Tarek Aly
26 patients underwent decompression-stabilization procedures for their malignant spinal lesions. Fifteen were females and 11 males. Their average age was 60.6 years (range 18-73 years). These patients were classified according to extent of involvement of the spine. One column was involved in 1/26 (3.8%) case, two in 11/26 cases (42.3%) and three in 14/26 cases (53.8%). A posterior approach alone was done in 8/26 (30.8%) patients while a combined anterior and posterior approaches were done in 18/26 (69.2%) cases. A variety of posterior stabilization procedures were used. Out of 24 patients who were able to attend the follow-up 16 (66.7%) were able to walk, five (20.8%) were paraparetic, and 3 patients (12.5%) were paraplegic. Patients with combined approach showed higher percentage of neurologic improvement (62%) while patients with posterior approach showed only 35% improvement in their neurologic status. Accordingly results obtained from direct anterior approaches using corpectomy and anterior reconstruction of the anterior and middle columns have produced the best results in terms of neurological improvement. Almost all of our patients had 2 or 3 columns involvement but the results did not support the three columns theory where we could not correlate any significant results, regarding pre- or post-operative radiographic measurements (mechanical instability) and pre- or post-operative neurologic findings (neurologic instability), with the number of involved columns.
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