Abstract
Tumors of the vertebral column include both primary and metastatic lesions. These tumors can cause significant morbidity consisting of lesional pain and pain from deformity. Compression of the spinal cord and spinal nerve roots can also cause radicular pain as well as neurologial deterioration including sensory deficits, weakness, paralysis, and/or sexual/bowel/ bladder dysfunction. In cases of metastatic lesions, the spine is the most common region of osseous involvement (1). Metastatic vertebral spine lesions can result in pathological fractures or have significant epidural tumor involvement, both of which can lead to neurological deterioration (2). Mortality and morbidity can be significant in malignant tumors and overall treatment is best addressed by a multidisciplinary approach.
Keywords
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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Gokaslan ZL. Spine surgery for cancer. Curr Opin Oncol 1996; 8:178–181.
Klimo K, Kestle JRW, Schmidt MH. Treatment of metastatic spinal epidural disease: a review of the literature. Neurosurg Focus 2003; 15:1–9.
Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 1978; 3:40–51.
Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980; 53:741–748.
Dahlbeck S, Kagan AR. Spinal cord compression, infection, and unknown primary cancers. Am J Clin Oncol 2001; 24:315–318.
Ratliff JK, Cooper PR. Metastatic spine tumors. South Med J 2004; 97:246–253.
Durr HR, Wegener B, Krodel A, Muller PE, Jansson V, Refior HJ. Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients. Spine 2002; 27:320–324.
Sundaresan N, Rothman A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine 2002; 27:1802–1806.
Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine 2001; 26:818–824.
Gokaslan ZL, York JE, Walsh GL, et al. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg 1998; 89:599–609.
Cooper PR, Errico TJ, Martin R, Crawford B, DiBartolo T. A systematic approach to spinal reconstruction after anterior decompression for neoplastic disease of the thoracic and lumbar spine. Neurosurgery 1993; 32:1–8.
Walsh GL, Gokaslan ZL, McCutcheon IE, et al. Anterior approaches to the thoracic spine in patients with cancer: indications and results. Ann Thorac Surg 1997; 64:1611–1618.
Fourney DR, Abi-Said D, Rhines LD, et al. Simultaneous anteriorposterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. J Neurosurg 2001; 94:232–244.
Yao KC, Boriani S, Gokaslan ZL, Sundaresan N. En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 2003; 15:1–5.
Regine WF, Tibbs PA, Young A, et al. Metastatic spinal cord compression: a randomized trial of direct decompressive surgical resection plus radiotherapy vs. radiotherapy alone. Int J Radiat Oncol Biol Phys 2003; 57:S125.
Parikh SN, Crawford AH. Orthopaedic implications in the management of pediatric vertebral and spinal cord tumors: a retrospective review. Spine 2003; 28:2390–2396.
Raskas DS, Graziano GP, Herzenberg JE, Heidelberger KP, Hensinger RN. Osteoid osteoma and osteoblastoma of the spine. J Spinal Disord 1992; 5:204–211.
Jallo GI, Kothbauer KF, Epstein FJ. Intrinsic spinal cord tumor resection. Neurosurgery 2001; 49:1124–1128.
Roonprapunt C, Silvera VM, Setton A, Freed D, Epstein FJ, Jallo GI. Surgical management of isolated hemangioblastomas of the spinal cord. Neurosurgery 2001; 49:321–327.
Lonstein JE. Post-laminectomy kyphosis. Clin Orthop 1977:93–100.
Otsuka NY, Hey L, Hall JE. Postlaminectomy and postirradiation kyphosis in children and adolescents. Clin Orthop 1998:189–194.
Freiberg AA, Graziano GP, Loder RT, Hensinger RN. Metastatic vertebral disease in children. J Pediatr Orthop 1993; 13:148–153.
York JE, Gokaslan ZL. Craniocervical junction neoplastic conditions. Seminars in Neurosurgery 2002:145–150.
Bilsky MH, Shannon FJ, Sheppard S, Prabhu V, Boland PJ. Diagnosis and management of a metastatic tumor in the atlantoaxial spine. Spine 2002; 27:1062–1069.
Phillips E, Levine AM. Metastatic lesions of the upper cervical spine. Spine 1989; 14:1071–1077.
