Transthoracic vertebrectomy for metastatic spinal tumors

Ziya L. Gokaslan, Julie E. York, Garrett L. Walsh, Ian E. Mccutcheon, Frederick F. Lang, Joe B. Putnam, David M. Wildrick, Stephen G. Swisher, Dima Abi-Said, Raymond Sawaya

Research output: Contribution to journalArticle

Abstract

Object. Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region. Methods. Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M.D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p <0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p <0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%. Conclusions. TheSe results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)599-609
Number of pages11
JournalJournal of Neurosurgery
Volume89
Issue number4
StatePublished - Oct 1998
Externally publishedYes

Fingerprint

Neoplasms
Spine
Thorax
Methylmethacrylate
Neoplasm Metastasis
Lumbosacral Region
Intractable Pain
Kyphosis
Pulmonary Atelectasis
Mortality
Kidney Neoplasms
Narcotics
Thoracic Wall
Back Pain
Decompression
Visual Analog Scale
Pulmonary Embolism
Sarcoma
Walking
Lower Extremity

Keywords

  • Metastasis
  • Spine
  • Thoracic spine
  • Transthoracic approach
  • Tumor
  • Vertebrectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Gokaslan, Z. L., York, J. E., Walsh, G. L., Mccutcheon, I. E., Lang, F. F., Putnam, J. B., ... Sawaya, R. (1998). Transthoracic vertebrectomy for metastatic spinal tumors. Journal of Neurosurgery, 89(4), 599-609.

Transthoracic vertebrectomy for metastatic spinal tumors. / Gokaslan, Ziya L.; York, Julie E.; Walsh, Garrett L.; Mccutcheon, Ian E.; Lang, Frederick F.; Putnam, Joe B.; Wildrick, David M.; Swisher, Stephen G.; Abi-Said, Dima; Sawaya, Raymond.

In: Journal of Neurosurgery, Vol. 89, No. 4, 10.1998, p. 599-609.

Research output: Contribution to journalArticle

Gokaslan, ZL, York, JE, Walsh, GL, Mccutcheon, IE, Lang, FF, Putnam, JB, Wildrick, DM, Swisher, SG, Abi-Said, D & Sawaya, R 1998, 'Transthoracic vertebrectomy for metastatic spinal tumors', Journal of Neurosurgery, vol. 89, no. 4, pp. 599-609.
Gokaslan ZL, York JE, Walsh GL, Mccutcheon IE, Lang FF, Putnam JB et al. Transthoracic vertebrectomy for metastatic spinal tumors. Journal of Neurosurgery. 1998 Oct;89(4):599-609.
Gokaslan, Ziya L. ; York, Julie E. ; Walsh, Garrett L. ; Mccutcheon, Ian E. ; Lang, Frederick F. ; Putnam, Joe B. ; Wildrick, David M. ; Swisher, Stephen G. ; Abi-Said, Dima ; Sawaya, Raymond. / Transthoracic vertebrectomy for metastatic spinal tumors. In: Journal of Neurosurgery. 1998 ; Vol. 89, No. 4. pp. 599-609.
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AU - York, Julie E.

AU - Walsh, Garrett L.

AU - Mccutcheon, Ian E.

AU - Lang, Frederick F.

AU - Putnam, Joe B.

AU - Wildrick, David M.

AU - Swisher, Stephen G.

AU - Abi-Said, Dima

AU - Sawaya, Raymond

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N2 - Object. Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region. Methods. Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M.D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p <0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p <0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%. Conclusions. TheSe results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.

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KW - Metastasis

KW - Spine

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KW - Transthoracic approach

KW - Tumor

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