Minimally Invasive Treatment of Spinal Metastasis

Abstract

Advancements in the treatment of systemic cancer have improved life expectancy in cancer patients and consequently the incidence of spinal metastasis. Traditionally, open spinal approaches combined with cEBRT (conventional external beam radiation therapy) allowed for local tumor control as well as stabilization and decompression of the spine and neural elements, but these larger operations can be fraught with one complications and delayed healing as well as additional morbidity. Recently, minimally invasive spine techniques are becoming increasingly popular in the treatment of spinal metastasis for many reasons, including smaller incisions with less perioperative complications and potential for expedited time to radiation therapy. These techniques include kyphoplasty with radiofrequency ablation, percutaneous stabilization, laminectomy, and epidural tumor resection through tubular retractors, as well as minimally invasive corpectomy. These techniques combined with highly conformal stereotactic radiosurgery have led to the advent of separation surgery, which allows for decompression of neural elements while creating space between neural elements and the tumor so adequate radiation may be delivered, improving local tumor control. The versatility of these minimally invasive techniques has significantly improved the modern management of metastatic disease of the spine by protecting and restoring the patient’s quality of life while allowing them to quickly resume radiation and systemic treatment.

Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature

“…Surgical resection of a tumor can be done in a few ways: intralesional (debulking), marginal, and wide (en bloc) resection. Our literature review showed that in spine metastases, wide resection is mainly reserved for radioresistant tumors, 48,49 while intralesional/ marginal resections are proposed in two conditions: palliative surgery 50 and minimally invasive techniques combined with radiotherapy 48,51 . Conventionally, Patchell et al demonstrated that decompression surgery followed by cEBRT was preferred over cEBRT alone 52 .…”

“…Our literature review showed that in spine metastases, wide resection is mainly reserved for radioresistant tumors, 48,49 while intralesional/ marginal resections are proposed in two conditions: palliative surgery 50 and minimally invasive techniques combined with radiotherapy. 48,51 Conventionally, Patchell et al demonstrated that decompression surgery followed by cEBRT was preferred over cEBRT alone. 52 More recently, separation surgery followed by stereotactic radiosurgery has been described and made more minimally invasive techniques and subtotal resections possible.…”

“…52 More recently, separation surgery followed by stereotactic radiosurgery has been described and made more minimally invasive techniques and subtotal resections possible. 51 Tokuhashi et al presented a treatment strategy for spinal metastases based on the prognosis score of the lesion determined through a set of criteria. They proposed conservative, palliative, and excisional surgery for scores 0-8, 9-11, and 10-15, respectively.…”

“…Conventionally, Patchell et al demonstrated that decompression surgery followed by cEBRT was preferred over cEBRT alone 52 . More recently, separation surgery followed by stereotactic radiosurgery has been described and made more minimally invasive techniques and subtotal resections possible 51 . Tokuhashi et al presented a treatment strategy for spinal metastases based on the prognosis score of the lesion determined through a set of criteria.…”