Spinal stabilization of pathological fractures in metastatic disease in distant segments - a case report

Spinal stabilization of pathological fractures

  • Ivan Stojadinović Clinic for Orthopedics and Traumatology, UCC Kragujevac
  • Jelena Milošević Department of Physical medicine and rehabilitation, Faculty of Medical Sciences, University of Kragujevac and1Clinic for Orthopedics and Traumatology, UCC Kragujevac
  • Srđan Vlajović Clinic for Orthopedics and Traumatology, UCC Kragujevac
  • Zoran Jovanović Clinic for Orthopedics and Traumatology, UCC Kragujevac
  • Nikola Prodanović University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Surgery and Clinic for Orthopedics and Traumatology, UCC Kragujevac
  • Dušan Todorović University of Kragujevac, Serbia, Faculty of Medical Sciences Department of Ophthalmology and Clinic of Ophthalmology, UCC Kragujevac
DOI: https://doi.org/10.5937/mckg55-31873
Keywords: pathological fracture, cervical spine, lumbar spine, spinal stabilization

Abstract


Introduce: About 2/3 of malignant tumors develop metastases. The skeletal system is the third most common site of metastasis, of which the spine is in the first place in terms of prevalence. Skeletal metastases can occur in all types of malignant tumors, and the breast is one of the most common localizations. Treatment of vertebral fractures can be non-operative and operative. Although numerous studies show the benefit of both non-operative and operative treatment, depending on the situation, several of them recommend a surgical approach as a better way to preserve patient mobility. Case report: The patient contacted a spinal surgeon due to back pain, when she was diagnosed with a pathological fracture of the 7th cervical and 12th thoracic vertebrae. Both fractures were operatively treated, in two time intervals. Discussion and conclusion: Given the advances in the treatment of malignant diseases, more people with spinal metastases live today than ever before in history. Patients with unstable pathological fractures are treated surgically, while patients who have stable fractures without dislocation can be treated only with chemotherapy and radiotherapy. The presentation of this patient showed how pathologically unstable vertebral fractures were treated on several levels. Operational approaches were as different as operational techniques. After surgical treatment and early rehabilitation, there was a significant improvement in the clinical picture and quality of life of the patient.

References

1. Masala S, Lunardi P, Fiori R, et al. Vertebroplasty and kyphoplasty in the treatment of malignant vertebral fractures. J Chemother. 2004; 16(5): 30-3.
2. Macedo RD, Linhares KM. Treatment of vertebral pathological fractures by percutaneous vertebroplasty. Coluna/Columna 2014; 13(3): 239-44
3. Lee SC, Jung CH. Metastatic Spinal Tumor. Asian Spine J. 2012; 6(1): 71–87.
4. Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Baldrston RA. Rothman-Simeone The Spine Sixth Edition, Elsevier Saundars 2011; 1525.
5. Chong S, Shin SH, Yoo H, et al. Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients’ survival. The Spine Journal 2012; 12: 1083–92.
6. Galovich LA, Bermejo FT, Moza AB, et al. Safety and Efficacy With Augmented Second Generation Perforated Pedicle Screws i Treating Degenerative Spine Disease in Elderly Population. Int J Spine Surg. 2020; 14(5): 811-17.
7. Vaccaro AR, Lim MR, Hurlbert RJ, et al. Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group. J Spinal Disord Tech 2006; 19: 1–10.
8. Mayr MT, Subach BR, Comey CH, Rodts GE, Haid RW . Cervical spinal stenosis: Outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg 2002; 96(1): 10-6.
9. Dhillon RS, Parker J, Syed YA, et al. Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy. Acta Neuropathol Commun 2016; 23(4): 89.
10. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing and Health. 1990; 13(4): 227-36.
11. Cheung KMC, Mak KC, Luk KDK. Anterior Approach to cervical Spine. Spine (Phile Pa 1976). 2012; 37(5): 297-302.
12. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22):2 940-52.
13. Yin JJ, Pollock CB, Kelly K. Mechanisms of cancer metastasis to the bone. Cell Res 2005; 15: 57–62.
14. Alexanian R, Dimopoulos M. The treatment of multiple myeloma. N Engl J Med 1994; 330: 484–9.
15. Schoenfeld AJ, Schwab JH, Ferrone ML, et al. Non-operative management of spinal metastases: A prognostic model for failure. Clin Neurol Neurosurg. 2020; 188:105574.
16. Berg AJ, Hernandez M, Bhatia C. Complete C4 vertebral body destruction: a dramatic finding in a patient with a new diagnosis of myeloma. BMJ Case Rep 2014. doi:10.1136/bcr-2013-203108.
17. Zee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of literature. J Spine Surg. 2020; 6(1): 302-22.
18. Huo X, Hu C, Zhang Y, Yang S, Yang D, Ding W. Curative effects of Dynesys dynamic stabilization system for lumbar intervertebral disc herniation. Int J Clin Exp Med 2017; 10(11): 15459-64.
19. Biščević M, Hamzaoglu A, Ljuca F, et al. Minimalno invazivna hirugija patoloških prijeloma kičme – vertebroplastika i kifoplastika na Klinici za ortopediju i traumatologiju Kliničkog centra Univerziteta u Sarajevu. MED ARH 2009; 63(4) 234-37.
Published
2022/02/08
Issue
Vol. 55 No. 2 (2021): MEDICINSKI ČASOPIS
Section
Review