A comparison of spinal laser interstitial thermotherapy with open surgery for metastatic thoracic epidural spinal cord compression

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The proximity of the spinal cord to compressive metastatic lesions limits radiosurgical dosing. Open surgery is used to create safe margins around the spinal cord prior to spinal stereotactic radiosurgery (SSRS) but carries the risk of potential surgical morbidity and interruption of systemic oncological treatment. Spinal laser interstitial thermotherapy (SLITT) in conjunction with SSRS provides local control with less morbidity and a shorter interval to resume systemic treatment. The authors present a comparison between SLITT and open surgery in patients with metastatic thoracic epidural spinal cord compression to determine the advantages and disadvantages of each method.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This is a matched-group design study comprising patients from a single institution with metastatic thoracic epidural spinal cord compression that was treated either with SLITT or open surgery. The two cohorts defined by the surgical treatment comprised patients with epidural spinal cord compression (ESCC) scores of 1c or higher and were deemed suitable for either treatment. Demographics, pre- and postoperative ESCC scores, histology, morbidity, hospital length of stay (LOS), complications, time to radiotherapy, time to resume systemic therapy, progression-free survival (PFS), and overall survival (OS) were compared between groups.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Eighty patients were included in this analysis, 40 in each group. Patients were treated between January 2010 and December 2016. There was no significant difference in demographics or clinical characteristics between the cohorts. The SLITT cohort had a smaller postoperative decrease in the extent of ESCC but a lower estimated blood loss (117 vs 1331 ml, p &lt; 0.001), shorter LOS (3.4 vs 9 days, p &lt; 0.001), lower overall complication rate (5% vs 35%, p = 0.003), fewer days until radiotherapy or SSRS (7.8 vs 35.9, p &lt; 0.001), and systemic treatment (24.7 vs 59 days, p = 0.015). PFS and OS were similar between groups (p = 0.510 and p = 0.868, respectively).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors’ results have shown that SLITT plus XRT is not inferior to open decompression surgery plus XRT in regard to local control, with a lower rate of complications and faster resumption of oncological treatment. A prospective randomized controlled study is needed to compare SLITT with open decompressive surgery for ESCC.</jats:p></jats:sec>

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

“…Another evolution of focusing surgery to epidural decompression was represented by spine Laser Interstitial Thermal Therapy (LITT) [98] , [99] , [100] , [101] . Tatsui et al have described an ablative percutaneous procedure able to reduce ESCC heating up the epidural component of the tumor using laser under real time thermal MRI control.…”

Minimally Invasive Treatment of Spinal Metastasis

“…Laser interstitial thermal therapy is an alternative method for treatment of epidural cord compression that may be performed via a percutaneous minimally invasive approach. This technique may achieve both epidural decompression and local control when combined with radiosurgery with less morbidity than surgery [26]. However, the time it takes for the tumor to respond to the treatment and shrink away may preclude widespread adoption of this technique.…”

“…However, the time it takes for the tumor to respond to the treatment and shrink away may preclude widespread adoption of this technique. Compared with open decompression, there may be shorter interval to resume systemic treatment averaging 7.8 days [26]. Small, early studies suggest noninferiority of laser interstitial thermal therapy plus XRT compared with open decompression plus XRT in select patients [26].…”

“…Compared with open decompression, there may be shorter interval to resume systemic treatment averaging 7.8 days [26]. Small, early studies suggest noninferiority of laser interstitial thermal therapy plus XRT compared with open decompression plus XRT in select patients [26].…”

Bone Cement and Pedicle Screw for the Treatment of Spinal Tumors with Spinal Cord Compression and Posterior Wall Defects

“…However, this radical procedure can induce secondary spinal instability and is associated with extensive dissection, massive blood loss, and long surgical duration with poor recovery. 10 Bone cement augmentation procedures like kyphoplasty (KP) and vertebroplasty (VP) were first introduced for treating pathologic compression fractures in the 1990s and have been shown to be highly effective in the treatment of metastatic spinal disease. 11 , 12 The major complication of VP and KP is bone cement leaking into the spinal canal or nerve root foramen, which can lead to spinal cord compression, radiculopathy, and related complications.…”