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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Surgical treatment of spinal metastases of the cervicothoracic junction

Operative Versorgung spinaler Metastasen des zervikothorakalen Übergangs

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  • presenting/speaker Vanessa Hubertus - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Michelle Mariño - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Arthur Wagner - Technische Universität München, Neurochirurgie, München, Deutschland
  • Nicole Lange - Technische Universität München, Neurochirurgie, München, Deutschland
  • Ann-Kathrin Jörger - Technische Universität München, Neurochirurgie, München, Deutschland
  • Jens Gempt - Technische Universität München, Neurochirurgie, München, Deutschland
  • Björn Sommer - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Sven Oliver Eicker - Universitätsklinikum Hamburg-Eppendorf, Neurochirurgie und Universitäres Wirbelsäulenzentrum, Hamburg, Deutschland
  • Martin Stangenberg - Universitätsklinikum Hamburg-Eppendorf, Unfallchirurgie und Universitäres Wirbelsäulenzentrum, Hamburg, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Julia Onken - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Bernhard Meyer - Technische Universität München, Neurochirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV122

doi: 10.3205/20dgnc124, urn:nbn:de:0183-20dgnc1240

Published: June 26, 2020

© 2020 Hubertus et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Spinal metastases of the cervicothoracic junction pose a challenge for treatment due to the region’s anatomical condition, their rarity and a high complication rate. The aim of our multicentric study is to compare surgical strategies for metastases of this anatomical region(C7-Th2) with respect to their complexity and associated complications.

Methods: 216 patients were surgically treated with spinal metastases of segments C7-Th2 in 2005-19 in 4 university neurosurgical units in Germany. Spinal instability neoplastic score (SINS), clinical and operation data were assessed. Patients were divided into 4 surgical groups: Patients with high comorbidities were only decompressed (1), decompression and instrumentation from dorsal (2) or ventral (3) was performed in case of instability according to SINS and dependent on location of myelon compression (2/3). A 360° ventro-dorsal instrumentation was performed in extensive lytic lesions and in patients with lower comorbidity rate (4).

Results: 33 patients were included in (1) (15%), 114 patients were included in (2) (53%), 16 patients received treatment in (3) (7%) and 53 patients received treatment in (4) (25%). Medium SINS was (1) 7, (2) 10 and (3+4) 12. In (1-2) patients presented with worse neurological function than in (3-4), whereas in (1) systemic tumor burden was highest. In (3-4) 83-89% suffered from mechanical pain, in (1) 45%. The mean duration of surgery was (1) 144 min, (2) 229min, (3) 187min and (4) 308min. Surgical complications occurred in (1) 11%, (2) 32%, (3) 25% and (4) 15%, mostly being internistic. Mortality associated with surgery was 0%. Hardware failure (HwF) occurred exclusively in (2) and led to surgical revision in 6 cases. HwF occurred exclusively in monocortically placed massa lateralis screws (mMLS) in the cervical spine. In case of bicortical massa lateralis screws (bMLS) or pedicle screws (PS), no HwF was observed at 10 months follow up.

Conclusion: The biomechanical loading capacity of dorsal instrumentation alone seems to have a decisive influence on the revision rate in metastases of the cervicothoracic junction. In patients with favorable comorbidity rate, the continuous extension of life expectancy through new therapy options should play a crucial role in choosing the right surgical strategy. Hereby, special attention should be paid to the biomechanical properties of the cervicothoracic junction, with 360° stabilization and placement of bMLS or PS preferable to mMLS in our multicentric cohort.