The spine is the most common site of osseous metastasis. These metastases not only cause pain and pathologic fractures resulting in instability or deformity, but they can also compress neurologic structures with ensuing deficits in movement, sensation, or bowel/bladder function.
Patients with metastatic disease are challenging to treat operatively due to their medical comorbidities, the presence of other osseous metastases in the surrounding region, and poor prognosis. Preoperative planning is of utmost importance with detail to the extent of surgery and approach.
Posterior fixation can correct many deformities and bring about stability; however, anterior reconstruction is often required for the correction itself or to assist with stabilizing a posterior construct. Similarly, osseous metastases usually occur in the vertebral bodies, and when they extend epidurally to compress neurologic structures anteriorly, the most straightforward method of decompression is via a corpectomy and vertebral body reconstruction.
There are a variety of techniques to accomplish this: bone cement either injected percutaneously or in an open fashion, corpectomy and insertion of a cage, or placement of bone cement into the defect.
Depending on the symptoms and the areas which require correction, the approach can be anterior only, posterior only, or a combination. This chapter discusses some options and techniques along with their pros and cons. It also considers some common pitfalls seen in vertebral body reconstruction in the metastatic spine population.
Vertebral body Corpectomy Reconstruction Techniques Cage Bone cement Approach
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