Abstract
Background
There are limited information and inconclusive results for the management of patients with cervical spine metastases. Therefore, we performed this study to evaluate the survival and outcome of these patients, and the surgical risk and complications.
Materials and Methods
We retrospectively studied 24 patients [14 men and 10 women; mean age, 71 years (range 54–89 years)], with cervical spine metastases, who underwent palliative surgical treatment, from December 2010 to December 2016. Mean follow-up was 14 months (range 1–42 months). We evaluated the survival and the outcome of the patients with respect to pain relief and neurological status, and the surgical risk and complications.
Results
At the last follow-up, three patients were alive with disease, and 21 patients were dead with disease. Overall median survival was 14.8 months (range 1–47 months). A posterior approach was performed in 15 patients, an anterior approach with corpectomy and fusion in eight patients, and a two-stage combined approach in one patient. Overall, 21 patients experienced complete or almost complete, two patients mild, and one patient no pain relief; seven patients experienced complete neurological improvement, two patients moderate, while four patients remained stable. Overall, five patients experienced six complications including residual pain, sagittal malalignment with instability, and wound dehiscence; in five complications, a reoperation was necessary.
Conclusions
Palliative surgical treatment is usually performed in patients with metastatic bone disease of the cervical spine. Appropriate selection of the surgical technique is mandatory. However, the survival of the patients is dismal, and complications should be expected.
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References
Cho W, Chang UK (2012) Neurological and survival outcomes after surgical management of subaxial cervical spine metastases. Spine (Phila Pa 1976) 37(16):E969–E977. doi:10.1097/BRS.0b013e31824ee1c2
Molina CA, Gokaslan ZL, Sciubba DM (2012) Diagnosis and management of metastatic cervical spine tumors. Orthop Clin North Am 43(1):75–87. doi:10.1016/j.ocl.2011.08.004 (viii–ix)
Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, Rhines LD, Gokaslan ZL (2010) Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 13(1):94–108. doi:10.3171/2010.3.SPINE09202
Wu X, Ye Z, Pu F, Chen S, Wang B, Zhang Z, Yang C, Yang S, Shao Z (2016) Palliative surgery in treating painful metastases of the upper cervical spine: case report and review of the literature. Med (Baltim) 95(18):e3558. doi:10.1097/MD.0000000000003558
Jenis LG, Dunn EJ, An HS (1999) Metastatic disease of the cervical spine. A review. Clin Orthop Relat Res 359:89–103
Mazel C, Balabaud L, Bennis S, Hansen S (2009) Cervical and thoracic spine tumor management: surgical indications, techniques, and outcomes. Orthop Clin North Am 40(1):75–92. doi:10.1016/j.ocl.2008.09.008 (vi–vii)
Quan GM, Vital JM, Pointillart V (2011) Outcomes of palliative surgery in metastatic disease of the cervical and cervicothoracic spine. J Neurosurg Spine 14(5):612–618. doi:10.3171/2011.1.SPINE10463
Lee BH, Kim TH, Chong HS, Moon ES, Park JO, Kim HS, Kim SH, Lee HM, Cho YJ, Kim KN, Moon SH (2013) Prognostic factor analysis in patients with metastatic spine disease depending on surgery and conservative treatment: review of 577 cases. Ann Surg Oncol 20(1):40–46. doi:10.1245/s10434-012-2644-4
Davarski AN, Kitov BD, Zhelyazkov CB, Raykov SD, Kehayov II, Koev IG, Kalnev BM (2013) Surgical management of metastatic tumors of the cervical spine. Folia Med (Plovdiv) 55(3–4):39–45
Fehlings MG, David KS, Vialle L, Vialle E, Setzer M, Vrionis FD (2009) Decision making in the surgical treatment of cervical spine metastases. Spine (Phila Pa 1976) 34(22 Suppl):S108–S117. doi:10.1097/BRS.0b013e3181bae1d2
Rao J, Tiruchelvarayan R, Lee L (2014) Palliative surgery for cervical spine metastasis. Singap Med J 55(11):569–573
Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61(2):277–284
