Journal of Korean Neurosurgical Society

  • 제56권4호
  • /
  • Pages.323-329
  • /
  • 2014
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Clinical Significance of Radiological Stability in Reconstructed Thoracic and Lumbar Spine Following Vertebral Body Resection

  • Sung, Sang-Hyun (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences) ;
  • Chang, Ung-Kyu (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences)
  • 투고 : 2014.02.18
  • 심사 : 2014.09.29
  • 발행 : 2014.10.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Vertebral body replacement following corpectomy in thoracic or lumbar spine is performed with titanium mesh cage (TMC) containing any grafts. Radiological changes often occur on follow-up. This study investigated the relationship between the radiological stability and clinical symptoms. Methods : The subjects of this study were 28 patients who underwent corpectomy on the thoracic or lumbar spine. Their medical records and radiological data were retrospectively analyzed. There were 23 cases of tumor, 2 cases of trauma, and 3 cases of infection. During operation, spinal reconstruction was done with TMC and additional screw fixation. We measured TMC settlement in sagittal plane and spinal angular change in coronal and sagittal plane at postoperative one month and last follow-up. Pain score was also checked. We investigated the correlation between radiologic change and pain status. Whether factors, such as the kind of graft material, surgical approach, and fusion can affect the radiological stability or not was analyzed as well. Results : Mean follow-up was 23.6 months. During follow-up, $2.08{\pm}1.65^{\circ}$ and $6.96{\pm}2.08^{\circ}$ of angular change was observed in coronal and sagittal plane, respectively. A mean of cage settlement was $4.02{\pm}2.83mm$. Pain aggravation was observed in 4 cases. However, no significant relationship was found between spinal angular change and pain status (p=0.518, 0.458). Cage settlement was seen not to be related with pain status, either (p=0.644). No factors were found to affect the radiological stability. Conclusion : TMC settlement and spinal angular change were often observed in reconstructed spine. However, these changes did not always cause postoperative axial pain.

키워드

참고문헌

  1. Bagby GW : Arthrodesis by the distraction-compression method using a stainless steel implant. Orthopedics 11 : 931-934, 1988
  2. Bhat AL, Lowery GL, Sei A : The use of titanium surgical mesh-bone graft composite in the anterior thoracic or lumbar spine after complete or partial corpectomy. Eur Spine J 8 : 304-309, 1999 https://doi.org/10.1007/s005860050178
  3. Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K : Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976) 20 : 1410-1418, 1995 https://doi.org/10.1097/00007632-199506020-00014
  4. Buttermann GR, Glazer PA, Bradford DS : The use of bone allografts in the spine. Clin Orthop Relat Res (324) : 75-85, 1996
  5. Chen Y, Chen D, Guo Y, Wang X, Lu X, He Z, et al. : Subsidence of titanium mesh cage : a study based on 300 cases. J Spinal Disord Tech 21 : 489-492, 2008 https://doi.org/10.1097/BSD.0b013e318158de22
  6. Dvorak MF, Kwon BK, Fisher CG, Eiserloh HL 3rd, Boyd M, Wing PC : Effectiveness of titanium mesh cylindrical cages in anterior column reconstruction after thoracic and lumbar vertebral body resection. Spine (Phila Pa 1976) 28 : 902-908, 2003
  7. Eck KR, Bridwell KH, Ungacta FF, Lapp MA, Lenke LG, Riew KD : Mesh cages for spinal deformity in adults. Clin Orthop Relat Res (394) : 92-97, 2002
  8. Eck KR, Lenke LG, Bridwell KH, Gilula LA, Lashgari CJ, Riew KD : Radiographic assessment of anterior titanium mesh cages. J Spinal Disord 13 : 501-509; discussion 510, 2000 https://doi.org/10.1097/00002517-200012000-00006
  9. Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam JB Jr, et al. : Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg 89 : 599-609, 1998 https://doi.org/10.3171/jns.1998.89.4.0599
  10. Hee HT, Majd ME, Holt RT, Pienkowski D : Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15 : 149-156; discussion 156, 2002 https://doi.org/10.1097/00024720-200204000-00010
  11. Hughes SS, Pringle T, Phillips F, Emery S : Settling of fibula strut grafts following multilevel anterior cervical corpectomy : a radiographic evaluation. Spine (Phila Pa 1976) 31 : 1911-1915, 2006 https://doi.org/10.1097/01.brs.0000228776.74770.eb
  12. Karaeminogullari O, Tezer M, Ozturk C, Bilen FE, Talu U, Hamzaoglu A : Radiological analysis of titanium mesh cages used after corpectomy in the thoracic and lumbar spine : minimum 3 years' follow-up. Acta Orthop Belg 71 : 726-731, 2005
  13. Liu JK, Rosenberg WS, Schmidt MH : Titanium cage-assisted polymethylmethacrylate reconstruction for cervical spinal metastasis : technical note. Neurosurgery 56 (1 Suppl) : E207; discussion E207, 2005
  14. Molinari RW, Bridwell KH, Klepps SJ, Baldus C : Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine (Phila Pa 1976) 24 : 967-972, 1999 https://doi.org/10.1097/00007632-199905150-00007
  15. Nakase H, Park YS, Kimura H, Sakaki T, Morimoto T : Complications and long-term follow-up results in titanium mesh cage reconstruction after cervical corpectomy. J Spinal Disord Tech 19 : 353-357, 2006 https://doi.org/10.1097/01.bsd.0000210113.09521.aa
  16. Rajpal S, Hwang R, Mroz T, Steinmetz MP : Comparing vertebral body reconstruction implants for the treatment of thoracic and lumbar metastatic spinal tumors : a consecutive case series of 37 patients. J Spinal Disord Tech 25 : 85-91, 2012 https://doi.org/10.1097/BSD.0b013e318214b489
  17. Robertson PA, Rawlinson HJ, Hadlow AT : Radiologic stability of titanium mesh cages for anterior spinal reconstruction following thoracolumbar corpectomy. J Spinal Disord Tech 17 : 44-52, 2004 https://doi.org/10.1097/00024720-200402000-00010
  18. Vaccaro AR, Cirello J : The use of allograft bone and cages in fractures of the cervical, thoracic, and lumbar spine. Clin Orthop Relat Res (394) : 19-26, 2002
  19. Zahra B, Jodoin A, Maurais G, Parent S, Mac-Thiong JM : Treatment of thoracolumbar burst fractures by means of anterior fusion and cage. J Spinal Disord Tech 25 : 30-37, 2012 https://doi.org/10.1097/BSD.0b013e31820bb0a9

피인용 문헌

  1. Answer to the Letter to the Editor of V. Bartanusz concerning “Surgery and survival outcomes of 30 patients with neurological deficit due to clear cell renal cell carcinoma spinal metastases vol.25, pp.6, 2014, https://doi.org/10.1007/s00586-016-4514-4
  2. Lumbar subtotal corpectomy non-fusion model produced using a novel prosthesis vol.137, pp.11, 2017, https://doi.org/10.1007/s00402-017-2753-4
  3. Treatment of funnel chest in children vol.5, pp.3, 2014, https://doi.org/10.17816/ptors5317-24
  4. Multilevel spinal reconstruction in pediatric patients under 4 years old with non-congenital pathology (10-year single-center cohort study) vol.28, pp.5, 2019, https://doi.org/10.1007/s00586-018-5756-0