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Surgical management of spinal metastases involving the cervicothoracic junction: results of a multicenter, European observational study.
Hubertus, Vanessa; Gempt, Jens; Mariño, Michelle; Sommer, Björn; Eicker, Sven O; Stangenberg, Martin; Dreimann, Marc; Janssen, Insa; Wipplinger, Christoph; Wagner, Arthur; Lange, Nicole; Jörger, Ann-Kathrin; Czabanka, Marcus; Rohde, Veit; Schaller, Karl; Thomé, Claudius; Vajkoczy, Peter; Onken, Julia S; Meyer, Bernhard.
Afiliación
  • Hubertus V; 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin.
  • Gempt J; 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich.
  • Mariño M; 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin.
  • Sommer B; 3Department of Neurosurgery, Universitätsmedizin Göttingen.
  • Eicker SO; 4Department of Neurosurgery and Interdisciplinary University Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
  • Stangenberg M; 5Department of Trauma and Orthopedic Surgery and Interdisciplinary University Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
  • Dreimann M; 5Department of Trauma and Orthopedic Surgery and Interdisciplinary University Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
  • Janssen I; 6Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland; and.
  • Wipplinger C; 7Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria.
  • Wagner A; 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich.
  • Lange N; 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich.
  • Jörger AK; 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich.
  • Czabanka M; 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin.
  • Rohde V; 3Department of Neurosurgery, Universitätsmedizin Göttingen.
  • Schaller K; 6Department of Neurosurgery, Hôpitaux Universitaires de Genève, Switzerland; and.
  • Thomé C; 7Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria.
  • Vajkoczy P; 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin.
  • Onken JS; 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin.
  • Meyer B; 2Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich.
Neurosurg Focus ; 50(5): E7, 2021 05.
Article en En | MEDLINE | ID: mdl-33932937
OBJECTIVE: Surgical management of spinal metastases at the cervicothoracic junction (CTJ) is highly complex and relies on case-based decision-making. The aim of this multicentric study was to describe surgical procedures for metastases at the CTJ and provide guidance for clinical and surgical management. METHODS: Patients eligible for this study were those with metastases at the CTJ (C7-T2) who had been consecutively treated in 2005-2019 at 7 academic institutions across Europe. The Spine Instability Neoplastic Score, neurological function, clinical status, medical history, and surgical data for each patient were retrospectively assessed. Patients were divided into four surgical groups: 1) posterior decompression only, 2) posterior decompression and fusion, 3) anterior corpectomy and fusion, and 4) anterior corpectomy and 360° fusion. Endpoints were complications, surgical revision rate, and survival. RESULTS: Among the 238 patients eligible for inclusion this study, 37 were included in group 1 (15%), 127 in group 2 (53%), 18 in group 3 (8%), and 56 in group 4 (24%). Mechanical pain was the predominant symptom (79%, 189 patients). Surgical complications occurred in 16% (group 1), 20% (group 2), 11% (group 3), and 18% (group 4). Of these, hardware failure (HwF) occurred in 18% and led to surgical revision in 7 of 8 cases. The overall complication rate was 34%. In-hospital mortality was 5%. CONCLUSIONS: Posterior fusion and decompression was the most frequently used technique. Care should be taken to choose instrumentation techniques that offer the highest possible biomechanical load-bearing capacity to avoid HwF. Since the overall complication rate is high, the prevention of in-hospital complications seems crucial to reduce in-hospital mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fusión Vertebral / Neoplasias de la Columna Vertebral Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Neurosurg Focus Asunto de la revista: NEUROCIRURGIA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fusión Vertebral / Neoplasias de la Columna Vertebral Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Neurosurg Focus Asunto de la revista: NEUROCIRURGIA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos