gms | German Medical Science

Objective: The thoracic spine is the most common site of metastatic spinal cord compression mostly due to infiltration by prostate, lung or breast cancer. Due to the palliative nature of the procedure and often reduced health status of the patients the extent of surgery in these cases is still a matter of debate. In case of spinal cord compression, we prefer a posterolateral corpectomy with posterior instrumentation over only dorsal decompression and stabilization or anterior transthoracic corpectomy. The aim of the present study was to critically assess outcome and complications of our treatment strategy to potentially optimise future interventions.

Methods: 20 patients, who were treated in our department from 2011 to 2015 and who were available for a minimum follow-up of 12 months, were included in this retrospective evaluation. The mean age was 57 (±16) years with a female to male ratio of 8 to 12. One- to four-level corpectomies were performed via a posterolateral approach followed by dorsal transpedicular instrumentation. The intraoperative loss of blood (LOB), red cell-transfusions (rcT), the length of operation (LOO) and the length of hospitalisation (LOH) were evaluated and correlated with postoperative outcome.

Results: The majority of our patients suffered from metastatic lesions, only two patients had a primary vertebral body tumour. The mean follow-up was 3.53 years (±1,33). An average of 1.35 (±0.81) thoracic vertebras were resected and as a routine the dorsal pedicle screw instrumentation involved two levels above and below the resection. All patients with metastatic lesions were admitted to radiotherapy postoperatively. The mean LOO was 307min (±124) and the mean LOB was 1616ml (±1611) with 2.6 (±3.38) rcT per patient used. All participants were transferred to the intensive care unit postoperatively with a mean ICU stay of 2.3 days. The mean LOH amounted to 12 days (±7). One patient required revision surgery due to a wound infection, which results in a postoperative complication rate of 5%. No implant-related failures or procedure-related death were observed. Four of our patients died within two years after the operation due to progression of primary disease.

Conclusion: Thoracic corpectomies in patients with metastatic or primary spine lesions are challenging procedures which are associated with a significant loss of blood, transfusion requirement and long hospitalisation time. Nevertheless, the posterolateral approach is associated with a low rate of surgery-related complications and encouraging local tumour control as suggested by satisfactory overall survival.