Endoprothetischer Wirbelkörperersatz bei Metastasen der Lendenwirbelkörper
Resection of tumor as complete as possible without injury to the spinal cord or nerve roots. Maintenance of stability of the spinal column. Painful instability or imminent quadriplegia due to primary and secondary malignant tumors. Multiple metastases, poor general health. Lateral, followed by a knee-chest position. Through a standard approach for a left thoracophrenotomy resection of the involved vertebra, decompression of the dural sack, insertion of an adjustable intervertebral spreader which will maintain the distance between the vertebrae and serve as replacement for the removed vertebra. After turning the patient into prone position transpedicular fixation of the vertebral segment. (Example is given for resection of the first lumbar vertebra.) Regular control of sensory and motoric nerve function of the limbs hourly on the day of surgery and two hourly on 1. and 2. postoperative day. Removal of drains 2 to 3 days postoperatively. Pharmacological stimulation of bowels. Daily radiographic control of chest till 1 day after the removal of drains. Mobilization within 1 week without corset. Injury to lungs, ureters, large vessels, intestines, lumbar plexus, dura, and plexus sympathici. Haemothorax, Chylothorax, Infection. Between 1982 and 1993 thirty-seven patients underwent vertebral resection of tumors. For analysis of retrospective results refer to Tables 1 to 3. Average surgical blood loss: 2378 ml (800 to 6500). Average duration of surgery: 238 minutes (120 to 550). Complications: 2 bronchopneumonia, 2 deep infections, 2 thrombophlebitis, 3 transient mental confusion, 1 breakage of implant after 18 months.