Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine

  • Park, Sung Bae (Department of Neurosurgery, Seoul National University Boramae Medical Center) ;
  • Kim, Ki Jeong (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Han, Sanghyun (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Oh, Sohee (Department of Biostatistics, Seoul National University Boramae Medical Center) ;
  • Kim, Chi Heon (Department of Neurosurgery, Seoul National University College of Medicine) ;
  • Chung, Chun Kee (Department of Neurosurgery, Seoul National University College of Medicine)
  • Received : 2017.05.15
  • Accepted : 2017.09.06
  • Published : 2018.05.01
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Abstract

Objective : To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. Methods : We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. Results : There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). Conclusion : When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

Keywords

References

  1. Bilsky MH, Laufer I, Burch S : Shifting paradigms in the treatment of metastatic spine disease. Spine (Phila Pa 1976) 34(22 Suppl) : S101-S107, 2009 https://doi.org/10.1097/BRS.0b013e3181bac4b2
  2. Binning MJ, Gottfried ON, Klimo P Jr. Schmidt MH : Minimally invasive treatments for metastatic tumors of the spine. Neurosurg Clin N Am 15 : 459-465, 2004 https://doi.org/10.1016/j.nec.2004.04.010
  3. Bouchard JA, Koka A, Bensusan JS Stevenson S, Emery SE : Effects of irradiation on posterior spinal fusions. A rabbit model. Spine (Phila Pa 1976) 19 : 1836-1841, 1994 https://doi.org/10.1097/00007632-199408150-00008
  4. Coleman RE, Rubens RD : The clinical course of bone metastases from breast cancer. Br J cancer 55 : 61-66,1987 https://doi.org/10.1038/bjc.1987.13
  5. Emery SE, Brazinski MS, Koka A, Bensusan JS, Stevenson S : The biological and biomechanical effects of irradiation on anterior spinal bone grafts in a canine model. J Bone Joint Surg Am 76 : 540-548,1994 https://doi.org/10.2106/00004623-199404000-00008
  6. Emery SE, Hughes SS, Junglas WA Herrington SJ, Pathria MN : The fate of anterior vertebral bone grafts in patients irradiated for neoplasm. Clin Orthop Relat Res (300) : 207-212, 1994
  7. Firth D : Bias reduction of maximum likelihood estimates. Biometrika 80 : 27-38, 1993 https://doi.org/10.1093/biomet/80.1.27
  8. Gerszten PC, Welch WC : Current surgical management of metastatic spinal disease. Oncology (Williston Park) 14 : 1013-1024; discussion 1024, 1029-1030, 2000
  9. Grant R, Papadopoulos SM, Greenberg HS : Metastatic epidural spinal cord compression. Neurol Clin 9 : 825-841, 1991 https://doi.org/10.1016/S0733-8619(18)30251-2
  10. Harel R, Chao S, Krishnaney A, Emch T, Benzel EC, Angelov L. Spine instrumentation failure after spine tumor resection and radiation: comparing conventional radiotherapy with stereotactic radiosurgery outcomes. World Neurosurg 74 : 517-522, 2010 https://doi.org/10.1016/j.wneu.2010.06.037
  11. Hatrick NC, Lucas JD, Timothy AR, Smith MA : The surgical treatment of metastatic disease of the spine. Radiother Oncol 56 : 335-339, 2000 https://doi.org/10.1016/S0167-8140(00)00199-7
  12. Jacobs WB, Perrin RG : Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11 : e10, 2001
  13. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Park EC, et al. : Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat 43 : 1-11, 2011 https://doi.org/10.4143/crt.2011.43.1.1
  14. Kim CH, Chung CK, Sohn S, Lee S, Park SB : Less invasive palliative surgery for spinal metastases. J Surg Oncol 108 : 499-503, 2013 https://doi.org/10.1002/jso.23418
  15. Kim JM, Losina E, Bono CM, Schoenfeld AJ, Collins JE, Katz JN, et al. : Clinical outcome of metastatic spinal cord compression treated with surgical excision ${\pm}$ radiation versus radiation therapy alone: a systematic review of literature. Spine (Phila Pa 1976) 37 : 78-84, 2012 https://doi.org/10.1097/BRS.0b013e318223b9b6
  16. Klimo P Jr, Thompson CJ, Kestle JR, Schmidt MH : A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol 7 : 64-76, 2005 https://doi.org/10.1215/S1152851704000262
  17. Kwok Y, Tibbs PA, Patchell RA : Clinical approach to metastatic epidural spinal cord compression. Hematol Oncol Clin North Am 20 : 1297-1305, 2006 https://doi.org/10.1016/j.hoc.2006.09.008
  18. Mantravadi RV, Skolnik EM, Applebaum EL : Complicationsof postoperative and preoperative radiation therapy in head and neck cancers. A comparative study. Arch Otolaryngol 107 : 690-693, 1981 https://doi.org/10.1001/archotol.1981.00790470038009
  19. Maranzano E, Trippa F, Chirico L, Basagni ML, Rossi R : Management of metastatic spinal cord compression. Tumori 89 : 469-475, 2003 https://doi.org/10.1177/030089160308900502
  20. Miller DJ, Lang FF, Walsh GL, Abi-Said D, Wildrick DM, Gokaslan ZL : Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection. J Neurosurg 92(2 Suppl) : 181-190, 2000 https://doi.org/10.3171/jns.2000.92.1.0181
  21. Riseborough EJ : Irradiation induced kyphosis. Clin Orthop Relat Res (128) : 101-106, 1977
  22. Roodman GD : Mechanisms of bone metastasis. N Engl J Med 350 : 1655-1664, 2004 https://doi.org/10.1056/NEJMra030831
  23. Sohn S, Kim J, Chung CK, Lee NR, Park E, Chang UK, et al. : A nationwide epidemiological study of newly diagnosed spine metastasis in the adult Korean population. Spine J 16 : 937-945, 2016 https://doi.org/10.1016/j.spinee.2016.03.006
  24. Sugimoto M, Takahashi S, Toguchida J, Kotoura Y, Shibamoto Y, Yamamuro T : Changes in bone after high-dose irradiation. Biomechanics and histomorphology. J Bone Joint Surg Br 73 : 492-497, 1991
  25. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T : Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26 : 298-306, 2001 https://doi.org/10.1097/00007632-200102010-00016
  26. Vrionis FD, Small J : Surgical management of metastatic spinal neoplasms. Neurosurg Focus 15 : E12, 2003

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