Anterior Approach Surgery Research Articles

Metastatic spinal tumors

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.

A Study of the Factors which influence the Postoperative Long-Term Follow-up Results of cervical Spondylotic Myelopathy a comparison of the anterior and the posterior approaches

The purpose of this paper is to describe the factors which influence the postoperative long-term results of cervical spondylotic myelopathy.In this report, 128 patients were studied. There were 86 males and 42 females. The mean age of this group of patients was 50 years with a range from 28 to 72 years. Ninety-one patients underwent anterior approach operation and 37 patients did posterior approach operation. The duration of follow-up varied from 5 years to 29 years, the average being 10 years. The follow-up results were divided into five groups according to the Japanese Orthopaedic Association Score: excellent, good, fair, unchanged and worse. Each group was evaluated with regard to 15 major factors: age, sex, dysfunction of extremities, type of myelopathy, urinary bladder dysfunction, ROM of neck, antero-posterior diameter of cervical canal, cervical lordosis, the number of involved cervical discs, surgical method and so on.The main results found in this study were as follows:1) The results at the time of final follow-up were excellent and good in 76% in the anterior approach, and in 65% in the posterior approach.2) Long-term results were influenced by the factors of the age and the duration of symptoms in the anterior and the posterior approach operation.3) In the posterior approach operation, the cervical lordosis was an important factor whether patients have good prognosis or not.These results show that our operative indication in anterior and posterior approaches is appropriate, Namely anterior approach is better than the posterior approach in less than three involved discs and the posterior approach is better than the anterior approach in more than three involved discs and narrow cervical canal. In patients with local kyphosis, anterior approach is better according to results of this study.