Vertebral replacement with Harms' titanium cage in spinal metastases.

Objective: Vertebral metastases are quiet common and may result in vertebra l collapse, spinal instability, and progressive neurological compromise. An anterior approach is the accepted method for decompression and stabilizati on by vertebral replacement. There is still need for discussion regarding t he material of the replacement device. Here, the authors report on Harms' t itanium cage (DePuy-Motech) for vertebral replacement. Methods: From 1992 u ntil 1995 17 patients with spinal metastases were treated by anterior verte bral replacement at the Orthopaedic Department, University of Magdeburg. In dications for the procedure were single metastases and respectivety, progre ssive neurological deficit with vertebrat destruction seen radiologically. Implantation of the cage was performed solely or in combination with anteri or or posterior instrumentation. Pre- and postoperative assessments were ev aluated by clinical scores. Results: Mean follow-up was 9.3 months. At the end of our study 11 patients had died (mean survival 6.7 months). Mean foll ow-up of the surviving 6 was 9.8 months. Patient's daily activity (Karnofsk y) improved in 8 cases, became worse in 4 cases, and did not change in 5 ca ses. Neurologically (Frankel) there was improvement in 3 patients, deterior ation in 4 patients, and no change in 10 patients. Walking ability showed i mprovement in 6 cases, deterioration in 3 cases and no change in 8 cases. R elief of pain (Moskowitz) was reported by 12 patients, no patient complaine d of increasing pain, 5 patients reported no change, and 10 patients were p ain-free. Conclusion and clinical relevance: In most cases with spinal meta stases, the quality of life may be improved by vertebral replacement with H arms' titanium cage. Amelioration of clinical symptoms such as neurological deficit, pain, and tack of walking ability occurred in most patients.