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

Lau, Darryl; Chou, Dean

doi:10.3171/2014.12.spine14543

Cited by 80 publications

(55 citation statements)

References 56 publications

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“…2 In a recent report, Chou and Lu 8 discussed the use of a mini-open transpedicular corpectomy for metastatic lesions; additional reports have shown the mini-open transpedicular procedure to be associated with less blood loss and shorter hospital stay than open transpedicular procedures, with nonsignificant trends toward lower infection and complication rates. 23 The blood loss is still considerably higher than that documented in our series in which the mini-open TAA was used to acces the thoracolumbar junction. Although these procedures may be considered in the setting of thoracolumbar junction metastatic disease, injury to the spinal cord, blood loss, surgical time, and perioperative morbidity in mini-open TAA, mini-open transpedicular corpectomy, and traditional open posterior corpectomy procedures need to be evaluated.…”

Section: -4mentioning

confidence: 45%

“…In a comparison of the mini-open and open posterior thoracic corpectomy with cage reconstruction, Lau and Chou 23 found a difference between infection rates (17.9% in the open group vs 9.5% in the mini-open group) that was not statistically significant. This high rate of posterior infection is likely reflected on our small cohort of patients who underwent posterior stabilization.…”

Section: Circumferential Fusionmentioning

confidence: 99%

“…32 The EBL of 613 ml is also lower than that reported for newer techniques such as the mini-open posterior thoracic corpectomy with cage reconstruction (mean 917.7 ml) and the traditional open posterior thoracic corpectomy (mean 1697 ml). 23 Thus, the mini-open TAA can be used to decrease perioperative morbidity while achieving the goal of ventral decompression and stabilization to improve pain, preserve neurological function, and provide stability. The results of a study comparing open and thoracoscopic corpectomy, which included metastatic tumor patients, confirmed that patients undergoing mini-open TAA required fewer blood transfusions.…”

Section: -4mentioning

confidence: 99%

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The role of the mini-open thoracoscopic-assisted approach in the management of metastatic spine disease at the thoracolumbar junction

Ravindra

Brock

Awad

et al. 2016

FOC

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OBJECTIVE Treatment advances have resulted in improved survival for many cancer types, and this, in turn, has led to an increased incidence of metastatic disease, specifically to the vertebral column. Surgical decompression and stabilization prior to radiation therapy have been shown to improve functional outcomes, but anterior access to the thoracolumbar junction may involve open thoracotomy, which can cause significant morbidity. The authors describe the treatment of 12 patients in whom a mini-open thoracoscopic-assisted approach (mini-open TAA) to the thoracolumbar junction was used to treat metastatic disease, with an analysis of outcomes. METHODS The authors reviewed a retrospective cohort of patients treated for thoracolumbar junction metastatic disease with mini-open TAA between 2004 and 2016. Data collection included operative time, estimated blood loss, length of stay, follow-up duration, and pre- and postoperative visual analog scale scores and Frankel grades. RESULTS Twelve patients underwent a mini-open TAA procedure for metastatic disease at the thoracolumbar junction. The mean age of patients was 59 years (range 53–77 years), mean estimated blood loss was 613 ml, and the mean duration of the mini-open TAA procedure was 234 minutes (3.8 hours). The median length of stay in the hospital was 7.5 days (range 5–21 days). All 12 patients had significant improvement in their postoperative pain scores in comparison with their preoperative pain scores (p < 0.001). No patients suffered from worsening neurological function after surgery, and of 7 patients who presented with neurological dysfunction, 6 (86%) had an improvement in their Frankel grade after surgery. No patients experienced delayed hardware failure requiring reoperation over a mean follow-up of 10 months (range 1–45 months). CONCLUSIONS The mini-open TAA to the thoracolumbar junction for metastatic disease is a durable procedure that has a reduced morbidity rate compared with traditional open thoracotomy for ventral decompression and fusion. It compares well with traditional and novel posterior approaches to the thoracolumbar junction. The authors found a significant improvement in preoperative pain and neurological symptoms that supports greater use of the mini-open TAA for the treatment of complex metastatic disease at the thoracolumbar junction.

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Section: -4mentioning

confidence: 45%

Section: Circumferential Fusionmentioning

confidence: 99%

Section: -4mentioning

confidence: 99%

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The role of the mini-open thoracoscopic-assisted approach in the management of metastatic spine disease at the thoracolumbar junction

Ravindra

Brock

Awad

et al. 2016

FOC

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“…Lau and Chou[33] compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. Compared with the open group, the mini-open group had significantly less blood loss (917.7 ml vs. 1697.3 ml, respectively, P = 0.019) and a significantly shorter hospital stay (7.4 days vs. 11.4 days, respectively, P = 0.001).…”

Section: Discussionmentioning

confidence: 99%

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

Turel

Kerolus

O’Toole

2017

J Craniovert Jun Spine

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Aim:This study aimed to describe the application of minimally invasive surgery (MIS) in separation surgery combined with postoperative stereotactic body radiation therapy (SBRT) in patients with symptomatic metastatic epidural spinal disease.Methods:Three techniques are described: (1) MIS posterior separation surgery alone, (2) MIS posterolateral separation surgery with percutaneous pedicle screw placement, and (3) MIS lateral corpectomy with percutaneous pedicle screw placement. Seven representative cases are presented in which the above techniques were applied and after which postoperative SBRT was performed.Results:The seven representative patients (3 male, 4 female) had a mean age of 54 years (range, 46–62 years). Two patients had a primary diagnosis of cholangiocarcinoma and in one patient each a diagnosis of breast, renal, lung adenocarcinoma, melanoma, and urothelial squamous cell carcinoma as their primary tumor. All patients had additional multiorgan disease apart from the metastatic spine involvement. Three patients underwent operations in the lumbar spine, two in the thoracic spine, and one in each of the thoraco-lumbar and lumbo-sacral spine. The average operating time was 149 ± 60.3 min (range, 90–240 min). The mean estimated blood loss was 188.8 cc. The mean length of stay in the hospital was 4 days (range, 3–7 days). There were no surgical complications. All patients received postoperative SBRT (typically 24 Gy in 3 fractions) at a mean of 43.2 days after surgery (range, 30–83).Conclusions:Early reports such as this suggest that MIS techniques can be successfully and safely applied in accomplishing “separation surgery” with adjuvant SBRT in the management of metastatic spinal disease. The potential advantages conferred by MIS techniques such as shortened hospital stay, decreased blood loss, reduced perioperative complications, and earlier initiation of adjuvant radiation are highly desirable in the treatment of this challenging patient population.

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“…As a result, minimally invasive surgery (MIS) has been increasingly practiced for spinal metastases and has been shown to decrease operative morbidity. MIS techniques include kyphoplasty/vertebroplasty, 1–7 percutaneous fixation, 8–11 tubular retractors, 12–14 mini-open procedures, 15,16 and thoracoscopy/endoscopy. 17,18 …”

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confidence: 99%

When Less Is More

Zuckerman

Laufer

Sahgal

et al. 2016

Spine

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Study Design Systematic review. Objective The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic spine disease. Summary of Background Data The utilization of MIS techniques in patients with spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. Methods PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic spine disease. PRISMA guidelines were followed. Results Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. Conclusions Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic spine disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery.

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

Cited by 80 publications

References 56 publications

The role of the mini-open thoracoscopic-assisted approach in the management of metastatic spine disease at the thoracolumbar junction

The role of the mini-open thoracoscopic-assisted approach in the management of metastatic spine disease at the thoracolumbar junction

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

When Less Is More

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