Schaeren S, Jeanneret B. Occipitocervical Instrumentation. Tech Orthop 2002; 17:287–295.
Crockard HA. Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg 1988; 34:389–416.
Schmelzle R, Harms J. [Craniocervical junction-diseases, diagnostic application of imaging procedures, surgical technics]. Fortschr Kiefer Gesichtschir 1987; 32:206–208.
Sar C, Eralp L. Transoral resection and reconstruction for primary osteogenic sarcoma of the second cervical vertebra. Spine 2001; 26:1936–1941.
Bongioanni F, Assadurian E, Polivka M, George B. Aneurysmal bone cyst of the atlas: operative removal through an anterolateral approach. A case report. J Bone Joint Surg Am 1996; 78:1574–1547.
McAfee PC, Bohlman HH, Riley LH Jr., Robinson RA, Southwick WO, Nachlas NE. The anterior retropharyngeal approach to the upper part of the cervical spine. J Bone Joint Surg Am 1987; 69:1371–1383.
Kratimenos GP, Crockard HA. The far lateral approach for ventrally placed foramen magnum and upper cervical spine tumours. Br J Neurosurg 1993; 7:129–140.
Harms J, Melcher RP. Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 2001; 26:2467–2471.
Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. New York, NY: Springer-Verlag; 1986.
Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 1978; 60:279–284.
Simmons E. Alternatives in the surgical stabilization for the upper cervical spine. In: Tator CH, ed. Early Management of Acute Spinal Cord Injury. New York, NY: Raven; 1982:393–434.
Sonntag VKH, Dickman CA. Posterior atlantoaxial wiring techniques. In: Dickman CA, Spetzler RF, Sonntag VKH, eds. Surgery of the Craniovertebral Junction. New York, NY: Thieme; 1997:783–794.
Wright N. Posterior C2 Fixation Using Bilateral, Crossing C2 Laminar Screws. J Spinal Disord 2004; 17:158–162.
Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine 2002; 27:2435–2440.
Henriques T, Cunningham BW, Olerud C, et al. Biomechanical comparison of five different atlantoaxial posterior fixation techniques. Spine 2000; 25:2877–2883.
Dickman CA, Crawford NR, Paramore CG. Biomechanical characteristics of C1–2 cable fixations. J Neurosurg 1996; 85:316–322.
Puttlitz CM, Melcher RP, Kleinstueck FS, Harms J, Bradford DS, Lotz JC. Stability analysis of craniovertebral junction fixation techniques. J Bone Joint Surg Am 2004; 86:561–568.
Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 1995; 37:688–692.
Dickman CA, Sonntag VK. Surgical management of atlantoaxial nonunions. J Neurosurg 1995; 83:248–253.
Stillerman CB, Wilson JA. Atlanto-axial stabilization with posterior transarticular screw fixation: technical description and report of 22 cases. Neurosurgery 1993; 32:948–954.
Asazuma T, Toyama Y, Maruiwa H, Fujimura Y, Hirabayashi K. Surgical strategy for cervical dumbbell tumors based on a threedimensional classification. Spine 2004; 29:E10–E144.
Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hosp 1955; 96:223–224.
Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958; 15:602–617.
Eleraky MA, Llanos C, Sonntag VK. Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg 1999; 90:35–41.
Narotam PK, Pauley SM, McGinn GJ. Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study. J Neurosurg 2003; 99:172–180.
Dorai Z, Morgan H, Coimbra C. Titanium cage reconstruction after cervical corpectomy. J Neurosurg 2003; 99:3–7.
Majd ME, Vadhva M, Holt RT. Anterior cervical reconstruction using titanium cages with anterior plating. Spine 1999; 24:1604–1610.
DeWald RL, Bridwell KH, Prodromas C, Rodts MF. Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine 1985; 10:21–26.
Miller DJ, Lang FF, Walsh GL, Abi-Said D, Wildrick DM, Gokaslan ZL. Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection. J Neurosurg 2000; 92:181–190.
Liu JK, Apfelbaum RI, Chiles BW, Schmidt MH. Cervical spinal metastasis: anterior reconstruction and stabilization techniques after tumor resection. Neurosurg Focus 2003; 15:1–7.
