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Surgical treatment for metastases of the cervical spine

  • Original Article • SPINE - METASTASES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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

  1. 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

    Article  Google Scholar 

  2. 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)

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. Jenis LG, Dunn EJ, An HS (1999) Metastatic disease of the cervical spine. A review. Clin Orthop Relat Res 359:89–103

    Article  Google Scholar 

  6. 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)

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Google Scholar 

  10. 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

    Article  Google Scholar 

  11. Rao J, Tiruchelvarayan R, Lee L (2014) Palliative surgery for cervical spine metastasis. Singap Med J 55(11):569–573

    Article  Google Scholar 

  12. 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

    Article  CAS  PubMed  Google Scholar 

  13. Anesthesiologists ASo (1963) New classification of physical status. Anesthesiology 24:111. doi:10.1097/00000542-196301000-00018

    Google Scholar 

  14. 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

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  CAS  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  CAS  Google Scholar 

  21. 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

    PubMed  PubMed Central  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. 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

    Article  CAS  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. Schnake KJ, Tropiano P, Berjano P, Lamartina C (2016) Cervical spine surgical approaches and techniques. Eur Spine J 25(Suppl 4):486–487

    Article  PubMed  Google Scholar 

  27. 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

    CAS  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  CAS  PubMed  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. 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

    Article  Google Scholar 

  32. 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

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Vasilios G. Igoumenou.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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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

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