Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine

Fang, Taolin; Dong, Jian; Zhao, Xiaogang; McGuire, Robert A.; Li, Xilei

doi:10.3171/2012.7.spine111086

Cited by 51 publications

(34 citation statements)

References 38 publications

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“…14,15,31,35,46,48 When posterior-based corpectomies are performed in the traditional open fashion, large incisions with extensive stripping of the paraspinal muscles can occur. 7,14,19,31,35 The morbidity and complication rates can be as high as 50%-60%, and recovery time can be extensive. 18,25,27 Over the past decade, there has been a movement toward the utilization of less invasive approaches to spine surgery because MIS has been shown to yield less blood loss, shorter hospitalization, and lower infection rates than open approaches.…”

Section: Discussionmentioning

confidence: 99%

“…21,26,31,35 However, they are commonly performed through a traditional open approach, with large exposures, requiring significant muscle and fascial dissection over several spinal levels for instrumentation and for access to the anterior spine. 7,14,19,31,35 Therefore, substantial blood loss, long recovery time, and relatively high rates of complications continue to be unfavorable issues. 31,35 Minimizing morbidity and shortening recovery time are important in all patients, but even more so in patients with spinal metastasis because of limited life spans.…”

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confidence: 99%

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Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Lau¹,

Chou²

2015

SPI

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OBJECT Spinal metastases most commonly affect the vertebral bodies of the spinal column, and spinal cord compression is an indication for surgery. Commonly, an open posterior approach is employed to perform a transpedicular costotransversectomy or lateral extracavitary corpectomy. Because of the short life expectancies in patients with metastatic spinal disease, decreasing the morbidity of surgical treatment and recovery time is critical. One potential approach to decreasing morbidity is utilizing minimally invasive surgery (MIS). Although significant advances have been made in MIS of the spine, data supporting the utility of MIS are still emerging. This study compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. METHODS A consecutive cohort from 2006 to 2013 of 49 adult patients who underwent thoracic transpedicular corpectomies for spinal metastases was retrospectively identified. Patients were categorized into one of 2 groups: open surgery and mini-open surgery. Mini-open transpedicular corpectomy was performed with a midline facial incision over only the corpectomy level of interest and percutaneous instrumentation above and below that level. The open procedure consisted of a traditional posterior transpedicular corpectomy. Chi-square test, 2-tailed t-test, and ANOVA models were employed to compare perioperative and follow-up outcomes between the 2 groups. RESULTS In the analysis, there were 21 patients who had mini-open surgery and 28 patients who had open surgery. The mean age was 57.9 years, and 59.2% were male. The tumor types encountered were lung (18.3%), renal/bladder (16.3%), breast (14.3%), hematological (14.3%), gastrointestinal tract (10.2%), prostate (8.2%), melanoma (4.1%), and other/unknown (14.3%). There were no significant intergroup differences in demographics, comorbidities, neurological status (American Spinal Injury Association [ASIA] grade), number of corpectomies performed, and number of levels instrumented. The open group had a mean operative time of 413.6 minutes, and the mini-open group had a mean operative time of 452.4 minutes (p = 0.329). Compared with the open group, the mini-open group had significantly less blood loss (917.7 ml vs 1697.3 ml, p = 0.019) and a significantly shorter hospital stay (7.4 days vs 11.4 days, p = 0.001). There was a trend toward a lower perioperative complication rate in the mini-open group (9.5%) compared with the open group (21.4%), but this was not statistically significant (p = 0.265). At follow-up, there were no significant differences in ASIA grade (p = 0.342), complication rate after the 30-day postoperative period (p = 0.999), or need for surgical revision (p = 0.803). The open approach had a higher overall infection rate of 17.9% compared with that in the mini-open approach of 9.5%, but this was not statistically significant (p = 0.409). CONCLUSIONS The mini-open transpedicular corpectomy is associated with less blood loss and shorter hospital stay compared with open transpedicular corpectomy. The mini-open corpectomy also trended toward lower infection and complication rates, but these did not reach statistical significance.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Lau¹,

