Surgical outcome of spinal tumors. I. Primary benign and malignant spinal tumors

Abstract

The objective of surgical treatment in painful and disabling spinal tumors is the pathological identification of the tumour, neurological decompression, establishment of spinal stability and maintenance of a comfortable life span. Eleven benign (BPST) and 14 malignant primary spinal tumour (MPST) cases were assessed according to their clinical, radiological and surgical outcome in this study. The average age of BPST and MPST cases were 47.7 (7-66) years and 50.4 (13-65) years, respectively. Computerised tomography (CT) and magnetic resonance (MR) was obtained for radiological assessment. Together with Enneking classification, Weinstein - Boriani - Bigiani (WBB) surgical staging was used for surgical planning. Benign tomours were most commonly located in L1 vertebra. The average of affected vertebra was 1.2 ± 0.4 and the most common BPST types were eosinophilic granuloma (3 patients), aneurysmal bone cyst (3 patients) and hemangioma (3 patients). Following en - block resection, neurological findings of 6 patients with BPST recovered 100 %. Anterior approach, autologous strut grafting and anterior instrumentation was carried out in 8 patients, while posterior approach, autologous fusion and instrumentation was preferred in 3 patients. The involvement of mobile segments in the fusion area was 3 in the cervical, 2.6 in the thoracal, and 2 in the lumbar region. Sagittal contours improved significantly by this method. Total pain relief was observed in 6 patients while pain decreased significantly in the remaining 5 BPST patients. In 14 MPST patients, the average of involved vertebra was 1.8 ± 0.8, all patients were Enneking stage II B and the involvement according to WBB was between 4 and 9. All patients underwent anterior vertebrectomy. 10 had anterior fusion and autologous strut grafting, while posterior autologous fusion and instrumentation at the same session was the method of treatment in the remaining 4 patients. An average of 3.2 ± 1.6 mobile segments were included in the instrumentation and fusion mass in these cases. 73 % improvement in the sagittal index was obtained by this method. Eight of the MPST patients had preoperative neurological deficits. The rate of total recovery following surgery was 75 % and improvement in neurological status was observed in 25 %. The most common type of lesion was multiple myeloma (42.8 %) followed by plasmocytoma (14.3 %), hystiocytoma (14.3 %), osteosarcoma (14.3 %) and lymphoma (14.3 %). The preoperative pain - functional assesment (PFA) score decreased from 16.7 to 10.0 (p < 0.05). In conclusion, en - block tumour excision, anterior strut grafting and / or anterior or posterior instrumentation in the same session is effective in the maintenance of spinal stability, relief of pain, recovery of neurological symptoms and improvement of functional capacity.

Keywords

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Omurga tümörlerinin cerrahi sonuçları I. Benign ve primer malign omurga tümörleri

Öz

Klinik olarak ciddi ağrı, nörolojik defisit ile maluliyete yol açan omurga tümörlerinin cerrahi tedavisinde amaç, patolojik kırıklar sonucu ortaya çıkan spinal instabilitenin ortadan kaldırılması, nörolojik dekompresyon, daha konforlu bir yaşamın temin edilmesi ve histopatolojik kesin tanının konulması gerekliliğidir. Bu çalışmada, 11 benign ve 14 malign primer omurga tümörü olan hastanın klinik, radyolojik ve cerrahi sonuçları değerlendirilmiştir. Benign tümörlü hastaların yaş ortalaması 47.7 (7-66), malign tümörlü hasta-ların ise 50.4 (13-65) idi. Benign tümörlerde en fazla tutulumun birinci lomber omurda olduğu, tümörün ortalama l.2 omur tuttuğu. En fazla eosinofilik granüloma (3 hasta), anevrizmal kemik kisti (3 hasta) ve he-manjiomaya (3 hasta) rastlandığı belirlendi. Tümörün "en - block" eksizyonu ile preoperatif 6 benign tümörü olan hastada saptanan nörolojik defisit postoperafif % 100 oranında düzeldi. Sagittal konturlarda yüksek oranda düzelme sağlandı. Hastaların 6'sı tamamen ağrısız hale geçerken, geri kalan 5 hastada da ağrının belirgin olarak azaldığı saplandı. 14 malign primer omurga tümörü olan hastada, tümörün ortalama 1.8 omur tuttuğu belirlendi. Hastaların tamamında anterior vertebrektomiyi takiben ortalama 3.2 mobil segment enstrümantasyon ve füzyon sahasına dahil edildi. Preoperatif 20.1°olan tutulan omurun sagittal indeksinde postoperatif ortalama % 73 düzelme sağlandı. Malign primer kemik tümörü olan hastaların 8 (% 57.1)’inde preoperatif nörolojik defisit olup, postoperatif 7 (% 88) hastada nörolojik iyileşme sağlandı. Preoperatif 16.7 olan, Ağrı ve Fonksiyonel Değerlendirme skoru, postoperatif ortalama 10'a düştü ve bu düzelmenin istatistiki olarak anlamlı olduğu belirlendi (p < 0.05). Bu verilerin ışığı altında, spinal stabilitenin sağlanması, ağrının azaltılması ve fonksiyonel kapasitenin arttırılması, nörolojik defisitlerin giderilmesi amacıyla, "en - block" tümör eksizyonu, anterior strut greftleme, anterior veya aynı seansta uygulanan posterior enstrümantasyonun yararlı olduğu fikri elde edildi.

Anahtar Kelimeler

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