TRANSTHORACIC VERTEBRECTOMY FOR METASTATIC SPINAL TUMORS

Object. Anterior approaches to the spine for the treatment of spinal t umors have gained acceptance; however, in most published reports, pati ents with primary, metastatic, or chest wall tumors involving cervical , thoracic, or lumbar regions of the spine are combined. The purpose o f this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, r econstruction, and stabilization for spinal metastases that are limite d to the thoracic region. Methods. Outcome is presented for 72 patient s with metastatic spinal tumors who were treated by transthoracic vert ebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, brea st cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine pa tients. The most common presenting symptoms were back pain, which occu rred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy , decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posteri or instrumentation was required in seven patients with disease involvi ng the cervicothoracic or thoracolumbar junction, which was causing se vere kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p < 0.001) bas ed on visual analog scales and narcotic analgesic medication use. Thir ty-five of the 46 patients who presented with neurological dysfunction improved significantly (p < 0.001) following the procedure. Thirty-th ree patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have w eakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surg ery and three were still unable to walk but showed improved motor func tion. Twenty-one patients had complications ranging from minor atelect asis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-ye ar survival rate for the entire study population was 62%. Conclusions. These results suggest that transthoracic vertebrectomy and spinal sta bilization can improve the quality of life considerably in cancer pati ents with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbid ity and mortality.