Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care
Diagnosis and Treatment of Adults with Neoplastic Vertebral Fractures
Recommendations
Surgical Treatment
Surgical Treatment Question 1: Does surgical fixation with or without fusion improve outcomes in patients with neoplastic vertebral fractures compared to nonoperative care or interventional procedures?
A systematic review of the literature yielded no studies to adequately address this question.
FLASK Future Directions for Research
The work group recommends high-quality prospective studies identifying subgroups of patients with neoplastic vertebral fractures that would benefit from surgical intervention more than interventional or nonoperative treatments.
Surgical Treatment Question 2: Does the use of minimally invasive surgical approaches (eg, percutaneous pedicle screws, muscle-sparing decompression/arthrodesis techniques) improve outcomes compared to open surgical approaches in patients undergoing surgery for neoplastic vertebral fractures?
A systematic review of the literature yielded no studies to adequately address this question.
FLASK Future Directions for Research
The work group recommends high-quality studies comparing differences in outcomes using minimally invasive vs. open surgical techniques in patients with neoplastic vertebral fractures.
Surgical Treatment Question 3: In patients undergoing surgery for neoplastic vertebral fractures, are clinical and radiological outcomes affected by the types of implants used?
There is insufficient evidence to make a recommendation for or against the use of specific implants in adults undergoing surgery for neoplastic vertebral fractures.
Grade of Recommendation: I (Insufficient Evidence)
In a retrospective comparative study, Bayram et al1 compared outcomes of palliative posterior instrumentation as compared to corpectomy with cage reconstruction in patients with thoracolumbar pathological fractures. The authors concluded that palliative posterior instrumentation “can decompress the tumor for functional improvement and can stabilize the spinal structure to provide relief.” The work group downgraded this potential Level III paper due to small sample size, less than 80% follow-up, diagnostic method not stated, and the choice of procedure was at the availability of a specific surgical team. This paper provides Level IV evidence that for adults with neoplastic vertebral fractures, either palliative posterior instrumentation or corpectomy with anterior cage reconstruction combined with posterior instrumentation provide similar pain relief and survival.
References
1. Bayram S, Akgül T, Altan M, et al. Palliative Posterior Instrumentation versus Corpectomy with Cage Reconstruction Treatment for Thoracolumbar Pathological Fracture. Asian Spine J. 2019;13(2):318-324. doi:10.31616/asj.2018.0153. FILE-ALT
FLASK Future Directions for Research
The work group recommends high-quality prospective studies comparing differences in outcomes with different spinal implant materials or instrumentation construct designs (e.g. number of levels instrumented, with or without anterior column reconstruction, etc.) as well as different surgical approaches and techniques in patients undergoing surgery for neoplastic vertebral fractures.
Surgical Treatment Question 4: In patients undergoing surgery for neoplastic vertebral fractures, are clinical and radiological outcomes affected by the use of vertebral augmentation of the implants, of the fractured vertebral body, or of adjacent levels?
A systematic review of the literature yielded no studies to adequately address this question.
FLASK Future Directions for Research
The work group recommends high-quality prospective studies comparing differences in outcomes with and without the incorporation of augmentation techniques during surgical procedures in patients with neoplastic vertebral fractures.