Artikel
Surgical treatment of spinal metastases of the thoracolumbar junction
Operative Versorgung spinaler Metastasen des thorakolumbalen Übergangs
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Spinal metastases of the thoracolumbar junction (TLJ) are common and pose a challenge for treatment due to the region’s anatomy and associated high rates of neurological deficits and postoperative complications. The aim of our study is to compare surgical strategies for TLJ metastases (Th11-L1) with respect to complexity and associated complications.
Methods: 88 patients were surgically treated with TLJ metastases in 2005-2020 at a tertiary neurosurgical care center. Spinal instability neoplastic score (SINS), clinical, surgical and outcome data were retrospectively analyzed. Patients were divided into 3 surgical groups: Decompression only (i), decompression and fusion (ii) and decompression and fusion with corpectomy (iii).
Results: 28 patients were decompressed (32%), 49 patients were treated with decompression and fusion (56%), and 11 patients received decompression and fusion combined with corpectomy (13%). In the median 5 vertebrae were instrumented in groups ii and iii, however with greatly varying range (3-9). Median SINS was 10 (i), 12 (ii) and 13 (iii). Preoperative neurological deficits were most common in patients treated with decompression (57%) and fusion (37%), whilst no deficits occurred in patients treated with corpectomy. Mechanical pain was common in all patients, but higher in patients treated with fusion (ii, iii 88-91% vs. i 61%). Mean duration of surgery was significantly shorter in group i (149min) compared to group ii (204min) and iii (189min). Surgical complications occurred in 14% (i), 6% (ii), and 14% (iii), mostly as surgical site infections. Mortality associated with surgery was 0%. No secondary Hardware failure (HwF) occurred at a median follow-up of 10 months independent of the number of fused segments.
Conclusion: In this cohort, patients with TLJ metastases received instrumentation +/- corpectomy in case of a potentially unstable and unstable SINS and presented with a higher rate of preoperative mechanical pain than patients treated with decompression alone. Patients treated with decompression showed a higher rate of other metastases, and more often neurological deficits. Surgical complication rate was moderate in all groups. With the fusion of in a median 5 vertebrae in potentially instable and instable TLJ metastases, no HwF occurred at a median follow-up of 10 months. Larger patient cohorts are necessary to define the actual number of segments that need to be fused to avoid HwF in metastases of the TLJ.