INDICATIONS AND RESULTS OF COMBINED ANTERIOR-POSTERIOR APPROACHES FORSPINE TUMOR SURGERY

Spinal instrumentation currently allows gross-total resection and reco nstruction in cases of malignancies at all levels of the spine. The au thors analyzed the results in 110 patients who underwent surgery for p rimary and metastatic spinal tumors over a 5-year period (1989-1993) a t a single institution. Major primary sites of tumor included breast ( 14 cases), chordoma (14 cases), lung (12 cases), kidney (11 cases), sa rcoma (13 cases), plasmacytoma (10 cases), and others (36 cases). Prio r to surgery, 55 patients (50%) had received prior treatment. Forty-ei ght patients (44%) were nonambulatory, and severe paraparesis was pres ent in 20 patients. Fifty-three patients (48%) underwent combined ante rior-posterior resection and instrumentation, 33 (30%) underwent anter ior resection with instrumentation, 18 (16%) underwent anterior or pos terior resection alone, and the remaining six patients (5%) underwent posterior resection and instrumentation. Major indications for anterio r-posterior resection included three-column involvement, high-grade in stability, involvement of contiguous vertebral bodies, and solitary me tastases. Postoperatively, 90 patients improved neurologically. The ov erall median survival was 16 months, with 46% of patients surviving 2 years. Fifty-three patients (48%) suffered postoperative complications . Despite the high incidence of complications, the majority of patient s reported improvement in their quality of life at follow-up review. O ur findings suggest that half of all patients with spinal malignancies require combined anterior-posterior surgery for adequate tumor remova l and stabilization.