gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Instrumentation failures in patients with cervicothoracic spine tumors

Meeting Abstract

  • M. Setzer - H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program and Department of Neurosurgery, University of South Florida College of Medicine, Tampa, USA
  • L. Robinson - H. Lee Moffitt Cancer Center and Research Institute, Thoracic Oncology Program, University of South Florida College of Medicine, Tampa, USA
  • K. Sommers - H. Lee Moffitt Cancer Center and Research Institute, Thoracic Oncology Program, University of South Florida College of Medicine, Tampa, USA
  • G. Marquardt - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Deutschland
  • V. Seifert - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Deutschland
  • F. Vrionis - H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program and Department of Neurosurgery, University of South Florida College of Medicine, Tampa, USA

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP03-09

DOI: 10.3205/09dgnc280, URN: urn:nbn:de:0183-09dgnc2806

Veröffentlicht: 20. Mai 2009

© 2009 Setzer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Tumors that span the cervicothoracic (C-T) junction frequently pose a surgical challenge with regard to approach, resection, type and extent of instrumentation. Although a variety of reconstructive options exist for the C-T junction (transitional rods, plates, hooks, various diameter rod and screw constructs), there is unclarity as to which method yields the best results and has the least chance of early and/or delayed failure.

The objective of this study was to compare the complication types and rates after reconstruction of the C-T spine after tumor resection in patients with C-T spine metastases and Pancoast tumors.

Methods: 60 patients with C-T junction tumors treated surgically were analyzed retrospectively. Of these, 30 patients underwent surgery with curative intent for Pancoast tumors, and 30 patients underwent palliative intralesional resection for metastatic tumors.

Results: En bloc resection was performed in 25 of 30 patients with Pancoast tumors (83%), whereas all patients of the metastasis group underwent intralesional resections. 15 of 30 Pancoast patients (50%) and 28 of 30 patients with palliative resections (93%) needed spinal instrumentation (p<0.001) (OR metastasis/instrumentation 5.5, 95% CI 1.4–20.7).

4 major complications (3 junctional kyphoses, 1 subclavian thrombosis) were seen in the Pancoast group (13.3%), vs. 5 major complications (1 junctional kyphosis, 1 misplaced screw, 1 chylothorax, 2 hardware failures) in the metastasis group (16.6%, p<0.71). All complications occurred in patients with instrumentation in both Pancoast tumor and metastasis groups. There was no perioperative mortality.

Conclusions: C-T tumors frequently require instrumentation and fusion. Complications are more frequent in patients who undergo C-T instrumentation. Patients with Pancoast tumors should therefore be carefully screened pre-operatively for the need of spinal instrumentation.