Springer Online Journal Archives 1860-2000
Summary Fifty-one consecutive patients with metastatic lesions of the cervical spine were treated surgically. The most common primary tumor types were breast cancer and myeloma. In 14 (27%) patients, the cervical lesion was the first manifestation of the malignancy. All patients suffered from severe pain but only six had long tract symptoms. Five tetraparetic patients were confined to bed. Vertebral body collapse occurred in 73% of cases. The surgical technique was individualized according to the patient's general condition, the site of metastasis on the vertebra, and the level and number of levels bearing in mind that the treatment is palliative in nature. The goal of treatment was a better quality of life. In the upper cervical spine the technique described by Sjöström et al. was used, if technically possible. If the odontoid process had been totally destroyed, an occipitocervical stabilization was chosen. In the lower cervical spine, an anterior approach was used to resect the tumor growth. Anterior support was provided with bone cement if the patient was not expected to survive long; otherwise bone grafting was used. In cases with two or more levels of involvement, a combined anteroposterior stabilization was usually performed. Good pain relief was achieved postoperatively. The operation was generally well-tolerated by the patients, mild dysphagia being the most common complaint. One patient died 2 days postoperatively of heart failure, giving a post-operative mortality of 2%. Rhizopathy symptoms were relieved totally in 15 patients and partially in 6. Five of six tetraparetic patients could walk postoperatively. Mechanical failures occurred three times, due to local progress of the metastatic lesion, which led to reoperation on two occasions. The average postoperative survival was 12 months. Patients with metastases from breast cancer or myeloma had the longest survival. Our study suggests that stabilization is important in the cervical spine when metastatic lesions jeopardize stability. Stabilization is effective in relieving pain and preventing paraplegia.
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