Posterolateral corpectomy with pyramesh titanium cage reconstruction in dorsolumbar metastatic lesions

Abstract

Background dataThe vertebral column represents the most common bony site for metastasis with an incidence ranged from 30% to 70% in patients with metastatic neoplasms. The dorsal spine carries the highest frequent site for metastasis all over the vertebral column followed by the lumber spine. These metastatic lesions are clinical entities that often necessitate a complex spinal decompression and anterior reconstruction. Posterolateral approaches alone allow for excellent decompression with transpedicular fixation and safe visualization of the neural elements for corpectomy and reconstruction so we can avoid the complications that can happen with the staged surgery.PurposeOur aim in the study is to report cases and evaluate our approach for fixation and assess the postoperative period regarding pain improvement and neurological deficit.Study designA retrospective study included 26 patients presented to the Neurosurgery Department at Sohag University Hospital within 3 years, between August 2014 and August 2017. Evaluation was made through using the Quebec Back Pain Disability Scale and muscle power grading scale.Material and methodsTwenty-six patients with metastatic dorsolumbar spine lesions underwent a single-stage surgery by midline posterior approach. Posterior decompression with transpedicular fixation above and below the affected segment was done for all patients. Unilateral facetectomies and pediculectomy followed by corpectomy were done. Insertion of pyramesh titanium cage filled with iliac bone graft with tightness of the screws bilateral. Follow-up period was 6–12 months postoperatively.ResultsThe average age was 58.36 ± 5.96 (range 33–67) years. More than two-thirds of them were males (69.2%). Majority of the lesions were dorsal (77%). Postoperative infection was observed in four patients (15.4%) who improved by IV antibiotics and frequent dressing while CSF (cerebrospinal fluid) leak occurred in three patients (11.5%) who stopped after daily dressing, and we made CSF lumbar tap in one patient. Twenty-two patients showed neurological improvement postoperatively (84.6%). The remaining four were paraplegic with no improvement. Back pain improved for all cases.ConclusionPosterolateral approach alone is efficient and safe for dorsolumbar decompression and reconstruction in the metastatic spine.Trial registrationIRB#3747 registered on August 27, 2017