Application of internal stabilisation in the surgical treatment of spinal metastases.

Background And Purpose: Neoplastic disease damages the spine more often than trauma. Metastatic tumour causes vertebral column instability and neurological deficit. Surgical intervention indications depend on the patient's general and neurological status. The aim of neuro-orthopaedic treatment is to achieve pain relief and neurological improvement. Spine stability is secured by various implant systems. The aim of the paper is to present indications, operative techniques and stabilisation methods in patients with metastatic spine disease.

Material And Methods: There were 73 patients included in this study: 50 males and 23 females, aged 17-74 years. The dominant tumour location was the thoracic spine (41 cases), followed by the lumbar spine (19). Symptoms of spinal cord lesion were observed in 71 patients. Qualification for surgery and approach planning were based on different scales (ASA, DeWald, Frankel, Karnofsky, Denis, Tomita). Internal stabilisation implantation followed tumour resection.

Results: Anterior approach was used in 15 cases, posterolateral in 39, posterior in 13, and combined in 6 cases. Histological findings generally allowed the primary tumour location to be disclosed, which in most cases involved the kidney, prostate, lung and the haematopoietic system. Neurological improvement was observed in 82% of cases. Perioperative death occurred in 3% of all patients.

Conclusions: Employed operative techniques are adequate for tumour removal, neural and vascular structures decompression and for implant placement.