Outcomes of Corpectomy in Patients with Metastatic Cancer

The objective of surgical management of spinal metastases is to reduce pain and improve the patient's quality of life. The operation should restore spinal stability and decompress neural structures. One surgical technique is corpectomy followed by vertebral body reconstruction and stabilisation of the spine. The procedure may be performed in patients in overall good health and a good survival prognosis. The aim of this paper is to present the outcomes of surgical management of spinal metastases in patients who underwent corpectomy followed by vertebral body reconstruction and stabilisation of the spine.

The aim of the study was achieved by analysing medical histories of 124 patients with spinal metastases treated in the Oncological Orthopaedics Department in Brzozów in the period 2010-2015. The majority of patients in the group were women, who represented 64% of all the subjects. The average age was 63 years for women and 67 for men. The metastases were most frequently produced by breast cancer (36%) and myeloma (22%). A total of 87% of the group were diagnosed with pathologic fractures and 92% had spinal instability. Stenosis of the spinal canal was found in 78% of the patients. The surgeries were performed in 18 persons with metastases to the cervical spine, 69 patients with metastases to the thoracic spine and 37 participants with metastases to the lumbar spine. Single-level corpectomies were performed in 83 patients and multilevel corpectomies in 41 persons. Parameters analysed comprised overall health condition, neurological function (the Frankel Grade) and performance status (the Karnofsky score) of the patients. A VAS was used to assess the intensity of pain. The course of the operation and complications were also analysed.

Following the surgeries, the average VAS pain score decreased from 7.2 to 3.8. Performance improved from a Karnofsky score of 50.26 to 68.65. Neurological function improved in 21 out of 34 patients with pareses. The average duration of the surgery was 67 minutes for the cervical spine, 123 minutes for the thoracic spine and 112 minutes for the lumbar spine. The loss of blood was strongest for lumbar spine surgeries, amounting on average to 580 ml. 62% of patients required transfusion ofblood substitutes after the operation. The average hospitalisation time was 14 days, with a minimum and maximum duration of 7 and 24 days, respectively. The most common complication was damage to the endplate of the vertebra adjacent to the prosthesis (11%). Two patients developed complete and irreversible paralysis of lower limbs.

1. Corpectomy followed by vertebral body reconstruction should be used in patients with a good prognosis. 2. Therapeutic outcomes are good. The surgery produced a considerable reduction in pain and improvement in performance in the majority of patients. 3. Complications are not frequent. The most common complication is intrusion of the implant into the endplate of the adjacent vertebrae. 4. A high survival rate at one year after the surgery, exceeding 90% of the patients, is evidence of effectiveness of the treatment and appropriate qualification of patients for the operation.