Thoracic Deformity (Tumor) Surgery Complications

Abstract

As treatment regimens for primary cancer improve, patients are surviving longer and experiencing increased incidence of spinal column metastases. After the lungs and the liver, the skeletal system is the third most common site for metastases (Witham et al, Nat Clin Pract Neurol 2(2):87–94, 2006), with breast, lung, and prostate cancer accounting for greater than 50% of tumor origin sites (Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression. NICE Clinical Guidelines, No. 75. National Collaborating Centre for Cancer (UK). Cardiff (UK), 2008). The typical symptoms of spinal column metastases are pain, mechanical instability, and neurologic deficits. Surgical management of such lesions often requires circumferential decompression with instrumented fixation, followed by adjuvant radiation therapy to the affected levels.

The preferred method for obtaining circumferential decompression and instrumented fusion varies by institution and surgeon, with some surgeons utilizing anterior transcavitary approaches, others using posterior/posterolateral approaches, and some using combined approaches. A major consideration when choosing these approaches should be their associated rates of hardware failure (i.e., screw haloing, screw pullout, rod fractures, and adjacent level fractures). Additionally, patient-specific factors such as morbidity, bone quality, and life expectancy may need to be taken into account when considering an appropriate approach for treating metastatic epidural spinal cord compression.

In this chapter, we will discuss potential complications, complication avoidance strategies, and complication management techniques for patients who have undergone circumferential decompression and/or instrumented fusion for metastatic disease to the spinal column.