Neurosurgical treatment of pathological fracture-dislocation of the spine

✓ The treatment of 20 patients with symptomatic pathological fracture-dislocation of the spine is reviewed. The single most common primary disease was carcinoma of the breast (12 cases). Pain was the presenting symptom in 19 patients. At the time of surgery, six patients were weak but ambulatory, seven were bedridden, and three were paraplegic. The cervical spine (10 cases) was most frequently involved, followed by the thoracic region in six, and the lumbar segments in four. Treatment aimed at improving or preserving neurological function involved decompression of the cord (or cauda) with reduction of bone deformity and stabilization of the spine. Laminectomy decompression was performed in 18 cases. Posterior rib graft fusion was used to stabilize the spine in all patients with cervical, and in three with upper thoracic, pathological fracture-dislocation; Harrington rod instrumentation was used for lower thoracic and lumbar levels. All patients were considered for radiotherapy and/or chemotherapy. Ten patients are living, an average of 20 months following surgery. Among the remainder, the average survival was 5 months. Fourteen patients were ambulatory after surgery, four were improved, and two were unchanged. Twelve patients have achieved a “satisfactory” result (walking and continent 6 months after treatment), including the three who were paraplegic at the time of surgery. Spinal metastases presenting as pathological fracture-dislocation of the spine may produce potentially devastating cord compression. Critical neurological sequelae can be avoided, and a satisfactory result can be achieved by urgent decompression of the cord and stabilization of the spine.