Evid Based Spine Care J 2011; 2(4): 45-50
DOI: 10.1055/s-0031-1274756
Case report
© AOSpine International Stettbachstrasse 6 8600 Dübendorf, Switzerland

Surgical treatment of multiple spine metastases from gastrinoma

Kelli L Crabtree
University of Kansas Medical Center, Kansas City, KS, USA
Karen K Anderson
University of Kansas Medical Center, Kansas City, KS, USA
Neal G Haynes
University of Kansas Medical Center, Kansas City, KS, USA
Paul M Arnold
University of Kansas Medical Center, Kansas City, KS, USA
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16. Februar 2012 (online)


Study design: Case report.

Clinical question: To report successful surgical therapy for spinal cord compression in a patient with spinal metastases from a pancreatic gastrinoma.

Methods: A 43-year-old man presented three times within 4 years with cervical and upper thoracic spinal cord compression because of metastatic gastrinoma. He had two previous spine metastases to the lower thoracic and lumbar spine, a T11 compressive lesion which required a T9L1 fusion, and an L4 lesion that was treated with chemotherapy and stereotactic radiation. The compression was relieved each time by surgery.

Results: The patient underwent three surgeries in 4 years: (1) debulking and removal of the rib head on the left at T3, and debulking of the tumor at T3 with hemilaminectomy and spinal cord decompression with internal fixation from T1–T5 using posterolateral instrumented fusion and allograft; (2) anterior C7 corpectomy with placement of a cage from C7–T1 with both anterior and posterior fusion of C2C7; and (3) T1–T3 laminectomy, T1–T3 exploration of wound, revision of hardware, T1–T3 removal of spinal tumor, and T3 bilateral transpedicular circumferential decompression. The patient is alive and regained the ability to walk 8 years after initial diagnosis, despite the appearance of spinal metastases 1 year after the diagnosis of liver metastases.

Conclusion: Surgery for spinal cord compression in patients with metastatic neuroendocrine tumors can be effective in relieving radicular pain, weakness and numbness, and while not curative can greatly improve quality of life.


    • 1 Metz DC, Jensen RT. 2008; Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135 (5) 1469-1492
    • 2 Oberg K, Eriksson B. 2005; Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol 19 (5) 753-781
    • 3 Duerr EM, Chung DC. 2007; Molecular genetics of neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 21 (1) 1-14
    • 4 Jensen RT, Berna MJ, Bingham DB et al.. 2008; Inherited pancreatic endocrine tumor syndromes: advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer 113 (7) Suppl 1807-1843
    • 5 Jensen RT, Niederle B, Mitry E et al. 2006; Gastrinoma (duodenal and pancreatic). Neuroendocrinology 84 (3) 173-182
    • 6 Nishio K, Nishio A, Nishikawa T et al. 2007; Recurrent gastrinoma in the mesentery 19 years after primary resection. Dig Dis Sci 52 (11) 3104-3108
    • 7 Hirschowitz BI, Simmons J, Mohnen J. 2005; Clinical outcome using lansoprazole in acid hypersecretors with and without Zollinger-Ellison syndrome: a 13-year prospective study. Clin Gastroenterol Hepatol 3 (1) 39-48
    • 8 Gibril F, Venzon DJ, Ojeaburu JV et al. 2001; Prospective study of the natural history of gastrinoma in patients with MEN1: definition of an aggressive and a nonaggressive form. J Clin Endocrinol Metab 86 (11) 5282-5293
    • 9 Jensen RT. 1998; Management of the Zollinger-Ellison syndrome in patients with multiple endocrine neoplasia type 1. J Intern Med 243 (6) 477-488
    • 10 Gibril F, Doppman JL, Reynolds JC et al. 1998; Bone metastases in patients with gastrinomas: a prospective study of bone scanning, somatostatin receptor scanning, and magnetic resonance image in their detection, frequency, location, and effect of their detection on management. J Clin Oncol 16 (3) 1040-1053
    • 11 Gibril F, Jensen RT. 2005; Advances in evaluation and management of gastrinoma in patients with Zollinger-Ellison syndrome. Curr Gastroenterol Rep 7 (2) 114-121
    • 12 Singh K, Samartzis D, Vaccaro AR et al. 2006; Current concepts in the management of metastatic spinal disease: the role of minimally-invasive approaches. J Bone Joint Surg Br 88 (4) 434-442
    • 13 Sze WM, Shelley MD, Held I et al. 2003; Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy: a systematic review of randomised trials. Clin Oncol (R Coll Radiol) 15 (6) 345-352
    • 14 Gerszten PC, Welch WC. 2000; Current surgical management of metastatic spinal disease. Oncology (Williston Park) 14 (7) 1013-1024
    • 15 Ryken TC, Eichholz KM, Gerszten PC et al.. 2003; Evidence-based review of the surgical management of vertebral column metastatic disease. Neurosurg Focus 15 (5) E11
    • 16 Klimo Jr P, Kestle JR, Schmidt MH. 2004; Clinical trials and evidence-based medicine for metastatic spine disease. Neurosurg Clin N Am 15 (4) 549-564
    • 17 Maranzano E, Trippa F, Chirico L et al. 2003; Management of metastatic spinal cord compression. Tumori 89 (5) 469-475
    • 18 de Herder W, O’Toole D, Rindi G et al. (eds) 2006; ENETS Consensus guidelines for the management of patients with digestive neuroendocrine tumors. Part 1—stomach, duodenum and pancreas. Neuroendocrinology 84 (3) 151-216
    • 19 Klöppel G. 2007; Tumour biology and histopathology of neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab 21 (1) 15-31
    • 20 Power N, Reznek RH. 2002; Imaging pancreatic islet cell tumours. Imaging 14 (2) 147-159
    • 21 Meko JB, Norton JA. 1995; Management of patients with Zollinger-Ellison syndrome. Annu Rev Med 46: 395-411
    • 22 Quatrini M, Castoldi L, Rossi G et al. 2005; A follow-up study of patients with Zollinger-Ellison syndrome in the period 1966–2002: effects of surgical and medical treatments on long-term survival. J Clin Gastroenterol 39 (5) 376-380
    • 23 Yu F, Venzon DJ, Serrano J et al. 1999; Prospective study of the clinical course, prognostic factors, causes of death, and survival in patients with long-standing Zollinger-Ellison syndrome. J Clin Oncol 17 (2) 615-630
    • 24 Akerström G, Hellman P. 2007; Surgery on neuroendocrine tumours. Best Pract Res Clin Endocrinol Metab 21 (1) 87-109
    • 25 Norton JA, Alexander HR, Fraker DL et al. 2001; Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg 234 (4) 495-505
    • 26 Lebtahi R, Cadiot G, Delahaye N et al. 1999; Detection of bone metastases in patients with endocrine gastroenteropancreatic tumors: bone scintigraphy compared with somatostatin receptor scintigraphy. J Nucl Med 40 (10) 1602-1608
    • 27 Virgolini I, Traub-Weidinger T, Decristoforo C. 2005; Nuclear medicine in the detection and management of pancreatic islet-cell tumours. Best Pract Res Clin Endocrinol Metab 19 (2) 213-227
    • 28 Forrer F, Waldherr C, Maecke HR et al. 2006; Targeted radionuclide therapy with 90Y-DOTATOC in patients with neuroendocrine tumors. Anticancer Res 26 (1B) 703-707
    • 1 Metz DC, Jensen RT. 2008; Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135 (5) 1469-1492
    • 2 Patchell RA, Tibbs PA, Regine WF et al. 2005; Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet 366 (9486) 643-648