[Treatment of metastases of thoracic and lumbar vertebrae with predominant corporeal involvement by osteotomy of the vertebral body and anterior approach with cement and screwed plate]

Abstract

Forty-seven patients with predominant corporeal thoracic, thoraco-lumbar or lumbar vertebral metastases were treated surgically by corporectomy. The vertebral body was replaced by acrylic cement sustained by a vertebral U shaped plate screwed to the adjacent vertebral bodies: this corporectomy was completed in 17 cases by a posterior approach. In 9 cases it allowed to treat a posterior epiduritis. The spinal metastases were symptomatic in 45 cases (pain and/or neurologic deficit); 22 of the operated patients were bed-ridden, either due to an important pain (16), or due to a severe neurological deficit (6). In 36 cases, the intervention was done on the spinal lord segment (7 times on the upper thoracic column). The patients were authorized to get up the fifth or sixth postoperative day. The functional results, at a price of 15 per cent of mortality during the first two postoperative months, were satisfactory and stable in time (particularly, 70 per cent of the operated patients with neurologic deficits were improved and 13 of the 21 bed-ridden became autonomous). The intracanalar decompressions controlled by a postoperative myelography, were nearly always total. The sets were stables in time when the block of cement was sustained by a metallic device. The mortality and the functional failure with pain and neurological impairment occurred essentially, when there was spreading of the tumor to the peri-vertebral soft tissues and when there was epiduritis extending beyond the bone lesion. Thus, to be perfectly efficacious, the anterior surgery of the vertebral metastasis, which gives durable and better results than the posterior one, should be soon enough integrated, in the global treatment of the metastatic disease.