Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The Efficacy of Each Treatment Modality

Jae Hwan Cho; Jung-Ki Ha; Chang Ju Hwang; Dong-Ho Lee; Choon Sung Lee

doi:10.4055/cios.2015.7.4.476

Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The Efficacy of Each Treatment Modality

Clinics in Orthopedic Surgery ◽

10.4055/cios.2015.7.4.476 ◽

2015 ◽

Vol 7 (4) ◽

pp. 476 ◽

Cited By ~ 8

Author(s):

Jae Hwan Cho ◽

Jung-Ki Ha ◽

Chang Ju Hwang ◽

Dong-Ho Lee ◽

Choon Sung Lee

Keyword(s):

Treatment Modality ◽

Pathological Fractures ◽

Fractures Of The Spine

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Pathological fractures of the spine in children (review of the literature and clinical and morphological monocenter cohort analysis)

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors19015 ◽

2020 ◽

Vol 8 (1) ◽

pp. 5-14

Author(s):

Vyacheslav I. Zorin ◽

Alexander Yu. Mushkin ◽

Tatyana A. Novitskaya

Keyword(s):

Vertebral Fractures ◽

Clinical Symptoms ◽

Cohort Analysis ◽

Morphological Characteristics ◽

Morphological Structure ◽

Spinal Fracture ◽

Thoracic Vertebrae ◽

Pathological Fractures ◽

Fractures Of The Spine ◽

Mechanical Back Pain

Background. Pathological vertebral fractures are rare and occur in inflammatory, tumor, and dystrophic lesions. Aim. This study aimed to analyze clinical features and morphological structure of pathological fractures of the spine in children. Materials and methods. The authors examined and operated 62 children aged 217 years for pathological vertebral fractures. We investigated the clinical, radiological, and morphological features. Results. The average age of children at the time of hospitalization was 10 years. Lesions of thoracic vertebrae prevailed (78%) with the maximum frequency of occurrence at the apex of physiological kyphosis Th78. In 10 cases, multiple lesions were noted, including the pathology of other parts of the skeleton. In 69% of observations, clinical symptoms were not dominated by mechanical back pain. Palpation pain (34%) and local spinal deformation (27%) were noted. On average, local kyphosis was 24. Eleven patients (18%) manifested a neurological deficiency, of which nine fractures were a consequence of the tumor process. In 16% of observations, the fracture of the vertebra was detected to be an accidental Х-ray finding. Among the radiation manifestations, all cases (12 patients) registered the decrease in the height of the vertebral body in the form of collapse. Destruction was manifested by various options other than blastic. Therapeutic and diagnostic interventions were performed in 56 patients, and in six children, manipulation was limited to trepan biopsy. The pathological fracture was caused by an inflammatory process in 50% of observations and tumors in 42%, of which 31% is malignant. Conclusions. Pathological spinal fracture in children should be considered as a syndrome, which in most cases is based on an inflammatory or tumor process. The high frequency of neoplastic, including malignant processes, requires active invasive diagnosis. Therapeutic tactics are determined by the clinical, radiation, and morphological characteristics of pathology.

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Pathological Fractures of the Spine Etiology and Diagnosis

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-196042010-00010 ◽

1960 ◽

Vol 42 (1) ◽

pp. 127-137 ◽

Cited By ~ 1

Author(s):

James A. Nicholas ◽

Philip D. Wilson ◽

Robert Freiberger

Keyword(s):

Pathological Fractures ◽

Fractures Of The Spine

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Harrington rod stabilization for pathological fractures of the spine

Journal of Neurosurgery ◽

10.3171/jns.1984.60.2.0282 ◽

1984 ◽

Vol 60 (2) ◽

pp. 282-286 ◽

Cited By ~ 29

Author(s):

Narayan Sundaresan ◽

Joseph H. Galicich ◽

Joseph M. Lane

Keyword(s):

Thoracolumbar Spine ◽

Preoperative Pain ◽

Pathological Fractures ◽

Primary Tumors ◽

Decompressive Laminectomy ◽

Content Type ◽

Harrington Rod ◽

Increased Risk ◽

Fractures Of The Spine ◽

Postoperative Irradiation

✓ Nineteen patients with tumors involving the thoracolumbar spine were treated by Harrington rod stabilization following laminectomy. Sixteen patients had metastatic neoplasms, and three had primary tumors of the vertebral column. In five patients, extensive decompressive laminectomy and Harrington distraction rods to provide immediate stability were used as initial treatment; postoperative irradiation was then given. All five patients were ambulatory, and the four patients with preoperative pain all noted relief of pain following treatment. The remaining 14 patients had received radiation therapy to the spine prior to surgery; in these 14, indications for surgery included a combination of pain and weakness (10 patients), pain alone (two patients), or weakness alone (two patients). Of 12 patients with preoperative pain, after surgery pain relief was noted in nine patients, and eight were ambulatory. Major wound breakdowns occurred in two of the 14 patients who had received radiation prior to surgery. These results suggest that Harrington rod instrumentation is useful in providing postoperative stability and restoring alignment following laminectomy for tumors involving the spine, but carries an increased risk of wound-related complications if used in a previously irradiated region.

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