gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Management of spinal metastasis: Indications, strategy and technical considerations

Management des spinalen Metastasis: Anzeigen, Strategie und technische Betrachtungen

Meeting Abstract

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  • corresponding author R. Assaker - Clinique de Neurochirurgie, Hôpital Roger Salengro, Lille, France
  • M. Allaoui - Clinique de Neurochirurgie, Hôpital Roger Salengro, Lille, France
  • H. Vieillard - Clinique de Neurochirurgie, Hôpital Roger Salengro, Lille, France

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.02.09

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Veröffentlicht: 11. April 2007

© 2007 Assaker et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Spinal metastasis represents a challenging problem in terms of patients selection and choice of the surgical technique. The metastatic spinal lesions mostly affect the vertebral body and pedicle. Management of spinal metastases remains controversial. The role of decompressive laminectomy without stabilization has been questioned. The involvement of Vertebral Body and anterior compression had led to an increasing attention to anterior decompressive procedures, reconstruction and stabilization. Indication and surgical strategy are based on the Tokuhashi scoring. Surgery will be palliative for a score between 0 to 8 and excisionnal between 11 to 15.

Methods: We present a series of 50 patients operated on for spinal metastasis with a tokuhashi score >11. All underwent a combined first posterior and second anterior approach for large corpectomy and circumferential stabilisation using pedicle screw fixation posteriorly and vertebral cage anteriorly with or without plating. Posterior stabilisation consisted of a short segment fixation one level above and below the metastatic vertebrae. Anterior reconstruction was performed in a video-assisted minimal invasive approach with an expandable vertebral cage to replace the vertebral body. Expandable cylindrical cages have been utilized successfully to reconstruct the thoracic and lumbar spine. Their advantages include ease of insertion, reduced endplate trauma, direct application/maintenance of interbody distraction force, and one-step kyphosis correction. The implant is filled with cement and usually associated to an anterior plate. All the patients had radiation therapy focused on the level of the metastasis. The morbidity, the hospital stay and complications are presented. Technical issues are discussed.

Results: The preliminary results support the front and back stabilisation in the treatment of patients with spinal metastasis. No significant subsidence was noted, and pain and functional scores improved in all cases. Overall survival rates were comparable to the series described in the literature; the post-operative morbidity and preservation of the neurological status and function were satisfactory.

Conclusions: The combined front and back approach to a good prognostic metastasis seems adequate and appropriate to ensure reliable, safe stabilisation and neurological protection for these patients during their survival period.