Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures

Object. Few reports are available on the use of pedicle screw fixation for cancer-related spinal instability. The authors present their experience wit h pedicle screw fixation in the management of malignant spinal column tumor s. Methods. Records for patients with malignant spinal tumors who underwent pe dicle screw fixation at the authors' institution between September 1994 and December 1999 were retrospectively reviewed. Results. Ninety-five patients with malignant spinal tumors underwent 100 surgeries involving pedicle scr ew fixation: metastatic spinal disease was present in 81 patients, and loca lly invasive tumors were demonstrated in 14 patients. Indications for surge ry were pain (98%) and/or neurological dysfunction (80%). A posterior (48%) or a combined anterior-posterior (52%) approach was performed depending on the extent of tumor and the patient's condition. At the mean follow up of 8.2 months, 43 patients (45%) had died; median survival, as determined by K aplan-Meier analysis, was 14.8 months. At 1 month postsurgery, self-reporte d pain had improved in 87% of cases (p < 0.001), which is a finding substan tiated by reductions in analgesic use, and 29 (47%) of 62 patients with pre operative neurological impairments were functionally improved (p < 0.001). Postoperative complications were associated only with preoperative radiatio n therapy (p = 0.002) and with preexisting serious medical conditions (p = 0.04). In two patients asymptomatic violation of the lateral wall of the pe dicle was revealed on postoperative radiography. The 30-day mortality rate was 1%. Conclusions. For selected patients with malignant spinal tumors, pedicle sc rew fixation after tumor resection may provide considerable pain relief and restore or preserve ambulation with acceptable rates of morbidity and mort ality.