Introduction: Metastatic spinal tumor is a debilitating disease and a common complication of cancer. The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has been posing problems for surgical access. In this study, we describe clinical experiences about treatment of metastatic spinal tumor at CTJ and its results.
Methods: From June 2006 until December 2011, 29 patients underwent surgery for spinal tumors involving the CTJ. Patients who are not candidate for surgery were excluded on the basis of therir conditions such as presence of the advanced systemic disease, significant comorbidities, or short life expectancy less than 3months. Thorough preoperative work-ups were performed. In some instance, preoperative angiography and tumor embolization were used. Surgical approaches were either anterior or posterior, and extent of resection was classified as radical, debulking, and simple neural decompression. All patient who had undergone CTJ surgery stayed at intensive care unit. For some patients, adjuvant radiation therapy (RT) was considered.
Results: Almost all of the patients were operated through posterior approach (90%, 26/29) and using limited surgical methods (82%, 24/29) including debulking surgery or simple neural decompression. In regard to hypervascular tumor, tumor embolization could help reduce blood loss during surgery. Total of 10 problems of complication following surgery had occurred to 9 patients. Of the 29 patients, 27 patients showed pain relief according to their VAS scores. In the aspect of neurological recovery, mean MRC grade was significantly improved after surgery. (p<0.001) In terms of pain and motor improvement, posterior approach and debulking surgery had significant role. Median overall survival was 406 days after surgery, and adjuvant-RT group had longer survival times than RT-prior-to-surgery group.
Conclusions: Surgical procedure in CTJ is difficult, but it is not impossible. We are expecting good clinical result simply by limited posterior surgical method with appropriate preoperative preparation and postoperative treatment.
Patient Care: Few previous study about metastatic spinal tumors at cervicothoracic junction was reported. Our research will be help other clinician judging their treatment modality to patients harboring this type of tumor.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)know about unique features of metastatic cervico-thoracic junction tumor, 2) deal with this type of tumor by appropriate treatment approach.