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The Journal of Bone and Joint Surgery, Vol 63, Issue 1 36-46, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease
KD Harrington
Metastatic malignant lesions involving the spine occasionally cause severe
enough vertebral-body collapse to result in either spinal instability or
neural compression, or both. Conventional decompressive laminectomy in such
cases rarely results in neural improvement. It may, however, cause local
instability of the spine, leading to a progressive kyphotic deformity and
an increasing neural deficit. Anterior decompression allows excision of the
focus of tumor and direct neural decompression. However, anterior
stabilization by bone grafts usually does not succeed, as postoperative
irradiation in dosages sufficient for tumor control may interfere with
incorporation of the graft. Over a four and one-half-year period, fourteen
patients with spinal instability secondary to metastatic pathological
fractures of one or more vertebrae received anterior stabilization by
replacement of the affected vertebral bodies with methylmethacrylate
polymerized in situ. No postoperative external support was required, and
the acrylic fixation achieved by this method was not affected adversely by
subsequent irradiation averaging 4375 rads. There was only one soft-tissue
infection, which did not involve the anterior stabilization. Twelve
patients had major neural impairment preoperatively and required spinal
cord or nerve-root decompression anteriorly prior to fixation. Nine had
complete neural recovery postoperatively, two others were improved
significantly, and one remained unchanged. None deteriorated
neurologically. Five patients had undergone decompressive laminectomy
before the anterior stabilization was attempted. None had improved
neurologically, and all had increased spinal instability. There was one
failure of fixation. The remaining thirteen patients had excellent relief
of pain and restoration of spinal stability which did not deteriorate
during the follow-up period, ranging from thirteen to forty-five months
postoperatively.
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