Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive operative procedures

Abstract

We are presenting our experience with vertebral body resection in forty-seven operative procedures in forty patients with a malignant epidural tumor. The indication for surgery was neural relapse after previous radiotherapy in eighteen procedures, the need for a tissue diagnosis in sixteen, a radioresistant tumor in seven, neural deterioration while receiving radiotherapy in five, and a pathological fracture-dislocation in one. In thirty-three procedures (70 per cent) the level of compression was in the thoracic spine. Replacement of the resected vertebral bodies was achieved by anterior instrumentation and the use of methylmethacrylate in twenty-one procedures (45 per cent), while bone-grafting, cement, and instrumentation in various combinations were used in the remainder. Before surgery all of the patients had some neural deficit. The patient was still able to walk prior to twelve (26 per cent) of the procedures, was paraparetic prior to twenty-three (49 per cent), and was paraplegic prior to twelve (26 per cent). Bowel and bladder dysfunction was present before twenty-five (53 per cent). The outcome of only forty-four procedures could be evaluated because three patients died postoperatively. The patient was able to walk following thirty-five (80 per cent) of the procedures, was paraparetic after eight (18 per cent), and was still paraplegic after one. The patient regained normal sphincter control after forty-one (93 per cent) of the procedures. Three (6 per cent) of the procedures were followed by the death of the patient, and complications occurred after five (11 per cent) of the procedures.(ABSTRACT TRUNCATED AT 250 WORDS)