Posterior stabilisation of a malignant cervico-thoracic vertebral bone defect.

Published online: Jun 27 2005

Benjamin ULMAR, Balkan CAKIR, Klaus HUCH, Wolfhart PUHL, Marcus RICHTER

From Department of Orthopedic Surgery and Spinal Cord Injury, University of Ulm, Germany


Oesophageal cancer is frequently complicated by malignant fistulae. Necrosis of the tumour following radiotherapy or chemotherapy may lead to the development of fistulae between the oesophagus and adjacent tissues and organs. We report the expansion of an extra-luminal oesophageal cancer after resection, invading the cervico-thoracic spine, fortunately without neurological deficit, and leading to instability and formation of a malignant fistula linking the tracheobronchial tree to the subarachnoidal space. To prevent imminent paraplegia and to alleviate severe pain, we rigidly stabilised the spine at the cervicothoracic junction using an angle-stable system through a single posterior approach. Further postoperative follow-up revealed no signs of neurological deterioration. Cervico-thoracic stability was preserved until the patient died nearly five months postoperatively. This case shows that posterior stabilisation and decompression may be a palliative option for patients with imminent paraplegia and severe pain due to advanced tumour infiltration of the cervico- thoracic spine.