Diagnosis and Treatment of Vertebral Column Metastases

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Presentation transcript:

Diagnosis and Treatment of Vertebral Column Metastases Robert D. Ecker, MD, Toshiki Endo, MD, Nicholas M. Wetjen, MD, William E. Krauss, MD Mayo Clinic Proceedings Volume 80, Issue 9, Pages 1177-1186 (September 2005) DOI: 10.4065/80.9.1177 Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Positioning of the patient, skin incision line, and exposure of the vertebral bodies with transection of the rib for the posterolateral approach. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Surgical approach and skin incision line for the transoral-transpalatopharyngeal approach. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Exposure of cervical spine via the anterior approach. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 A 63-year-old man, with a history of renal cell carcinoma 9 years previously, experienced neck pain radiating into the bilateral upper limbs on the left side more than the right for 2 weeks. The patient had weakness in the left C7 myotome. Preoperative computed tomogram (CT) (A) shows destruction of the C7 vertebral body and left greater than right pedicles. Axial (B) and sagittal (C) T1-weighted magnetic resonance images with contrast show abnormally enhanced tissue circumferentially around the C7 vertebral body in epidural space and paravertebral soft tissues, centered at the left C7 foramen. Postoperative cervical CT with reconstruction (D) and plain radiograph (E) show anterior plating and fibular strut graft placed after C6 and C7 corpectomy via the anterior approach. Surgical specimen was consistent with metastatic renal cell carcinoma. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Positioning of the patient, skin incision line, and exposure of the thoracic vertebral bodies for the anterior transthoracic approach. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 6 A 67-year-old man with a history of hyperthyroidism and coronary artery disease presented with sudden onset of interscapular back pain and gait disturbance. The patient had upper motor neuron type weakness in bilateral lower limbs. A preoperative sagittal T2-weighted magnetic resonance image (A) shows a T7 burst fracture associated with marked narrowing of the spinal canal (arrow); T7 corpectomy through left thoracotomy was performed. Postoperative computed tomogram with sagittal reconstruction (B) shows a titanium implant (Synex cage, Synthes, Inc, West Chester, Pa) in place. Postoperative plain radiographs (C and D) show the posterior fusion from T2 through T12 performed in a second staged operation. The pathology was metastatic renal cell carcinoma. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 7 Positioning of the patient, skin incision line, and exposure of the vertebral bodies in the thoracolumbar junction. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 8 Skin incision lines for various approaches including the retroperitoneal and transperitoneal approaches to expose the upper lumbar spine. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 9 Positioning of the patient, skin incision line, and exposure of the lumbar vertebral bodies for the retroperitoneal approach. Mayo Clinic Proceedings 2005 80, 1177-1186DOI: (10.4065/80.9.1177) Copyright © 2005 Mayo Foundation for Medical Education and Research Terms and Conditions