An Evidence-Based Review and Survey of Expert Opinion of Reconstruction of Metastatic Spine Tumors

STUDY DESIGN.: Systematic review and consensus expert opinion. OBJECTIVE.: To provide surgeons and other health care professionals with guidelines for surgical reconstruction of metastatic spine disease based on evidence and expert opinion. SUMMARY OF BACKGROUND DATA.: The surgical treatment of spinal metastases is controversial. Specifically two aspects of surgical reconstruction are addressed in this study: choice of bone graft used during surgery for metastatic spine tumors and the design of reconstruction or construct to stabilize. METHODS.: A systematic review of the available medical literature from 1980 to 2015 was conducted, and combined with consensus expert opinion from a recent survey of spine surgeons who treat metastatic spine tumors. RESULTS.: There is very little evidence in the literature to provide guidance on the use of bone graft in metastatic tumor reconstruction. There is little evidence in the literature to support the preferential use of one graft type over the other. 41% of respondents said they used bone graft or bone graft substitutes to accomplish fusion. There were 17 studies that described the use of a prefabricated prosthetic, 10 studies describing the use of polymethyl methacrylate (PMMA) bone cement, and only 3 studies describing the use of bone graft for anterior column reconstruction. The use of structural allograft was most popular amongst the experts for anterior reconstruction, followed by cage reconstruction, and PMMA bone cement. CONCLUSIONS.: Achieving bony union may be of importance for the maintenance of spinal stability in the long-term after reconstruction. Whether bony union is required for patients with shorter life expectancies is debatable. The literature supports the use of anterior reconstruction with either a prefabricated prosthetic or PMMA bone cement. It also supports the use of an anterior construct reinforced with bilateral posterior instrumentation when performing a three column reconstruction.