Article
Instrumentation failures in patients with cervicothoracic spine tumors
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Published: | May 20, 2009 |
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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.