Feasibility of Using Short-Segment Instrumentation and Vertebral Body Reconstruction for the Treatment of Metastatic Disease in the Thoracic Spine.

Background/

Objectives

When performing a vertebrectomy in the thoracic spine for metastatic disease with a pathological fracture, traditionally, surgeons include two vertebral levels above and below in the instrumented fusion. We evaluated the safety and feasibility of an alternative method involving short-segment instrumentation after a posterior transpedicular thoracic vertebrectomy and reconstruction with pedicle screw fixation at only one level above and below.

Methods

We retrospectively reviewed our series of thirty consecutive patients treated for non-junctional (T2 to T11), single-level thoracic spinal metastasis via vertebrectomy and reconstruction with posterior short-segment instrumented fusion. The primary outcome was a need for reoperation due to construct failure. The secondary outcomes included local tumor recurrence, neurological function, pain scores, operative time, estimated blood loss, post-operative wound complications, and length of stay.

Results

All patients had a minimum Bilsky Grade of 2 and a minimum SINS (Spinal Instability Neoplastic Score) of 10. Two patients suffered perioperative complications, but there was no construct failure or need for revision surgery at any time during the follow-up period. No patients experienced worsening neurological function, and an overall improvement in pain was seen postoperatively (7.67 versus 2.77; p < 0.001; 95% CI: 4.28-5.52). The mean intraoperative blood loss was 605 mL (range, 50-1200 mL; SD, 314.7 mL), and the mean operative time was 260.73 min (range, 169 to 442 min; SD, 64.4 min). The average length of stay was six days. The median length of the follow-up was 24 months (range, 1-65 months; IQR, 12-42 months). Three patients in this cohort had local tumor recurrence (two of these patients suffered from a radioresistant tumor pathology).

Conclusions

Our results support the safety and feasibility of this less invasive technique in the management of patients suffering from metastatic disease requiring single-level vertebrectomy and reconstruction in the non-junctional thoracic spine.