedCrossRefGoogle Scholar
  47. 47.
    Raycroft J, Hockmann R, Southwick W (1978) Metastatic tumors involving the cervical vertebrae: surgical palliation. J Bone Joint Surg 60A:763–768Google Scholar
  48. 48.
    Tomita K, Kawahara N, Kobayashi T et al (2001) Surgical strategy for spinal metastases. Spine 26:298–306PubMedCrossRefGoogle Scholar
  49. 49.
    Enkaoua EA, Doursounian L, Chatellier G et al (1997) Vertebral metastases: a critical appreciation of the pre-operative prognostic Tokuhashi score in a series of 71 cases. Spine 22(19):2293–2298PubMedCrossRefGoogle Scholar
  50. 50.
    Zimmermann JS, Grop MW, Riegel T (1999) Spinales Kompressionssyndrom. Zum Thema: Onkologische Nolfalle. Onkologe 5:1054–1061CrossRefGoogle Scholar
  51. 51.
    Obemdorfer S, Grisold W (2000) Letter to the editor. Spine 25:653–654CrossRefGoogle Scholar
  52. 52.
    Tomita K, Kawahara N, Kobayashi T et al (2001) Surgical strategy for spinal metastases. Spine (Phila Pa 1976). Feb1; 26(3):298–306PubMedCrossRefGoogle Scholar
  53. 53.
    Bauer HC, Wedin R (1995) Survival after surgery for spinal and extremity metastases. Acta Orthop Scand 66(1):J3–J6Google Scholar
  54. 54.
    Tokuhashi Y (2000) Letter to the editor. Spine 25:654PubMedCrossRefGoogle Scholar
  55. 55.
    Tokuhashi Y, Matsuzaki H, Toriyama S et al (1990) Scoring system for pre-operative evaluation of metastatic spine tumor prognosis. Spine 15:1110–1113PubMedCrossRefGoogle Scholar
  56. 56.
    Ulmar B, Huch K, Naumann U et al (2007) Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases. EJSO 33:914–919PubMedCrossRefGoogle Scholar
  57. 57.
    Katagiri H, Takahashi M, Wakai K et al (2005) Prognostic factors and a scoring system for patients with skeletal metastasis. J Bone Joint Surg 87:698–703Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Giuseppe Tonini
    • 1
  • Bruno Vincenzi
    • 1
  • Chiara Spoto
    • 1
  • Daniele Santini
    • 1
  1. 1.Department of Medical OncologyUniversity Campus Bio-MedicoRomeItaly

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