Operative Management of Post-tumor Spinal Deformity

Introduction The purpose of our research is evaluation of the outcome after surgery and health-related quality of life (HRQOL) parameters in patients with post-tumor spinal deformity. Material and Methods Retrospective clinical and radiographic data were collected for 33 patients (15 male and 18 female, average age of 61.4 years) with spinopelvic malalignments (SRS-Schwab sagittal modifiers: 2 grade and more) who underwent spinal deformity surgery. Patients were divided into two groups. The first group included 13 patients (n = 12 after chemotherapy of plasmacytoma, n = 1 patient after radiotherapy of cervix uteri cancer metastasis) with confirmed spinal oncology diagnosis by biopsy. All patients have had oncology remission with a 3-year minimum follow-up. Spinal deformity was developed in the period between 1 and 6 years after conservative treatment. Repeated biopsy did not show tumor cells, this was evaluated as local control of tumor. Low scores of HRQOL and unsuccessful nonoperative approach were indications for surgical intervention. The second comparative group consisted of 20 patients with “de novo” degenerative or posttraumatic spinal deformity. The aim of surgical management was to achieve sagittal balance, using osteotomies and transpedicular instrumentalization. Groups were evaluated with HRQOL-scales including VAS, ODI, SF36 and SRS-24. Radiographical assessment included Cobb coronal angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), sagittal vertical axis (SVA). Radiographical, HRQOL-parameters and complications were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant. Results Both groups showed a restoration of global spinal alignments without significant differences in TK, LL, PI, PT, SS, SVA parameters (p > 0.05). In addition, HRQOL-scores (VAS, ODI, SF36, SRS-24) of the patients were increased after operation. The HRQOL-scores after 2 years are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). The number of complications in the form of implant instability, proximal and distal junctional disorders was comparable (p > 0.05). However, general medical complications in the first group was significantly higher than in the second one (p