VERTEBRAL BODY REPLACEMENT WITH A CERAMIC PROSTHESIS FOR METASTATIC SPINAL TUMORS

Study Design. This study retrospectively analyzed the clinical outcome of vertebral replacement surgery with our unique ceramic prosthesis f or spinal metastases. Objectives. To indicate the results of vertebral replacement surgery with a ceramic prosthesis. Summary of Background Data. Spinal metastasis often involves the vertebral bodies, of which abnormal fracture causes intractable pain and paresis. For such condit ions, laminectomy or irradiation can have no effect because they do no t improve spinal stability. Autogenous bone or bone cement are not dur able materials, and fatigue fracture of the implanted material occasio nally occurs. We developed a simple prosthesis made of alumina ceramic , a bioinert material, to replace the affected vertebrae. There has no t been such a large study to assess vertebral replacement surgery with a ceramic prosthesis. Methods. From 1972 to 1993, 90 ceramic prosthes es were used in 84 patients with spinal metastasis, and the average fo llow-up period was 26.2 months. The primary tumor was thyroid cancer i n 13 patients, breast cancer in 12, multiple myeloma in eight, renal c ell cancer in eight, gastrointestinal cancer in eight, and lung cancer in eight. The clinical symptoms were assessed before and after surger y, and the maintenance of operative gain was investigated. Results. Pa in relief was achieved in 94%, motor function improved in 81%, and amb ulation recovered in 64%. There were no serious complications associat ed with the procedure, and the operative benefit was maintained until the terminal stage in the vast majority of patients. Conclusions. In s elected patients, vertebral replacement using our prosthesis proved to be a useful procedure, effectively managing the severe spinal pain or neurologic deficits associated with vertebral body destruction.