Palliative Posterior Instrumentation versus Corpectomy with Cage Reconstruction Treatment for Thoracolumbar Pathological Fracture

Abstract

Study design: Single-center, retrospective cohort study.

Purpose: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture.

Overview of literature: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization.

Methods: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time.

Results: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes).

Conclusions: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.

Keywords: Corpectomy; Expandable cage; Palliative surgery; Pathological fracture; Spinal metastases.

Fig. 1.

A 55-year-old patient with breast cancer. (A, B) Anteroposterior radiograph and sagittal magnetic resonance image showing the collapse of the T–12 vertebra because of metastatic breast cancer. (C, D) Anteroposterior and lateral radiograph obtained 3 months after the palliative posterior instrumentation, showing no loss of fixation.

Fig. 2.

A 67-year-old patient with renal cell cancer. (A, B) Lateral radiograph and sagittal magnetic resonance image showing the collapse of the L–3 vertebra because of metastases. (C, D) Anteroposterior and lateral radiograph obtained 6 months after the corpectomy and cage reconstruction surgery.

Fig. 3.

The Kaplan-Meier curve showing the postoperative survival status in the two groups. PPI, palliative posterior instrumentation; CCR, corpectomy with cage reconstruction.