Stability of lumbar vertebra in patients with thoracolumbar vertebral metastases after treated with artificial vertebral placement or internal fixation

doi:10.3969/j.issn.2095-4344.2013.30.025

Abstract

Abstract:

BACKGROUND: Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position.
OBJECTIVE: To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation.
METHODS: Sixteen patients (9 male and 7 female) with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, all the patients were evaluated according to Frankel classification: A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T₁₁ vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T₁₂-L₂ vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach.
RESULTS AND CONCLUSION: All the 16 patients were followed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from (6.22±1.31) before treatment to (3.25±0.94) after treatment, and there was significant difference between two groups (P < 0.05). The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with
spinal metastases, and thus improving the symptoms and quality of life.

Key words: bone and joint implants, academic discussion of bone and joint, artificial vertebral body, fixator, spinal metastases, thoracic vertebrae, lumbar vertebrae, stability, complications, provincial grants-supported paper

CLC Number:

R318

Wang Dong-lai, Feng Jian-gang, Li Zeng-huai, Feng He-lin, Zhang Jin-ming, Xun Jian-jun . Stability of lumbar vertebra in patients with thoracolumbar vertebral metastases after treated with artificial vertebral placement or internal fixation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(30): 5575-5580.

Figures/Tables 2

References

[1] 刘忠军,党耕町,马庆军,等.脊柱肿瘤的全脊椎切除术及脊柱稳定性重建[J].中华骨科杂志,2001,21(11):646-649.

[2] Tilleman TR, Richards WG, Zellos L, et al. Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg.2009;138(2): 405-411.

[3] 中国知网.中国学术期刊总库[DB/OL]. 2013-4-12. https://www.cnki.net

[4] 王清.椎体切除植骨融合内固定治疗颈胸交界椎体转移瘤[J].实用骨科杂志,2012,18(12):1100-1102.

[5] 胡豇,曾建成,宋跃明,等.胸腰椎肿瘤手术中脊柱稳定性的重建[J].四川医学,2003,24(4):333-335.

[6] 郭东明,徐中和,蔡维山,等.胸腰椎转移肿瘤手术切除和稳定性重建[J].广东医学,2004,25(6):683-684.

[7] 叶劲,莫茅,蔡维山,等.脊柱重建手术对胸腰椎转移瘤致脊髓功能障碍及疼痛的改善作用[J].中国临床康复,2004,8(23):4690-4691.

[8] 杨强.全脊椎整块切除术在治疗胸腰椎肿瘤中的应用及相关研究[D].山东:山东大学,2007:5-6.

[9] Boriani S, Weinstein JN, Biagini R.Primary bone tumors of the spine. Terminology and surgical staging.Spine (Phila Pa 1976). 1997;22(9):1036-1044.

[10] Casadei R, Greggi T, Miglietta A, et al.Posterior surgery for the treatment of thoracolumbar pathologic fractures in metastatic patients.Chir Organi Mov.1998;83(1-2):149-158.

[11] Mazel C, Hoffmann E, Antonietti P, et al.Posterior cervicothoracic instrumentation in spine tumors.Spine (Phila Pa 1976).2004;29(11):1246-1253.

[12] Cahill DW, Kumar R.Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach.J Neurosurg.1999;90(1):42-47.

[13] Kostuik JP, Errico TJ, Gleason TF, et al.Spinal stabilization of vertebral column tumors.Spine (Phila Pa 1976).1988; 13(3): 250-256.

[14] Akeyson EW, McCutcheon IE.Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis.J Neurosurg.1996; 85(2):211-220.

[15] Fourney DR, Abi-Said D, Rhines LD, et al.Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization.J Neurosurg.2001;94(2 Suppl):232-244.

[16] Jónsson B, Sjöström L, Olerud C, et al.Outcome after limited posterior surgery for thoracic and lumbar spine metastases. Eur Spine J.1996;5(1):36-44.

[17] Oda I, Cunningham BW, Abumi K, et al.The stability of reconstruction methods after thoracolumbar total spondylectomy. An in vitro investigation.Spine (Phila Pa 1976).1999;24(16):1634-1638.

[18] HODGSON AR, STOCK FE, FANG HS, et al. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott's disease of the spine.Br J Surg.1960; 48:172-178.

[19] Mirbaha MM. Anterior approach to the thoraco-lumbar junction of the spine by a retroperitoneal-extrapleural technic.Clin Orthop Relat Res.1973;(91):41-47.

[20] Moskovich R, Benson D, Zhang ZH, et al.Extracoelomic approach to the spine.J Bone Joint Surg Br.1993; 75(6): 886-893.

[21] David S.Bradford主编.卢世璧主译.骨科标准手术技术丛书-脊柱[M].辽宁科学技术出版社,2003:33-41.

[22] Kim M, Nolan P, Finkelstein JA. Evaluation of 11th rib extrapleural-retroperitoneal approach to the thoracolumbar junction. Technical note. J Neurosurg.2000;93(1 Suppl): 168-174.

[23] Knop C, Blauth M, Bühren V, et al. Surgical treatment of injuries of the thoracolumbar transition--3: Follow-up examination. Results of a prospective multi-center study by the "Spinal" Study Group of the German Society of Trauma Surgery. Unfallchirurg. 2001;104(7):583-600.