B.V. Gaidar, V.E. Parfenov, A.K. Dulaev, V.P. Orlov
(Medicomilitary Academy, Saint Petersburg)
There were 56 cases (29 males and 27 females) with spine tumors, operated in 1991-1999. A mean age was 36.2±3.5 years. Distribution of patients according to clinical entities was as follows: metastatic lesions of vertebral bodies - 38 cases (67.9%), hemangiomas - 4 cases (7.1%), lesions of the vertebral column due to myeloma - 8 cases (14.3%), chondromas - 3 cases (5.3%) and giant cell tumors - 3 cases (5.3%). Neoplastic lesions of vertebrae were most frequent in the thoracic (16 patients, 28.6%) and lumbar (28 patients, 50.0%) spine. Tumors of the cervical spine were watched less frequently (12 cases, 21.4%).The main indications for surgical treatment included presence and progression of neurological disorders (1), pathologic fractures of vertebral bodies with a syndrome of spine instability (2), a rapid growth of tumor with a high risk of development of neurological disorders or a pathologic fracture, watched during a dynamic follow-up (3). All operations were performed with taking into account principles of tumor surgery. The following interventions were performed: resection of vertebral bodies with tumor removal within the limits of normal tissue and anterior spondylodesis by an autograft (37 cases, 66.1%), resection of vertebral bodies with tumor removal in combination with anterior decompression of the spinal cord and its roots (33 cases, 48.9%), laminectomy (9cases, 16.1%). Internal correction and stabilization of the spine by metal implants were used in all cases. It was combined with decompression of neurovascular structures of the vertebral canal and osteoplastic reconstruction (46 patients, 82.2%) or performed in its classic form (10 patients, 17.8%). Stabilization of the spinal column was achieved by use of distracting devices proper (13 cases, 23.2%), their combination with contracting devices (27cases, 48.2%), transpedicular fixating devices of the Sofamor Danek company (14, 25.0%), Z-type plates (12cases, 21.4%). Good anatomic and functional results and absence of a recurrent tumor growth during the whole follow-up period (2-7 years) were watched in 8 patients with benign neoplasms of the spine. The rest 2 cases with benign tumors of vertebrae (chondroma -1 and giant cell tumor -1) had a relapse, observed in 1-3 years; it demanded repeated intervention. Considerable regression of neurological symptoms was present in 82% of cases with neurological deficit, watched before operation. It was preserved in 18% of spinal patients and caused by irreversible changes in the spinal cord. However, stabilization of the spinal column made their care much easier. Decompressing-stabilizing and stabilizing interventions on the spine, combined with rational chemo- and radiation therapy, resulted in considerable improvement of life quality in 33 out of 38 patients with metastatic lesions of the spine.
The analysis of obtained results proves, that active surgical tactics, aimed at radical removal of a tumor (benign neoplasms), decompression of the spinal cord and its roots, reconstruction of supporting structures, correction and stabilization of the spinal column makes it possible to get good anatomic and functional results in patients with spine tumors and to improve life quality of cases with malignant neoplasms to a great extent.