Current and emerging concepts in non-invasive and minimally invasive management of spine metastasis

Bhatt, Aashish D.; Schuler, John; Boakye, Maxwell; Woo, Shiao Y.

doi:10.1016/j.ctrv.2012.08.002

Cited by 63 publications

(49 citation statements)

References 134 publications

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“…45 In such cases, surgical intervention is warranted, and the goals of surgery are to decompress the spinal cord, facilitate local disease control (if possible), and stabilize the spine. 5,44 A corpectomy of the thoracolumbar spine can be performed through an anterior-only approach, a posterior-only approach, or an anterior-posterior (AP) approach. 35,48 Some surgeons prefer to use posterior-only approaches (such as costotransversectomy, transpedicular corpectomy, or lateral extracavitary) to perform thoracic corpectomy.…”

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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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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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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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“…It involves the percutaneous injection of polymethylmethacrylate bone cement (PMMA) into the collapsed vertebral bone, which has proven to have a rapid implementation, and to be associated with complications rarely 3) . This procedure has been highly eff ective in reducing axial spinal pain in osteoporotic vertebral compression fractures as well as vertebral metastatic diseases [4][5][6][7][8][9][10][11][12] . But little is known about PVP for malignant spinal lesions with epidural involvement in patients with neurologic defi cit.…”

Section: Introductionmentioning

confidence: 99%

Less PMMA Injection as an Independent Predictor of Poor Neurologic Recovery Following Percutaneous Vertebroplasty in Patients with Malignant Vertebral Compression Fractures

Cui

Zhang

Yan

et al. 2017

J. Hard Tissue Biology.

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To evaluate the effi cacy of percutaneous vertebroplasty (PVP) for malignant vertebral compression fractures with symptoms of neurological compression and the predictive factors for poor neurologic outcomes following PVP. Forty-three patients with malignant vertebral compression fractures and symptoms of neurological compression were treated with PVP, and were classifi ed into two groups according to the American Spinal Injury Association (ASIA) impairment scale at the last follow-up. Data were collected, and the patients were followed up for more than three months after the procedure. Univariate and multivariate analyses were performed to evaluate predictive factors of poor neurological recovery. PVP were successful in all patients. Full recovery from (n = 2) or improvement of (n =16) neurological compression symptoms was achieved in 18 patients (Group A), and no improvement of neurological compression symptoms in 25 patients (Group B). Univariate analysis showed more PMMA leakage (p = 0.038) and less PMMA volume injection (p < 0.001) was associated with the poor neurological recovery, and multivariate analysis showed that less PMMA volume injection (p = 0.004) was an independent predictor of poor neurologic recovery. PVP should not be served as an eff ective treatment for malignant compression fractures with symptoms of neurological compression, and less PMMA volume injection was an independent predictor of a poor neurologic recovery.

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“…Surgery, in the majority of spinal metastasis cases, does not have a curative aim, but only palliative, to assure stability, pain control, and maintenance of neurologic integrity [3]. Surgery is also important to confirm the primary diagnosis, to debulk or remove the tumor mass for a more effective adjuvant therapy, and permit a patient's mobilization.…”

Section: Management and Surgical Indicationmentioning

confidence: 99%

“…Spinal metastases are likely to increase their incidence because patients with cancer today can live longer, due to early detection, as well as to improvements in cancer treatment and care [3]. These lesions should be considered and treated both medically or surgically to prevent undesired sequelae, and to preserve or, whenever possible, improve the quality of their residual life [4,5].…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Surgery for Treatment of Patients with Advanced Cancer and Thoraco-lumbar Spine Metastases

Miscusi¹,

Forcato²,

Raco³

2016

Neurooncology - Newer Developments

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Spinal metastases are common in patients with cancer. Spinal cord compression is the initial symptom of 5-10% of patients with diffuse cancer, and about 70% of lesions are found in the thoracic vertebrae. Patients with advanced cancer are generally excluded from major spine surgery, to reduce postoperative morbidity and mortality. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, especially in advanced cancer patients, seeking to decrease the morbidity of more traditional open spine surgery; furthermore, reducing the recovery time, MISS permits the post-operative chemotherapy and radiotherapy to begin sooner.A series of 29 cancer patients, with a short life expectancy, presenting acute myelopathy due to vertebral thoracic metastases, underwent MISS, with simple laminotomy and percutaneous stabilization; results from such series were compared to those retrospectively obtained from an homogenous series of patients operated with traditional open surgery.No significant differences between two groups were demonstrated in terms of surgical complications and neurological recovery. Nevertheless, patients operated with MISS appear to have an earlier recovery and better quality of life in the immediate postoperative period, which is a fundamental aim for patients who have a short life expectancy.

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Current and emerging concepts in non-invasive and minimally invasive management of spine metastasis

Cited by 63 publications

References 134 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

Less PMMA Injection as an Independent Predictor of Poor Neurologic Recovery Following Percutaneous Vertebroplasty in Patients with Malignant Vertebral Compression Fractures

Minimally Invasive Surgery for Treatment of Patients with Advanced Cancer and Thoraco-lumbar Spine Metastases

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