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Medium-Term Outcomes in Palliative Transpedicular Corpectomy With Cement-based Anterior Vertebral Reconstruction
Maroun Rizkallah1,2, Ghassan Boubez3, Jesse Shen3
1Department of Orthopedic Surgery, Dr. Georges-L-Dumont University Hospital, Moncton, New Brunswick, Canada.
Study Design:
Retrospective study.
Objective:
The aim of this study was to assess the outcomes of single-stage posterior transpedicular corpectomy with cement-based anterior column support for spinal metastasis at longer follow-ups.
Summary Of Background Data:
Life expectancy of cancer patients is constantly increasing. Reliable anterior column reconstruction after posterior corpectomy becomes necessary.
Materials And Methods:
In this retrospective monocentric study, patients who underwent posterior transpedicular corpectomy and cement-based anterior reconstruction, with a minimum 6 months follow-up, were included. Ambulatory status and Pain Visual Analog Score (PVAS), complication rates, and local sagittal Cobb angle (LSA) were evaluated preoperatively, postoperatively, and at the latest follow-up.
Results:
In total, 253 patients were included, with a mean follow-up of 21 months (6-132) and a median survival of 9 months. Preoperatively, 202 patients (81%) were ambulant, while 47 patients (19%) were not. At the latest follow-up, 241 patients (95%) were ambulant, while 12 patients (5%) were not ( P <0.001). Dorsal/lumbar PVAS went from 8.2±2.2 preoperatively to 5.2±1.7 postoperatively reaching 3.4±1.9 at the latest follow-up ( P <0.001). Mean LSA decreased from 13.2 (±5.78) degrees preoperatively to 6.11 (±8.51) degrees ( P <0.001) postoperatively and reached 7.56 (±7.55) degrees at the latest follow-up ( P =0.59). Complications occurred in 39 (15.4%) patients. One third of those were mechanical (rod/screw fracture, cement displacement) needing re-intervention in four patients (1.6%).
Conclusions:
The mechanical stability offered by the cement-based anterior reconstruction is maintained during the lifespan of patients operated for the spinal metastasis. Satisfying functional and radiologic outcomes observed at the last follow-up show that this lasting, cost sparing, and relatively simple reconstruction technique, is a valid alternative for the costly and more complicated cage-based reconstruction.
Level Of Evidence:
Level 4.
