Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases Journal Article
| Authors: | Chakravarthy, V. B.; Hussain, I.; Laufer, I.; Goldberg, J. L.; Reiner, A. S.; Villavieja, J.; Newman, W. C.; Barzilai, O.; Bilsky, M. |
| Article Title: | Cervicothoracic junction instrumentation strategies following separation surgery for spinal metastases |
| Abstract: | OBJECTIVE The cervicothoracic junction (CTJ) is a challenging region to stabilize after tumor resection for metastatic spine disease. The objective of this study was to describe the outcomes of patients who underwent posterolateral decompression and instrumented fusion (i.e., separation surgery across the CTJ for instability due to metastatic disease). METHODS The authors performed a single-institution retrospective study of a prospectively collected cohort of patients who underwent single-approach posterior decompression and instrumented fusion across the CTJ for metastatic spine disease between 2011 and 2018. Adult patients (≥ 18 years old) who presented with mechanical instability, myelopathy, and radiculopathy secondary to metastatic epidural spinal cord compression (MESCC) of the CTJ (C7–T1) from 2011 to 2018 were included. RESULTS Seventy-nine patients were included, with a mean age of 62.1 years. The most common primary malignancies were non–small cell lung (n = 17), renal cell (11), and prostate (8) carcinoma. The median number of levels decompressed and construct length were 3 and 7, respectively. The average operative time, blood loss, and length of stay were 179.2 minutes, 600.5 ml, and 7.7 days, respectively. Overall, 58 patients received adjuvant radiation, and median dose, fractions, and time from surgery were 27 Gy, 3 fractions, and 20 days, respectively. All patients underwent lateral mass and pedicle screw instrumentation. Forty-nine patients had tapered rods (4.0/5.5 mm or 3.5/5.5 mm), 29 had fixed-diameter rods (3.5 mm or 4.0 mm), and 1 had both. Ten patients required anterior reconstruction with poly-methyl-methacrylate. The overall complication rate was 18.8% (6 patients with wound-related complications, 7 with hardware-related complications, 1 with both, and 1 with other). For the 8 patients (10%) with hardware failure, 7 had tapered rods, all 8 had cervical screw pullout, and 1 patient also experienced rod/screw fracture. The average time to hardware failure was 146.8 days. The 2-year cumulative incidence rate of hardware failure was 11.1% (95% CI 3.7%–18.5%). There were 55 deceased patients, and the median (95% CI) overall survival period was 7.97 (5.79–12.60) months. For survivors, the median (range) follow-up was 12.94 (1.94–71.80) months. CONCLUSIONS Instrumented fusion across the CTJ demonstrated an 18.8% rate of postoperative complications and an 11% overall 2-year rate of hardware failure in patients who underwent metastatic epidural tumor decompression and stabilization. ©AANS 2023, except where prohibited by US copyright law. |
| Keywords: | adolescent; adult; controlled study; middle aged; cancer surgery; retrospective studies; major clinical study; systemic therapy; cancer radiotherapy; nuclear magnetic resonance imaging; prospective study; bone morphogenetic protein; cohort analysis; diagnostic imaging; retrospective study; renal cell carcinoma; length of stay; decompression surgery; spinal cord compression; spinal neoplasms; operation duration; tumor; postoperative hemorrhage; wound dehiscence; spine metastasis; spinal cord disease; prostate carcinoma; spine surgery; spine tumor; single blind procedure; non small cell lung cancer; laminectomy; cervical vertebrae; thoracic vertebrae; complication; spine instability; spine oncology; radiculopathy; spine fusion; cervical; cervicothoracic junction; thoracic; bone screw; bone screws; hospital acquired pneumonia; humans; human; male; female; article; hardware failure; metastatic epidural spinal cord compression; adverse device effect; stereotactic spine radiosurgery; thoracic vertebra; cervical vertebra; hardware revision |
| Journal Title: | Journal of Neurosurgery |
| Volume: | 38 |
| Issue: | 4 |
| ISSN: | 0022-3085 |
| Publisher: | American Association of Neurological Surgeons |
| Date Published: | 2023-04-01 |
| Start Page: | 473 |
| End Page: | 480 |
| Language: | English |
| DOI: | 10.3171/2022.12.Spine22910 |
| PUBMED: | 36609370 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2023 -- Source: Scopus |
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