Comparing Vertebral Body Reconstruction Implants for the Treatment of Thoracic and Lumbar Metastatic Spinal Tumors

Abstract

Retrospective case series. To compare different interbody reconstruction implants after corpectomy in metastatic spine tumors. Vertebral body reconstruction after corpectomy is common for patients with metastatic spine tumors. Although various implants are reported individually in the literature, no study to-date has compared them with one another directly. Thirty-seven consecutive patients with metastatic tumors of the thoracic or lumbar spine underwent single or multilevel corpectomy with subsequent interbody reconstruction. Longevity of interbody graft was primarily evaluated in this study as defined by the need for any revision surgeries or complications after surgery. Data was collected retrospectively. Twenty-seven, 5, and 5 patients underwent reconstruction with metal implants, bone implants, and polymethylmethacrylate (PMMA), respectively. Twenty-three patients had metastatic tumor involvement of the thoracic spine and 14 patients had tumor involvement of the lumbar spine. Three patients (8.1%) required additional surgery: 1 wound infection, 1 hardware revision, and 1 for resection of an intradural, intramedullary tumor not identified at the first operation. Overall complication rate was 43.2% (16 patients) and 2 patients died within 30 days of their index spine surgery. Postoperative complication rates were more than double in the metal implant group (52%) compared with an equal number of complications in bone (20%) and PMMA (20%) implant group. The rate of revision surgery was highest in the bone group (40%) compared with none in the PMMA and only 3.7% in the metal interbody groups. Vertebral body reconstruction after corpectomy for patients with metastatic tumors to the thoracic and lumbar spine can be performed effectively with metal, bone, or cement implants. Although metal implants are used in the majority of reconstruction cases, they seem to have a higher rate of overall complications, with bone interbody constructs showing a higher rate of revision surgery.