Single stage corpectomy and instrumentation in the treatment of pathological fractures in the lumbar spine.

PURPOSE

Corpectomy and implantation of titanium cages is standard in pathological fracture treatment but additional single ventral instrumentation remains controversial with regard to rotational stability.

METHODS

This study included 45 patients suffering from vertebral metastases with spinal stenosis, instability and/or neurological deficits secondary to pathological lumbar spine fractures and bone mineral density (BMD) ≥ 1.20 g/cm(2). The clinical results of a single stage anterior decompression with corpectomy defect restoration with titanium cage and single double rod system in patients were evaluated at mean 36 months postoperatively with follow-up neurological and radiological exams at three months then every six months. Evaluation of neurological recovery included grading following a modified Frankel scale. Contentment, disability and actual pain were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). BMD was measured using dual-energy X-ray absorptiometry (DXA).

RESULTS

Postoperative neurological evaluations showed improvement in all patients. In the radiological follow-up in 40 patients (89%) findings were similar compared to the postoperative control. In five patients (11%) a loss of correction at a mean of 8° degrees (Cobb angle) secondary to cage subsidence occurred. No breakage of the device or displacement of the instrumentation was seen. Overall the Frankel scale improved 0.65 points (p < 0.05) and the ODI improved 40.69 points (p < 0.05).

CONCLUSIONS

In lumbar spine fractures of metastatic origin with stenosis, instability and/or neurological deficit, a single stage ventral decompression and instrumentation in patients with BMD ≥ 1.20 g/cm(2) should be considered.