Pluta RM, Iuliano B, DeVroom HL, Nguyen T, Oldfield EH. Comparison of anterior and posterior surgical approaches in the treatment of ventral spinal hemangioblastomas in patients with von Hippel-Lindau disease. J Neurosurg 2003; 98:117–124.
O’Toole JE, McCormick PC. Midline ventral intradural schwannoma of the cervical spinal cord resected via anterior corpectomy with reconstruction: technical case report and review of the literature. Neurosurgery 2003; 52:1482–1485.
Coumans JV, Marchek CP, Henderson FC. Use of the telescopic plate spacer in treatment of cervical and cervicothoracic spine tumors. Neurosurgery 2002; 51:417–424.
Walker MP, Yaszemski MJ, Kim CW, Talac R, Currier BL. Metastatic Disease of the Spine: Evaluation and Treatment. Clin Orthop 2003; 1:S165–S175.
Brown JA, Havel P, Ebraheim N, Greenblatt SH, Jackson WT. Cervical stabilization by plate and bone fusion. Spine 1988; 13:236–240.
Sundaresan N, Steinberger AA, Moore F, et al. Indications and results of combined anterior-posterior approaches for spine tumor surgery. J Neurosurg 1996; 85:438–446.
McAfee PC, Bohlman HH. One-stage anterior cervical decompression and posterior stabilization with circumferential arthrodesis. A study of twenty-four patients who had a traumatic or a neoplastic lesion. J Bone Joint Surg Am 1989; 71:78–88.
McAfee PC, Bohlman HH, Ducker TB, Zeidman SM, Goldstein JA. One-stage anterior cervical decompression and posterior stabilization. A study of one hundred patients with a minimum of two years of follow-up. J Bone Joint Surg Am 1995; 77:1791–1800.
Schultz KD Jr, McLaughlin MR, Haid RW Jr, Comey CH, Rodts GE Jr, Alexander J. Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg 2000; 93:214–221.
Le H, Balabhadra R, Park J. Surgical treatment of tumors involving the cervicothoracic junction. Neurosurg Focus 2003; 15:1–7.
Bellabarba C, Nemacek AN, Chapman JR. Management of Injuries to the Cervicothoracic Junction. Tech Orthop 2002; 17:355–364.
Fielding JW, Stillwell WT. Anterior cervical approach to the upper thoracic spine. Spine 1976; 1:158–161.
Gieger M, Roth PA, Wu JK. The anterior cervical approach to the cervicothoracic junction. Neurosurgery 1995; 37:704–709.
Luk KD, Cheung KM, Leong JC. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. A report of five cases. J Bone Joint Surg Am 2002; 84:1013–1017.
Le Huec JC, Lesprit E, Guibaud JP, Gangnet N, Aunoble S. Minimally invasive endoscopic approach to the cervicothoracic junction for vertebral metastases: report of two cases. Eur Spine J 2001; 10:421–426.
Nazzaro JM, Arbit E, Burt M. “Trap door” exposure of the cervicothoracic junction. Technical note. J Neurosurg 1994; 80:338–341
Korst RJ, Burt ME. Cervicothoracic tumors: results of resection by the “hemi-clamshell” approach. J Thorac Cardiovasc Surg 1998; 115:286–294
Kubo T, Nakamura H, Yamano Y. Transclavicular approach for a large dumbbell tumor in the cervicothoracic junction. J Spinal Disord 2001; 14:79–83.
Birch R, Bonney G, Marshall RW. A surgical approach to the cervicothoracic spine. J Bone Joint Surg Br 1990; 72:904–907.
McLain RF, Lieberman IH. Endoscopic approaches to metastatic thoracic disease. Spine 2000; 25:1855–1858.
McLain RF. Endoscopically assisted decompression for metastatic thoracic neoplasms. Spine 1998; 23:1130–1135.
Wolfla CE, Maiman DJ. Lateral extracavitary approach. Tech Neurosurg 2003; 8.
Larson SJ, Holst RA, Hemmy DC, Sances A Jr. Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg 1976; 45:628–637.
Fessler RG, Dietze DD Jr, Millan MM, Peace D. Lateral parascapular extrapleural approach to the upper thoracic spine. J Neurosurg 1991; 75:349–355.
