Abstract
Introduction
Metastases are the most frequent malignant lesions of the spine. Around 5 to 10% of the patients with a systemic tumor have got spinal metastases. More than 95% of spinal metastases are extradural lesions. The residual cases are intradural extramedullary lesions and only 0.5% are intramedullary lesions. Prostate, lung, breast, clear cell kidney tumors, lymphoma, myeloma, and gastric carcinoma are the most frequent primitive neoplasms to cause secondary lesions to the spine. The cervical spine is involved in 10% of the cases. In 80% of the cases, metastases are found to be in the lower cervical tract. Life expectancy in patients with lung carcinoma metastasis is approximately 6 months, 1.5/2 years in patients affected by breast, kidney, and prostate cancers. We reviewed our series of patients with spinal metastases operated between 1997 and 2013 with the aim to analyze the efficacy of the surgical treatment to recover the function and biomechanics of the vertebral column. We evaluated the prognosis in terms of duration and quality of residual life.
Materials and Methods
We included 36 patients (mean age 65 years). The patients were evaluated according to neurological status, Karnofsky score for the quality of life, and Denis score for pain. Indications for surgery were: pain resistant to pharmacological therapy, medullary compression, neurological deficits, and vertebral instability. Patients underwent CT and MR scan examinations of the cervical spine. In all patients, a total body CT scan was performed. All surgical procedures were performed with microsurgical techniques.
In 25 cases, the surgical treatment contemplated an anterior approach: single corpectomy in 16 cases and double in 11 cases. In these cases, the vertebral body was replaced by an expandable titanium cage with PMMA filling and plating. In 6 cases, the treatment consisted of a 360-degree reconstruction. In the residual 5 cases, where the lesion was located in the superior cervical tract of the spine, we performed an occipital–cervical fusion through a posterior approach. Postoperative follow-up controls were run at 1, 3, 6, and 12 months. A cervical orthosis was worn by the patient for 40 days.
Results
During the follow-up time, 18 patients died because of the progression of the primitive tumor. In 36 patients treated with surgery, the histological examination documented a primitive lesion of the breast in 12 cases, of the lung in 10 cases, of the prostate in 5, of the kidney in 4, of the thyroid in 2, and of the testicle in 2. One patient affected by plasmacytoma was also observed. No intra- and perioperative complications arose. The neurological status was preserved intact in all cases with a sensible improvement in those patients affected by severe tetraparesis. We noticed a rise in the Karnofsky score, on an average from 70 to 85. Postoperative neuroimaging controls documented that the instrumentation was in the correct place.
Conclusion
Surgical treatment of spine metastases allows pain control, management of neurological conditions, and an overall improvement in the quality of residual life.