Posterior stabilization strategies following resection of cervicothoracic junction tumors: Review of 90 consecutive cases Journal Article

  

Authors:	Placantonakis, D. G.; Laufer, I.; Wang, J. C.; Beria, J. S.; Boland, P.; Bilsky, M.
Article Title:	Posterior stabilization strategies following resection of cervicothoracic junction tumors: Review of 90 consecutive cases
Abstract:	Object. In this retrospective analysis the authors describe the assessment and outcomes of 90 patients who underwent placement of posterior instrumentation at the cervicothoracic junction following the resection of a primary or metastatic tumor during a 10-year period. Methods. All patients underwent a posterolateral laminectomy including uni- or bilateral facetectomy, and 44 patients additionally required vertebral body resection and reconstruction. In patients who underwent C-6 or C-7 decompression, the posterior instrumentation strategies changed from the use of lateral mass plate systems (LMPSs) to lateral mass screw/rod systems (LMSRSs). Similarly, for T1-3 tumor decompression, the strategy shifted from sublaminar hook/rod systems (SHRSs) to the use of pedicle screw systems (PSSs) in which the surgeon used either a 6.25-mm rod or dual-diameter rods with or without a connector. Results. The overall surgical complication rate was 19% including fixation failure in 11 patients (12%), 6 of whom required reoperation. Fixation failure rates for cervical decompression decreased from 2 (29%) of 7 patients in the LMPS group to 0 (0%) of 8 in the LMSRS group (p = 0.2). The fixation failure rates for thoracic decompression were 7 (15%) of 48 patients in the SHRS group, and there was a decrease to 2 (7%) of 27 in the PSS group (p = 0.48). Neurological and functional outcomes including American Spinal Injury Association, Eastern Cooperative Oncology Group, and Medical Research Council muscle strength and pain scores remained stable or improved in 94, 96, 100, and 96% of patients, respectively. Conclusions. Current posterior instrumentation strategies involving LMSRSs and PSSs provide excellent and safe stabilization of the cervicothoracic junction following resection of primary or metastatic tumors.
Keywords:	adult; treatment outcome; middle aged; cancer surgery; primary tumor; retrospective studies; major clinical study; outcome assessment; metastasis; pain; deep vein thrombosis; retrospective study; lung embolism; postoperative complication; postoperative complications; medical instrumentation; clinical study; decompression surgery; spinal cord tumor; decompression, surgical; spinal neoplasms; surgeon; reoperation; disease duration; safety; decision making; health care organization; wound infection; pain assessment; wound dehiscence; thorax tumor; aspiration pneumonia; cerebrovascular accident; spine tumor; vertebra; laminectomy; thorax; cervical vertebrae; thoracic vertebrae; kyphosis; vertebra body; spinal cord decompression; cervical spine; epidural hematoma; cervical spinal cord; orthopedic equipment; spine stabilization; cervicothoracic junction; muscle strength; epidural compression; lateral mass screw; metastatic tumor; pedicle screw; cervicothoracic junction tumor; fixation failure; bone screw; bone screws
Journal Title:	Journal of Neurosurgery
Volume:	9
Issue:	2
ISSN:	0022-3085
Publisher:	American Association of Neurological Surgeons
Date Published:	2008-08-01
Start Page:	111
End Page:	119
Language:	English
DOI:	10.3171/spi/2008/9/8/111
PUBMED:	18764742
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-52449129596&partnerID=40&md5=8d22f35a6f3c14efc119168b41c90e6d
Notes:	--- - "Cited By (since 1996): 5" - "Export Date: 17 November 2011" - "Source: Scopus"

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