Evaluation of Surgical Stabilization and Fusion in Management of Pathological Fractures of the Thoracic and Lumbar Spines

Abstract

Pathological fractures of the spine are a significant source of morbidity and a major public health concern. The aim of the work is to evaluate the surgical modalities used in the treatment of pathological fractures of the thoracic and lumbar spines regarding postoperative stabilization and fusion of the spine. The occurrences of pathological fractures are frequent in elderly patients and early recognition of an underlying malignant lesion is important for proper management. Computed tomography (CT) is the study of choice when looking for bone detail and cortical destruction, but is not as sensitive at assessing marrow replacement. The evaluation of tumors with a CT scan shows the exact bony destruction. MRI provides the best imaging of neural structures, can clearly define intramedullary, intradural,and extradural masses, and can reveal the compressive nature of the spinal lesion as well as the extent of its soft-tissue spread. Total body radionuclide bone scan is useful in searching for other skeletal sitesof tumor involvement. It is a fairly sensitive technique for the detection of bone metastases and can detect these lesions earlier than plain films. Percutaneous vertebroplasty (PV) is a minimally in¬vasive, in which bone cement, usually polymethyl methacrylate (PMMA), is injected under radiologic guidance into the collapsed vertebral body. The most accepted theory indicates augmentation withcement increases the fracturemechanical load threshold, stabilizing the vertebra. In tumor fractures, pain relief is relatedprimarily to vertebral body stabilization and secondarily tothe induction of tumor necrosis and the destruction of sensitive nerve endings. The goals ofsurgery are to decrease pain, to preserve or to improveneurologic function, and to mobilize the patient withoutlifelong external orthosis. Surgery should be individualized to the patient and his or her comorbidities.Ideally, for burst fractures with neurological problems, the anterior approach is preferred,but may be contraindicated in severe respiratory depression. Other approachesmay include posterior approaches, posterolateral decompression, or a combination of approaches. This is a prospective non-randomized study; thirteen patients with pathological thoracic and lumbar fractures. Their data are collected from the inpatient notes, operative theatre records, and outpatient clinic. Patients were divided into three groups group A (osteoporotic fractures), group B (neoplastic fractures) and group C (infection fractures). Follow up of patients will be done at 3, 6, 12 month. All patients will be assessed by the following methods: 1) Functional evaluation by ASIA (American Spinal Injury Association) scale, karnofsky scale and visual analog scale of pain. 2) Radiological evaluation by plain X-ray dynamic view for all patients to assess the stability, CT and/or MRI scans if required and radioisotopes bone scanning to assess new bone formation and bone density measurement (DEXA) to assess response to treatment. That the fixation most common intervention in 3 groupsrepresents. Vertebroplasty + fixation more common in osteoporotic fractures while corpectomy+ fixation more common in infection fractures.