Introduction. The instability derived from vertebral osteolysis of spinal bone tumors can be of two types, primary instability due to the tumor per se or instability produced by treatment. Review of the literature and authors experience. Four possible situations can occur. The first case is a tumor not requiring reconstruction, such as benign or non-aggressive lesions, or low-grade bone involvement treated by simple resection. The second possibility is bone resection and repair using a bone graft without instrumentation in cases of secondary metastases; the palliative treatment most often used is posterior stabilization with or without decompression. Regardless of the technique, isolated posterior instrumentation does not always provide sufficient stability. When the anterior and middle spine suffers extensive vertebral collapse, laminectomy can lead to severe postoperative instability with risk of iatrogenic nerve injury and paraplegia. Finally, in many cases circumferential stabilization by posterior instrumentation and anterior stabilization is needed. Stabilization with methylmetacrylate has fallen into disuse. Anterior reconstruction is based on the use of autografts or allografts and different types of synthetic spacers that can be joined by posterior instrumentation. Conclusions. Tumors of the thoracolumbar spine are susceptible to oncologically adequate surgical treatment if they are diagnosed and classified correctly. Knowledge of the characteristics of the neoplasms and their natural history should guide treatment.
|Journal||Revista de Ortopedia y Traumatologia|
|Publication status||Published - 1 May 2004|