Thoracolumbar Vertebral Reconstruction After Surgery for Tumors
Thoracolumbar Vertebral Reconstruction After Surgery for Tumors
Object: Metastatic spinal tumors continue to represent a major problem for patients and treating physicians.The Purpose of this study was to assess quantitatively the functional outcome, quality of life, and survival rates of patients after major reconstructive spine surgery.
Methods: A prospective database was established and 58 patients were identified who had undergone thoracolumbar vertebral reconstruction for metastatic spinal tumors between March 1993 and October 1999. Surgical indications included disabling pain (92%) and/or progressive neurological dysfunction (60%).
Forty-nine patients (85%) had clinical improvement in pain as determined based on the Oswestry pain scale (p < 0.05); 60% demonstrated improvement in their neurological status. The mean neurological improvement in Frankel grade was 1.2 (p < 0.05). The 12-month survival rate was 65%, and all patients who were ambulatory after surgery remained so until the time of death. Instrumentation failure requiring repeated operation occurred in two patients (3.5%), and in 12 patients (21%) local tumor recurrence necessitated repeated surgery. There were no cases of neurological deficit or death related to surgery.
Conclusions: Major anterior thoracolumbar vertebral reconstruction is an effective treatment for local tumor control. More importantly, the authors have demonstrated that surgical treatment can significantly improve the quality of life by improvement of pain control and maintenance of ambulation during the patient's remaining life span.
Despite recent advancements in the medical management of metastatic disease in the spine, surgery continues to play a central role. Proper patient selection and appropriate surgical intervention continues to be a frequent cause for concern among spine surgeons. Ambulation at the time of death and long-term functional viability is a primary concern when considering reconstructive spinal surgery in cancer patients, because the vertebral column is the most common site of skeletal metastases. The older oncology literature reported that surgery combined with radiotherapy did not improve survival rates any more than radiotherapy alone. The validity of these studies is unclear; they are very dated, poorly designed, and often reach inaccurate conclusions. More recent studies have demonstrated improved outcomes and lower morbidity after surgery. With increased survival times, spine surgeons are now more frequently faced with difficult decisions regarding treatment in patients with extensive lesions. Although palliative treatment is appropriate in some instances, resection can have potential beneficial effects on neurological function, pain, mobility, and overall quality of life. Moreover, tumor progression causing paraplegia may actually result in increased medical costs as well as decreased quality of life.
Our goal with this paper was to provide outcome data in patients with metastatic thoracolumbar vertebral tumors requiring major surgery. In particular, we were interested in providing data regarding ambulatory status, neurological function, and patient longevity.
Object: Metastatic spinal tumors continue to represent a major problem for patients and treating physicians.The Purpose of this study was to assess quantitatively the functional outcome, quality of life, and survival rates of patients after major reconstructive spine surgery.
Methods: A prospective database was established and 58 patients were identified who had undergone thoracolumbar vertebral reconstruction for metastatic spinal tumors between March 1993 and October 1999. Surgical indications included disabling pain (92%) and/or progressive neurological dysfunction (60%).
Forty-nine patients (85%) had clinical improvement in pain as determined based on the Oswestry pain scale (p < 0.05); 60% demonstrated improvement in their neurological status. The mean neurological improvement in Frankel grade was 1.2 (p < 0.05). The 12-month survival rate was 65%, and all patients who were ambulatory after surgery remained so until the time of death. Instrumentation failure requiring repeated operation occurred in two patients (3.5%), and in 12 patients (21%) local tumor recurrence necessitated repeated surgery. There were no cases of neurological deficit or death related to surgery.
Conclusions: Major anterior thoracolumbar vertebral reconstruction is an effective treatment for local tumor control. More importantly, the authors have demonstrated that surgical treatment can significantly improve the quality of life by improvement of pain control and maintenance of ambulation during the patient's remaining life span.
Despite recent advancements in the medical management of metastatic disease in the spine, surgery continues to play a central role. Proper patient selection and appropriate surgical intervention continues to be a frequent cause for concern among spine surgeons. Ambulation at the time of death and long-term functional viability is a primary concern when considering reconstructive spinal surgery in cancer patients, because the vertebral column is the most common site of skeletal metastases. The older oncology literature reported that surgery combined with radiotherapy did not improve survival rates any more than radiotherapy alone. The validity of these studies is unclear; they are very dated, poorly designed, and often reach inaccurate conclusions. More recent studies have demonstrated improved outcomes and lower morbidity after surgery. With increased survival times, spine surgeons are now more frequently faced with difficult decisions regarding treatment in patients with extensive lesions. Although palliative treatment is appropriate in some instances, resection can have potential beneficial effects on neurological function, pain, mobility, and overall quality of life. Moreover, tumor progression causing paraplegia may actually result in increased medical costs as well as decreased quality of life.
Our goal with this paper was to provide outcome data in patients with metastatic thoracolumbar vertebral tumors requiring major surgery. In particular, we were interested in providing data regarding ambulatory status, neurological function, and patient longevity.
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