Abstract
ABSTRACTOBJECTIVE: To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patientsMETHODS: This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformitiesRESULTS: One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgeryCONCLUSION: The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study.
Highlights
The spine is the most common site of metastatic bone disease, especially in patients with breast, lung or prostate cancer. 1 In autopsy studies, it can reach up to 90% of cases
Despite the importance of arthrodesis in other spine diseases, its effectiveness is questionable in the metastatic disease of the spine: bone healing capacity is impaired by the effect of adjuvant radiation therapy, malnutrition and chemotherapeutic drugs.[6,7]
If the rate of mechanical complications related to fixation without fusion is low, the possibility of using percutaneous fixation systems for spine stabilization is increased, with the potential reduction of surgical morbidity. 9,10 The objective of this study was to describe the rate of mechanical complications in the surgical treatment of spinal metastases in patients with spinal cord compression by metastatic solid tumors that underwent decompression and fixation with posterior approach without arthrodesis
Summary
The spine is the most common site of metastatic bone disease, especially in patients with breast, lung or prostate cancer. 1 In autopsy studies, it can reach up to 90% of cases. The role of surgery is well established in the treatment of patients with high-grade spinal cord compression due to solid tumor.[2,3] It is indicated for patients without spinal cord compression, but with pain due to mechanical instability.[4] In the presence of instability, with or without spinal cord compression, surgery should be performed with spine fixation to ensure mechanical stability. It can be done via posterior way, anterior way, or combination of both. If the rate of mechanical complications related to fixation without fusion is low, the possibility of using percutaneous fixation systems for spine stabilization is increased, with the potential reduction of surgical morbidity. 9,10 The objective of this study was to describe the rate of mechanical complications in the surgical treatment of spinal metastases in patients with spinal cord compression by metastatic solid tumors that underwent decompression and fixation with posterior approach without arthrodesis
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