Vertebral body replacement with a ceramic prosthesis for metastatic spinal tumors.

STUDY
DESIGN: This study retrospectively analyzed the clinical outcome of vertebral replacement surgery with our unique ceramic prosthesis for spinal metastases.
OBJECTIVES: To indicate the results of vertebral replacement surgery with a ceramic prosthesis. SUMMARY OF BACKGROUND DATA: Spinal metastasis often involves the vertebral bodies, of which abnormal fracture causes intractable pain and paresis. For such conditions, laminectomy or irradiation can have no effect because they do not improve spinal stability. Autogenous bone or bone cement are not durable materials, and fatigue fracture of the implanted material occasionally occurs. We developed a simple prosthesis made of alumina ceramic, a bioinert material, to replace the affected vertebrae. There has not been such a large study to assess vertebral replacement surgery with a ceramic prosthesis.
METHODS: From 1972 to 1993, 90 ceramic prostheses were used in 84 patients with spinal metastasis, and the average follow-up period was 26.2 months. The primary tumor was thyroid cancer in 13 patients, breast cancer in 12, multiple myeloma in eight, renal cell cancer in eight, gastrointestinal cancer in eight, and lung cancer in eight. The clinical symptoms were assessed before and after surgery, and the maintenance of operative gain was investigated.
RESULTS: Pain relief was achieved in 94%, motor function improved in 81%, and ambulation recovered in 64%. There were no serious complications associated with the procedure, and the operative benefit was maintained until the terminal stage in the vast majority of patients.
CONCLUSIONS: In selected patients, vertebral replacement using our prosthesis proved to be a useful procedure, effectively managing the severe spinal pain or neurologic deficits associated with vertebral body destruction.