Anterior Versus Posterior Decompression for Symptomatic Spinal Metastasis

Perrin, Richard G.; Mcbroom, Robert

doi:10.1017/s0317167100026871

Cited by 76 publications

(35 citation statements)

References 21 publications

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“…When a posterior stabilization procedure is performed in conjunction with laminectomy, neurological improvement increases from approximately 44 to 72%. 4,6,14,29,49,[53][54][55]57,63 Laminectomy is not, however, the proper surgical procedure because much of the spinal cord compression is caused by anterior disease. Transthoracic approaches were then performed more for spinal metastasis in an effort to achieve a more complete and direct decompression of the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…23,28,31,51,53,60,63,[66][67][68] Many authors have described techniques for resection of spinal metastasis that do not require a transcavitary approach. 5,[12][13][14]18,34,35,41,43,44,57,59,64 Costotransversectomy was first described by Menard 48 in 1894 for drainage of tuberculous abscesses in patients with Pott paraplegia. Various modifications of this procedure have been developed for removal of anterior thoracic disc herniation, 32,33,40,56,62 traumatic lesions, 40 and metastatic tumors of the spine.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 80% of spinal metastases involve the VBs rather than the posterior elements. 57 There is a growing body of evidence in the literature to support anterior decompression for anterior compressive lesions. 19,22,27,30,37,38,45,47,52,61,67,70 The use of thoracotomy has produced good functional results, but related morbidity such as persistent pleural effusions, hemothorax, chylothorax, and dural-pleural fistulas has been reported.…”

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confidence: 99%

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Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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Object Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach–related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome. Methods Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, pre-operative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups. Conclusions Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins¹,

Mirza²,

Bellabarba³

et al. 2001

FOC

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“…Both intradural extramedullary and intradural intramedullary disease most commonly originate from drop metastases in the setting of patients with either primary or metastatic brain disease [8,9] . Thoracic lesions (70%) are most often symptomatic due to the smaller space available for the spinal cord in this region, followed by lumbar (20%) and cervical (10%) lesions [7][8][9][10][11] . Eighty percent of spinal metastases involve vertebral bodies rather than posterior vertebral elements [7,12,13] .…”

Section: Treatment Of Spinal Metastatic Disease Overviewmentioning

confidence: 99%

Complications in the management of metastatic spinal disease

Dunning

Butler²,

Morris³

2012

WJO

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Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial spinal pain. No treatment has been proven to increase the life expectancy of patients with spinal metastasis. The goals of therapy are pain control and functional preservation. The most important prognostic indicator for spinal metastases is the initial functional score. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues; neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy is the most commonly used treatment modality for those patients presenting with spinal pain, causative by tumours which are not impinging on neural elements. Operative intervention has, until recently been advocated for establishing a tissue diagnosis, mechanical stabilization and for reduction of tumor burden but not for a curative approach. It is treatment of choice patients with diseaseadvancement despite radiotherapy and in those with known radiotherapy-resistant tumors. Vertebral resection and anterior stabilization with methacrylate or hardware (e.g., cages) has been advocated.Surgical decompression and stabilization, however, along with radiotherapy, may provide the most promising treatment. It stabilizes the metastatic deposited areaand allows ambulation with pain relief. In general, patients who are nonambulatory at diagnosis do poorly, as do patients in whom more than one vertebra is involved. Surgical intervention is indicated in patients with radiation-resistant tumors, spinal instability, spinal compression with bone or disk fragments, progressive neurologic deterioration, previous radiation exposure, and uncertain diagnosis that requires tissue diagnosis. The main goal in the management of spinal metastatic deposits is always palliative rather than curative, with the primary aim being pain relief and improved mobility. This however, does not come without complications, regardless of the surgical intervention technique used. These complication range from the general surgical complications of bleeding, infection, damage to surrounding structures and post operative DT/PE to spinal specific complications of persistent neurologic deficit and paralysis.

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“…[7] Spinal metastases involve vertebral bodies (80%) rather than posterior elements. [8] Pain is the initial symptom in most of the patients. It is usually local but sometimes radicular, radiating in the distribution of the nerve root of the involved level.…”

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confidence: 99%

Solitary spinous process metastasis: a case report

Demirçay

Çivelek

Demıralay

2013

Eklem Hastalik Cerrahisi

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Primary malignant tumors frequently metastasize to bone, third in frequency after liver and lung. [1] Breast, lung, prostate, and kidney cancers have been the most common malignancies with secondary spine involvement.[2] Breast and prostate cancers have particular clinical interest because of the prevalence of these diseases, with about 70% of the patients dying of these cancers having evidence of metastatic bone disease.[3] Bone metastases are also seen in carcinomas of the thyroid, kidney, and bronchus with an incidence of 30-40% at postmortem examination.[3] However, tumors of the gastrointestinal tract rarely (<10%) metastasize to the bone. [3] Sistemik malignitesi olan kemik metastazları vertebral kolonda sık görülür. Metastatik spinal tümörlü hastalar genellikle ağrı ile başvurur. Bazı tümörler asemptomatiktir ve tarama muayeneleri sırasında tespit edilebilir. Spinal metastaz tanısında vertebral kolona yönelik manyetik rezonans görüntüleme (MRG) ile birlikte mevcut olan diğer görüntüleme yöntemleri ve klinik muayene bulguları kullanılmalıdır. Kırk beş yaşında bir erkek bel ağrısıyla başvurdu. Rektum cerrahisi ve radyoterapi öyküsü olan hasta rektum adenokarsinomu için kemoterapi almaktaydı. Üç hafta önce yapılan F18 sodyum florid pozitron emisyon tomografisi taramasında primer cerrahi alan dışında bir anormallik yoktu. Lomber vertebra MRG'sinde L4 spinöz çıkıntı ucunda bir lezyon bulundu. L4 spinöz çıkıntıya eksizyonel biyopsi yapıl-dı. Histolojik inceleme sonucu musinöz adenokarsinom saptandı. İki aylık takipte hastanın bel ağrısı olmadı. İngilizce literatürde daha önce bildirilmiş soliter spinöz çıkıntı metastazına rastlamadık. Geçmişinde kanser öyküsü olan ve nonspesifik spinal ağrısı olan hastalarda spinal metastaz olasılığı dikkatle araştırılmalıdır. Soliter bir spinöz çıkıntı lezyonu dahi spinal metastazın ilk belirtisi olabilir.Anahtar sözcükler: Kemik dokusu; bel ağrısı; neoplazm metastazı; neoplazmlar; omurga.Vertebral column is a common site for bony metastases in patients with systemic malignancy. Patients with metastatic spinal tumors usually present with pain. Some tumors are asymptomatic and can be detected during screening examinations. Magnetic resonance imaging (MRI) of the vertebral column with the panel of available imagining methods and the clinical findings should be used for the diagnosis of spinal metastasis. A 45-year-old man was admitted with low back pain. With a history of rectum surgery and radiotherapy, he was on chemotherapy for rectum adenocarcinoma. F18 sodium fluoride positron emission tomography scan which was performed three weeks ago showed no abnormalities other than the primary surgical site. Magnetic resonance imaging of the lumbar vertebrae spine revealed a lesion on the tip of L4 spinous process. Excisional biopsy of L4 spinous process was performed. Histologic examination revealed mucinous adenocarcinoma. He had no low back pain at two-months follow-up. We could not find any solitary spinous process metastasis reported in English literature. Patients with nonspecif...

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Anterior Versus Posterior Decompression for Symptomatic Spinal Metastasis

Cited by 76 publications

References 21 publications

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Complications in the management of metastatic spinal disease

Solitary spinous process metastasis: a case report

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