gms | German Medical Science

Objective: The goal of surgery in patients with either spinal tumors and metastasis or unstable compression fractures is local cure, decompression of the spinal cord and stabilization of the spine. Therefore, a combination of different approaches can be used. For that reason we present our prospectively collected data of patients who received vertebrectomy and posterior spinal fixation through a single posterior approach.

Methods: Eighteen consecutive patients were treated at our department between 2004 and 2008 for thoracic vertebral metastasis (14), chondrosarcoma (1) and fractures (3). Neurological impairment was evaluated using the Frankel scale pre- and postoperatively. As well, ASA score, duration of operation, days of hospital stay, pre- and postoperative images, and complications related to surgery were analyzed. The stepwise procedure included bony and tumor decompression, implantation of pedicle screws in the adjacent levels, costotransversectomy, vertebral body resection/replacement with an expandable cage, and posterior fixation of pedicle screws.

Results: The average age was 64.9 years (ranging from 49–79). There were 12 male and 6 female patients. ASA score was 3 in 17 and 2 in 1 patient. The levels T 2 (4) and 4 (4) were affected in most of the patients. Complete vertebral body resection and replacement (expandable cages ADD or Obelisc; Ulrich medical^®, Germany) via a bilateral costotransversectomy was performed in 6 patients, the remaining 12 patients received a subtotal resection via a unilateral approach. In one patient two levels were treated. Pedicle screw navigation was done in 13 patients. Mean time of surgery was 278.7 min (range, 150–633). Postoperative imaging revealed 3 dislocations of a cage. However, surgical revision of the device was only required in one patient. One patient demonstrated a CSF fistula and two patients wound healing problems. One patient died 14 days after surgery not related to the procedure. Hospital stay ranged between 6 and 22 days (mean 11.6). Preoperative Frankel scale (B: 1, C: 7, D: 1, E: 9) did improve in 7 patients. Follow-up was available for 13 patients (mean 6.8 months). One patient died after 15 month.

Conclusions: The vertebral body replacement with expandable cages via a costotransversectomy combined with a posterior fixation technique through a single posterior approach is feasible. Surgical relevant complications occurred in 16.7%. The technique is reliable and an alternative to a transcavitary approach.