Anesthesiologists ASo (1963) New classification of physical status. Anesthesiology 24:111. doi:10.1097/00000542-196301000-00018
Mavrogenis AF, Guerra G, Romantini M, Romagnoli C, Casadei R, Ruggieri P (2012) Tumours of the atlas and axis: a 37-year experience with diagnosis and management. Radiol Med 117(4):616–635. doi:10.1007/s11547-011-0753-y
Brooks FM, Ghatahora A, Brooks MC, Warren H, Price L, Brahmabhatt P, De Vauvert S, John C, Farnworth E, Sulaiman E, Ahuja S (2014) Management of metastatic spinal cord compression: awareness of NICE guidance. Eur J Orthop Surg Traumatol 24(Suppl 1):S255–S259. doi:10.1007/s00590-014-1438-8
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(9486):643–648. doi:10.1016/S0140-6736(05)66954-1
Ibrahim A, Crockard A, Antonietti P, Boriani S, Bunger C, Gasbarrini A, Grejs A, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K (2008) Does spinal surgery improve the quality of life for those with extradural (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, March 2007. J Neurosurg Spine 8(3):271–278. doi:10.3171/SPI/2008/8/3/271
Lei M, Liu Y, Yan L, Tang C, Liu S, Zhou S (2015) Posterior decompression and spine stabilization for metastatic spinal cord compression in the cervical spine. A matched pair analysis. Eur J Surg Oncol 41(12):1691–1698. doi:10.1016/j.ejso.2015.09.025
Placantonakis DG, Laufer I, Wang JC, Beria JS, Boland P, Bilsky M (2008) Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases. J Neurosurg Spine 9(2):111–119. doi:10.3171/SPI/2008/9/8/111
Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 15(11):1110–1113
De la Garza-Ramos R, Benvenutti-Regato M, Caro-Osorio E (2016) Vertebroplasty and kyphoplasty for cervical spine metastases: a systematic review and meta-analysis. Int J Spine Surg 10:7. doi:10.14444/3007
Facchini G, Di Tullio P, Battaglia M, Bartalena T, Tetta C, Errani C, Mavrogenis AF, Rossi G (2016) Palliative embolization for metastases of the spine. Eur J Orthop Surg Traumatol 26(3):247–252. doi:10.1007/s00590-015-1726-y
Huch K, Cakir B, Dreinhofer K, Puhl W, Richter M (2004) A new dorsal modular fixation device allows a modified approach in cervical and cervico-thoracic neoplastic lesions. Eur Spine J 13(3):222–228. doi:10.1007/s00586-003-0656-2
King GJ, Kostuik JP, McBroom RJ, Richardson W (1991) Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976) 16(3):265–271
Oda I, Abumi K, Ito M, Kotani Y, Oya T, Hasegawa K, Minami A (2006) Palliative spinal reconstruction using cervical pedicle screws for metastatic lesions of the spine: a retrospective analysis of 32 cases. Spine (Phila Pa 1976) 31(13):1439–1444
Schnake KJ, Tropiano P, Berjano P, Lamartina C (2016) Cervical spine surgical approaches and techniques. Eur Spine J 25(Suppl 4):486–487
Abumi K, Kaneda K, Shono Y, Fujiya M (1999) One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 90(1 Suppl):19–26
Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D (2006) Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J 6(6):667–672. doi:10.1016/j.spinee.2006.03.019
Kast E, Mohr K, Richter HP, Borm W (2006) Complications of transpedicular screw fixation in the cervical spine. Eur Spine J 15(3):327–334. doi:10.1007/s00586-004-0861-7
Rhee JM, Kraiwattanapong C, Hutton WC (2005) A comparison of pedicle and lateral mass screw construct stiffnesses at the cervicothoracic junction: a biomechanical study. Spine (Phila Pa 1976) 30(21):E636–E640
Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine (Phila Pa 1976) 30(20):2280–2287
Cong Y, Bao N, Zhao J, Mao G (2015) Comparing accuracy of cervical pedicle screw placement between a guidance system and manual manipulation: a cadaver Study. Med Sci Monit 21:2672–2677. doi:10.12659/MSM.894074
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Vazifehdan, F., Karantzoulis, V.G. & Igoumenou, V.G. Surgical treatment for metastases of the cervical spine. Eur J Orthop Surg Traumatol 27, 763–775 (2017). https://doi.org/10.1007/s00590-017-2002-0
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DOI: https://doi.org/10.1007/s00590-017-2002-0