Introduction: Lymphoma is a systemic disease that has widespread impact on the body’s baseline homeostasis. Standard treatments for the disease – i.e. chemotherapy, radiation therapy, high-dose steroids, and bone marrow transplantation, drastically decrease fusion rates in those patients with unstable pathologic spinal fractures requiring surgical management. This potential for decreased fusion can lead to an increased risk of hardware failure, and the need for additional surgeries. Herein, the authors present a unique case series highlighting the management of 4 patients with unstable pathologic fractures secondary to lymphoma in the cervico-thoracic spine that required surgical management.
Methods: All patients underwent an anterior corpectomy followed by either 1) posterior fusion with postoperative external orthosis, or 2) only postoperative external orthosis.
Results: From this study, the authors determined that patients requiring more than a one-level corpectomy, also required a posterior fusion with postoperative external orthosis in order to obtain solid fusion. Furthermore, bone stimulators were utilized in all of the patients who underwent posterior fusion. However, in patients where only a one-level corpectomy was needed, a postoperative external orthosis was sufficient to help facilitate solid fusion. Postoperatively, all patients showed improvement of preoperative neurological symptoms. Additionally, they all had very close postoperative follow up of at least 9.5 months demonstrating sustained solid fusion, substantial improvement in pain, as well as, improvement in functional ability as demonstrated by both Frankel Grade and ability to ambulate.
Conclusions: This case series demonstrates that though difficult, solid fusion is possible in lymphoma patients with unstable pathologic spinal fractures despite standard adjuvant treatment for the disease.
Patient Care: Significance of surgical stabilization and resulting solid fusion in this patient population despite use of adjuvant therapies such as radiation, chemotherapy and bone marrow transplantation.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Despite the challenging nature of unstable pathologic fractures secondary to systemic lymphoma, patients may be successfully treated with surgical corpectomy/fusion in order to achieve spinal stability. 2) importance and role that close post-operative monitoring, post-operative bracing, bone stimulants, and posterior fixation in achieving favorable outcomes.