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Surgical stabilization of spinal malignant tumors

Stabilization chirurgicale des tumeurs malignes du rachis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Summary

The treatment of primary and secondary tumors of the spine is still controversial. The aim of this study is to review our series in order to discuss the indications, the techniques and the results of the surgical treatment. 153 patients with spinal tumor (78 primary lesions and 75 metastases) have been treated from 1977 to 1995. The objectives of surgical treatment are mainly aimed at suppressing pain, restoring or maintaining neurological functions and stabilizing the spine. Transoral, transthoracic, thoracoabdominal, combined anterior and posterior approaches were used in a single surgical procedure or in two different stages. The most frequently used instrumentation was the Cotrel-Dubousset. Somatic reconstructive devices were implanted in 5 patients. The postoperative result was judged as excellent in 46 patients, good in 34, fair in 28 and poor in 18. On the whole, satisfactory results were obtained in 63.5% of cases whereas the outcome was unsatisfactory in 36.5% of subjects. In 46% of our cases, a good neurological recovery was observed even though it was short-lived because of recurrences (40%). Pain was reduced in all, except two patients. Local relapses were observed in 9% of treated patients, while 5% had lesions in other sites.

Résumé

Le traitement des tumeurs primitives et secondaires du rachis reste encore un sujet de controverse. Le but de ce travail est de revoir notre série pour en discuter les indications, les techniques chirurgicales et les résultats. 153 patients porteurs de 78 tumeurs primitives et de 75 métastases ont été traités entre 1977 et 1995 Les objectifs du traitement chirurgical ont été surtout de supprimer les douleurs, de restaurer ou de maintenir les fonctions neurologiques et de stabiliser le segment rachidien.

Des voies d'abord transorales, transthoraciques, thoraco-abdominales, combinées antérieures et postérieures, en un ou en deux temps ont été utilisées. L'instrumentation de stabilisation la plus souvent mise en place a ðé celle de COTRELDUBOUSSET. Des implants de reconstruction de corps vertébral ont été mis en place chez 5 patients. Le résultat postopératoire a été estimé excellent chez 46 patients, bon chez 34, assez-bon chez 28 et mauvais chez 18 patients. Au total, des résultats satisfaisants ont pu être notés dans 63,5 % des cas, alors que le résultat était insuffisant dans 36,5 % des cas. Dans 46 % de nos cas, une bonne récupération du déficit neurologique a été constatée, même si cette récupération n'a pu être que de courte durée en raison des récidives (40 %). La douleur a été diminuée chez tous les opérés, sauf pour deux cas. Une récidive tumorale locale a eu lieu dans 9 % des cas et une localisation secondaire chez 5 %.

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Authors and Affiliations

  1. Department of Orthopaedics, Division for Spinal Surgery, Catholic University of Rome, L.Go A. Gemelli 8, I-00168, Rome, Italy

    C. A. Logroscino, V. F. Paliotta & N. Specchia

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  1. C. A. Logroscino
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  2. V. F. Paliotta
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  3. N. Specchia
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Logroscino, C.A., Paliotta, V.F. & Specchia, N. Surgical stabilization of spinal malignant tumors. Eur J Orthop Surg Traumatol 7, 69–74 (1997). https://doi.org/10.1007/BF00578770

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