Minimal Access Spine Surgery (MASS) for Decompression and Stabilization Performed as an Out-Patient Procedure for Metastatic Spinal Tumours Followed by Spine Stereotactic Body Radiotherapy (SBRT): First Report of Technique and Preliminary Outcomes

Abstract

We report a novel approach in the treatment of spinal metastases with epidural disease and mechanical instability using a combined minimal access spine surgery (MASS) technique followed by spine stereotactic body radiotherapy (SBRT). This study was performed as a retrospective review of the first ten consecutive patients treated with this combined approach.The MASS technique was based on a tubular retraction system to gain access for decom pression and mechanical stabilization achieved using methylmethacrylate (MMA) applied under direct visualization. SBRT consisted of one to five image-guided high dose per fraction treatments. Eight patients were symptomatic at baseline. Pain, disability, and quality of life (QOL) were prospectively determined using the visual analogue score (VAS), Oswestry Disability Index (ODI), and ShortForm36 version 2, respectively. The median followup was 13 months (range, 318). MASS successfully decompressed each patient. The median blood loss was 335 ml. Following MASS, the median time to SBRT treatment planning was 6.5 days and subsequent median time to treatment was 7 days. Local control was observed in 7 of the 10 patients. Improvements in VAS, ODI and QOL were observed postSBRT. We report preliminary efficacy for our MASS-SBRT combined approach for patients with spinal metastases, mechanical pain and epidural disease.

Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability

“…They reported one wound complication. Several smaller case reports and series are also available [37,[41][42][43].…”

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

“…Recently, Massicotte et al reported on the role of minimal access spine surgery (MASS) in a small series as an adjunct to definitive SBRT with a median time between surgery and irradiation of only 7 days. 39 The median total radiation dose was 24 Gy (range, 18-35 Gy), in a mean of 3 fractions (range, 1-5). With a median follow-up for the cohort of 13 months (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], local control based on imaging was achieved in 7 of the 10 patients treated.…”

Minimally invasive “separation surgery” plus adjuvant stereotactic radiotherapy in the management of spinal epidural metastases

“…[91011121314151617] However, there is a paucity of literature on the concomitant use of MIS separation surgery and adjuvant SBRT. [14] In this paper, we describe the various minimally invasive surgical techniques employed to achieve separation surgery and spinal stabilization followed by postoperative stereotactic radiotherapy.…”