Stefan M Knoeller1, Oliver Huwert, Tilman Wolter. 1. Department of Orthopaedic and Trauma Surgery, University Hospital Freiburg, Hugstetter Str 55, 79106 Freiburg, Germany. Stefan.knoeller@uniklinik-freiburg.de
Abstract
PURPOSE: Corpectomy and implantation of titanium cages is standard in pathological fracture treatment but additional single ventral instrumentation remains controversial with regard to rotational stability. METHODS: This study included 45 patients suffering from vertebral metastases with spinal stenosis, instability and/or neurological deficits secondary to pathological lumbar spine fractures and bone mineral density (BMD) ≥ 1.20 g/cm(2). The clinical results of a single stage anterior decompression with corpectomy defect restoration with titanium cage and single double rod system in patients were evaluated at mean 36 months postoperatively with follow-up neurological and radiological exams at three months then every six months. Evaluation of neurological recovery included grading following a modified Frankel scale. Contentment, disability and actual pain were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). BMD was measured using dual-energy X-ray absorptiometry (DXA). RESULTS: Postoperative neurological evaluations showed improvement in all patients. In the radiological follow-up in 40 patients (89%) findings were similar compared to the postoperative control. In five patients (11%) a loss of correction at a mean of 8° degrees (Cobb angle) secondary to cage subsidence occurred. No breakage of the device or displacement of the instrumentation was seen. Overall the Frankel scale improved 0.65 points (p < 0.05) and the ODI improved 40.69 points (p < 0.05). CONCLUSIONS: In lumbar spine fractures of metastatic origin with stenosis, instability and/or neurological deficit, a single stage ventral decompression and instrumentation in patients with BMD ≥ 1.20 g/cm(2) should be considered.
PURPOSE: Corpectomy and implantation of titanium cages is standard in pathological fracture treatment but additional single ventral instrumentation remains controversial with regard to rotational stability. METHODS: This study included 45 patients suffering from vertebral metastases with spinal stenosis, instability and/or neurological deficits secondary to pathological lumbar spine fractures and bone mineral density (BMD) ≥ 1.20 g/cm(2). The clinical results of a single stage anterior decompression with corpectomy defect restoration with titanium cage and single double rod system in patients were evaluated at mean 36 months postoperatively with follow-up neurological and radiological exams at three months then every six months. Evaluation of neurological recovery included grading following a modified Frankel scale. Contentment, disability and actual pain were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). BMD was measured using dual-energy X-ray absorptiometry (DXA). RESULTS: Postoperative neurological evaluations showed improvement in all patients. In the radiological follow-up in 40 patients (89%) findings were similar compared to the postoperative control. In five patients (11%) a loss of correction at a mean of 8° degrees (Cobb angle) secondary to cage subsidence occurred. No breakage of the device or displacement of the instrumentation was seen. Overall the Frankel scale improved 0.65 points (p < 0.05) and the ODI improved 40.69 points (p < 0.05). CONCLUSIONS: In lumbar spine fractures of metastatic origin with stenosis, instability and/or neurological deficit, a single stage ventral decompression and instrumentation in patients with BMD ≥ 1.20 g/cm(2) should be considered.
Authors: Christoph Wipplinger; Sara Lener; Christoph Orban; Tamara M Wipplinger; Anto Abramovic; Anna Lang; Sebastian Hartmann; Claudius Thomé Journal: Acta Neurochir (Wien) Date: 2022-06-11 Impact factor: 2.816