Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine.

Metastatic lesions involving the spine may cause vertebral body collapse, resulting in either spinal instability or neural compression, or both. Progressive destruction of the vertebral body by the tumor may cause increasing spinal instability, leading to a kyphotic deformity and further neural deficit. Anterior decompression allows direct excision of the tumor focus and direct neural decompression. Because of postoperative irradiation, conventional bone grafts are rarely incorporated. Over an 8-year period, 52 patients with spinal instability secondary to metastatic pathological fractures of one or more vertebrae underwent anterior decompression and stabilization by replacement of the affected vertebral bodies with methyl methacrylate, polymerizing in situ. No postoperative external support was required, and the acrylic fixation achieved by this method was not affected adversely by subsequent irradiation to a mean of 4020 rads. Forty patients had major neurological impairment preoperatively and required anterior spinal cord and/or nerve root decompression prior to fixation. Of these, 21 had complete neurological recovery postoperatively, 13 others were improved significantly, five remain unchanged, and one patient deteriorated neurologically. There were three cases with failure of fixation. Seven other patients did not benefit from the procedure because of specific complications or the advanced state of their disease. The remaining 42 patients had good relief of pain and restoration of spinal stability, which did not deteriorate during the follow-up period, ranging from 6 to 100 months postoperatively.