Weller SJ, Rossitch E Jr. Unilateral posterolateral decompression without stabilization for neurological palliation of symptomatic spinal metastasis in debilitated patients. J Neurosurg 1995; 82:739–744.
Wiggins GC, Mirza S, Bellabarba C, et al. Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors. Neurosurg Focus 2001; 11:1–9.
Mazel Ch, Grunenwald D, Laudrin P, Marmorat JL. Radical excision in the management of thoracic and cervicothoracic tumors involving the spine: results in a series of 36 cases. Spine 2003; 28:782–792.
Mazel C, Hoffmann E, Antonietti P, Grunenwald D, Henry M, Williams J. Posterior cervicothoracic instrumentation in spine Tumors. Spine 2004; 29:1246–1253.
Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery 1985; 17:424–432.
Siegal T, Tiqva P. Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive operative procedures. J Bone Joint Surg Am 1985; 67:375–382.
Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P. Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 1985; 63:676–684.
Bianchi C, Ballard JL, Abou-Zamzam AM, Teruya TH, Abu-Assal ML. Anterior retroperitoneal lumbosacral spine exposure: operative technique and results. Ann Vasc Surg 2003; 17:137–142.
Bergey DL, Villavicencio AT, Goldstein T, Regan JJ. Endoscopic lateral transpsoas approach to the lumbar spine. Spine 2004; 29:1681–1688.
Regan JJ, Guyer RD. Endoscopic techniques in spinal surgery. Clin Orthop 1997:122–139.
Onimus M, Papin P, Gangloff S. Extraperitoneal approach to the lumbar spine with video assistance. Spine 1996; 21:2491–2494.
Khoo LT, Beisse R, Potulski M. Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 2002; 51:104–117.
McAfee PC, Regan JR, Fedder IL, Mack MJ, Geis WP. Anterior thoracic corpectomy for spinal cord decompression performed endoscopically. Surg Laparosc Endosc 1995; 5:339–348.
Konno S, Yabuki S, Kinoshita T, Kikuchi S. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine 2001; 26:E130–E134.
Citow JS, Macdonald RL, Ferguson MK. Combined laminectomy and thoracoscopic resection of a dumbbell neurofibroma: technical case report. Neurosurgery 1999; 45:1263–1265.
Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL 3rd, Boyd M, Wing PC. Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine 2003; 28:902–908.
Buttermann GR, Glazer PA, Bradford DS. The use of bone allografts in the spine. Clin Orthop 1996:75–85.
Cotler HB, Cotler JM, Stoloff A, et al. The use of autografts for vertebral body replacement of the thoracic and lumbar spine. Spine 1985; 10:748–756.
Errico TJ, Cooper PR. A new method of thoracic and lumbar body replacement for spinal tumors: technical note. Neurosurgery 1993; 32:678–680.
McCormick PC. Surgical management of dumbbell and paraspinal tumors of the thoracic and lumbar spine. Neurosurgery 1996; 38:67–74.
Akeyson EW, McCutcheon IE. Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg 1996; 85:211–220.
Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine 2000; 25:2240–2249.
Tomita K, Kawahara N, Baba H, Tomita K, Kawahara N, Baba H. Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 1994; 18:291–298.
Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y. Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine 1997; 22:324–333.
Sakaura H, Hosono N, Mukai Y, Ishii T, Yonenobu K, Yoshikawa H. Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine. J Spinal Disord Tech 2004; 17:297–300.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Humana Press, Inc., Totowa, NJ
About this chapter
Cite this chapter
Lodhia, K.R., Park, P., Graziano, G.P. (2006). Spinal Cord and Nerve Root Decompression. In: McLain, R.F., Lewandrowski, KU., Markman, M., Bukowski, R.M., Macklis, R., Benzel, E.C. (eds) Cancer in the Spine. Current Clinical Oncology. Humana Press. https://doi.org/10.1007/978-1-59259-971-4_29
Download citation
DOI: https://doi.org/10.1007/978-1-59259-971-4_29
Publisher Name: Humana Press
Print ISBN: 978-1-58829-074-8
Online ISBN: 978-1-59259-971-4
eBook Packages: MedicineMedicine (R0)