Chou²

2015

SPI

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“…7,8,20 However, surgical treatment of spine metastases can lead to morbidity and a postoperative complication rate of around 20%-30%. 6 In particular, older patients have a higher risk of cardiopulmonary and infectious complications from surgery.…”

Section: Discussionmentioning

confidence: 99%

The use of spine stereotactic radiosurgery for oligometastatic disease

Tang

Deegan

et al. 2016

SPI

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OBJECTIVE The authors investigated the outcomes following spine stereotactic radiosurgery (SSRS) for patients with oligometastatic disease of the spine. METHODS The study was a secondary analysis of 38 of 209 patients enrolled in 2 separate institutional Phase I/II prospective protocols and treated with SSRS between 2002 and 2011. Of these 38 patients, 33 (87%) were treated for a solitary spine metastasis, with no other history of metastatic disease. SSRS was prescribed to 24 Gy in 1 fraction (8%), 18 Gy in 1 fraction (18%), 16 Gy in 1 fraction (11%), 27 Gy in 3 fractions (53%), 30 Gy in 5 fractions (8%), or 20 Gy in 5 fractions (3%). Seventeen patients (45%) received prior conventional external beam radiation therapy. RESULTS The median overall survival (OS) was 75.7 months, and the 2- and 5-year OS rates were 84% and 60%, respectively. In multivariate analysis, patients who had prior spine surgery and a better Karnofsky Performance Scale score had an improved OS (HR 0.16, 95% CI 0.05–0.52, p < 0.01, and HR 0.33, 95% CI 0.13%–0.84%, p = 0.02, respectively), and those who had undergone prior radiation therapy had a worse OS (HR 3.6, 95% CI 1.2%–10%, p = 0.02). The 1-, 2-, and 5-year local progression-free survival rates were 85%, 82%, and 78%, respectively. The median time to systemic therapy modification was 41 months. Two patients (5%) experienced late Grade 3–4 toxicity. CONCLUSIONS Patients with oligometastatic disease of the spine treated with SSRS can experience long-term survival and a long time before needing a modification in systemic therapy. In addition, SSRS leads to excellent local control and minimal late toxicity.

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“…Согласно данным литературы, выполнение остеотомии из одного заднего доступа ассоциируется с меньшим количеством осложнений и, соответственно, с более благоприятным течением послеоперационного периода [2][3][4]. Средняя дли-тельность проведения спондилэктомии из одного зад-него доступа зависит от степени деформации и вас-куляризации патологического процесса и составляет 240-480 мин при среднем объеме кровопотери 800-1960 мл, при применении последовательно переднего и заднего доступов -480-598 мин и 1000-5120 мл соответственно [1,5,6]. При использовании переднего и заднего доступов в структуре периоперационных осложнений доминируют легочные процессы (5-15%), при применении заднего монодоступа -ликворные фистулы (2-22%) [1,5].…”

Section: Introductionunclassified

“…Средняя дли-тельность проведения спондилэктомии из одного зад-него доступа зависит от степени деформации и вас-куляризации патологического процесса и составляет 240-480 мин при среднем объеме кровопотери 800-1960 мл, при применении последовательно переднего и заднего доступов -480-598 мин и 1000-5120 мл соответственно [1,5,6]. При использовании переднего и заднего доступов в структуре периоперационных осложнений доминируют легочные процессы (5-15%), при применении заднего монодоступа -ликворные фистулы (2-22%) [1,5]. Значительные длительность оперативных вмешательств, объем интраопераци-онной кровопотери и уровень осложнений связаны с необходимостью широкой мобилизации больших тканевых массивов и протяженной дуральной и со-судистой диссекцией [5].…”

Section: Introductionunclassified

Features of anterior and lateral vertebral body surface dissection from posterior approach

Pyatikop¹,

Romaev²,

Babalyan³

2018

Ukr Neurosurg J

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Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine

Cited by 51 publications

References 38 publications

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

The use of spine stereotactic radiosurgery for oligometastatic disease

Features of anterior and lateral vertebral body surface dissection from posterior approach

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