Purpose: To present a series of 49 patients which underwent single or two staged complete spondylectomy, vertebral body reconstruction and segmental spinal stabilization due to spinal tumors.

Materials and Methods: From 1992 to 2002, 49 patients with primary or metastatic spinal tumors were treated. There were 36 females and 13 males with mean age at operation of 53.5 years (19 – 80). The preoperative classification was Frankel E in 17 cases, B – D in 31 cases and A in one case. Five patients had nerve root dysfunction and one, classified as Frankel E, had sphincter inadequacy. The parts of the spine involved were lower cervical in 7 cases, thoracic in 10, thoracolumbar in 15 and lumbar in 17 cases. The operations were two staged in 36 cases and single staged in 13 cases. In the cervical spine, titanium cylinders filled with methylmethacrylate were used. For the rest of the spine, the most commonly used instruments were the Kaneda device, followed by the Miami–MOSS system. Bone graft was used in five benign tumors. Mean follow – up was 62.3 months.

Results: One patient died during the anterior procedure and in another it had to be interrupted, whereupon he died one week later. Two patients died due to their underlying pathology in the 6th post–operative month. Complications included wound healing problems in 9 patients and local recurrence in one patient. There were no neurological deteriorations or instrument failures. The majority of patients experienced improvement in their neurological status, reduction of pain or both. Most patients were functionally improved and spinal alignment was maintained in all.

Conclusion: Spinal tumor resection and spinal reconstruction provide stability, early weight bearing, symptom remission and neurological improvement.

Study design: Retrospective review of patients with cervical spondylosis treated with three-level anterior cervical discectomy and fusion with plate fixation.

Objective: To assess the radiographic and clinical outcome of three-level instrumented anterior cervical discectomy.

Summary of Background data: Three-level cervical discectomy without plate fixation has shown high rates of pseudarthrosis and poor outcomes. The addition of internal fixation may improve these parameters.

Methods: 46 patients were observed for an average of 17.6 months (range, 6–51). All had three level anterior cervical discectomy and fusion with tricortical iliac crest autograft (4 cases), fibular ring allograft (38 cases), or titanium cage (four cases). Allografts and cages were filled with iliac crest autograft. All patients had semi-rigid plating. Clinical and radiographic follow-up data were obtained. Clinical outcomes were measured as described by Robinson and with the Nurick scale.

Results: Forty-four patients achieved solid fusion. Two patients had additional surgery for junctional disease, and in one of them pseudarthrosis repair was also performed. One asymptomatic pseudarthrosis was noted. With a successful result defined as an excellent or good outcome accompanied by significant pain relief, 38 patients had a successful result (83%). Radiographic adjacent level disease was diagnosed in 11 patients postoperatively and was symptomatic in 5.

Conclusion: Three-level anterior cervical discectomy with plate fixation has a high rate of fusion, a low complication rate, and acceptable outcome in the treatment of multilevel cervical spondylosis.

In this retrospective study 27 patients who had undergone revision discectomies for recurrent lumbar disc herniations were surveyed to assess their clinical outcomes. The patients chosen for the study were compared to a control group of 30 matched patients who had undergone only a primary discectomy. The spine module of the MODEMS® outcome instrument was used to evaluate the patients’ satisfaction, their pain and functional ability following discectomy, as well as their quality of life. All patients were also asked whether they were improved or worsened with surgery. Those undergoing revision surgery were asked whether the improvement following the second surgery was more or less than the improvement following the first surgery. Differences in residual numbness/tingling in the leg and/or the foot as well as in frequency of back and/or buttock pain were identified. Nevertheless improvement due to the repeat discectomy was not statistically different from those who underwent just the primary operation. Based upon patient derived outcome data with a validated instrument, revision discectomy is as efficacious as primary discectomy in selected patients.