Anterior Spinal Arthrodesis With Structural Cortical Allografts and Instrumentation for Spine Tumor Surgery

In Brief Study Design. The authors report on anterior vertebral reconstruction following tumor resection with use of fresh-frozen, cortical, long-segment allografts prepared from diaphyseal sections of long bones. A retrospective analysis of clinical outcomes is presented. Objective. To analyze the results following the use of cortical allografts in the treatment of spine tumors. Summary of Background Data. Metastatic disease and primary spinal bone tumors may result in progressive vertebral collapse, instability, deformity, pain, and neurologic deficit. Controversy as to the appropriate type of anterior reconstruction and/or graft material persists. Methods. From 1995 until 2001, 30 patients with primary spinal bone tumors or metastases to the spine were treated by anterior vertebral reconstruction with fresh-frozen cortical bone allografts. Grafts were used in combination with anterior and posterior instrumentation. Results. The median survival was 14 months. Ninety-three percent of all allografts were radiographically incorporated as early as 6 months after surgery in spite of adjuvant chemotherapy and radiation therapy. Fourteen patients (46%) had intraoperative or postoperative complications. Two patients underwent revision surgery for local recurrence. There were no allograft infections, fractures, or collapse. Conclusion. Anterior column reconstruction with structural cortical allografts proved to be a reliable technique in patients with spine tumors. Postoperative complications can often be successfully managed. Anterior fresh-frozen structural allografts are effective in anterior column reconstruction of patients with spinal neoplasms. Allograft incorporation is dependent on additional use of autologous bone graft, maximized endplate contact, and rigid spinal instrumentation resulting in a high rate of fusion with the adjacent vertebral host bone. Patients receiving chemotherapy and radiation have a higher incidence of surgical complications.