Separation Surgery in the Treatment  of Spinal Metastasis

Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient’s condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end.

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“…However, there are reports that it is higher than in MISS [ 32 ]. It also has greater overall survival than open techniques [ 17 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Separation procedures of spinal metastases have been adequately described in the literature [ 33 ]. However, there are very few reports on the use of an endoscope for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Fully Endoscopic Spine Separation Surgery in Metastatic Disease—Case Series, Technical Notes, and Preliminary Findings

Łątka¹,

Kolodziej

Pawlak³

et al. 2023

Medicina

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“…These results once again emphasize the importance of a scheduled interdisciplinary treatment for achieving favorable midterm outcomes. For future treatment, it remains to be discussed whether the established protocol (decompression and instrumentation plus cEBRT) or separation surgery with or without PEEK instrumentation plus stereotactic radiation therapy will truly yield higher benefits for patients [29,30]. To our knowledge, no randomized controlled trials exist for this patient cohort to determine the optimal time for adjuvant radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease

Knöll,

Lenschow,

Lenz

et al. 2023

Cancers

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Background: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. Methods: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. Results: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. Conclusion: Surgical treatment of spinal metastatic disease improves patients’ quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.

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“…Separation surgery combined with SRS can improve not only functional outcomes and pain relief, but also oncological outcomes ( 120 ). Laufer et al.…”

Section: Advances In Treatments For Spinal Metastasismentioning

confidence: 99%

“…Separation surgery combined with SRS can improve not only functional outcomes and pain relief, but also oncological outcomes (120). Laufer et al performed separation surgeries combined with SRS under epidural compression in 186 patients with spinal metastases (121).…”

Section: Separation Surgery Combined With Radiotherapymentioning

confidence: 99%

A new era in the management of spinal metastasis

Morimoto,

Toda,

Hakozaki

et al. 2024

Front. Oncol.

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Despite the recent advances in cancer treatment, the incidence of patients with spinal metastases continues to grow along with the total number of cancer patients. Spinal metastases can significantly impair activities of daily living (ADL) and quality of life (QOL), compared with other types of bone metastases, as they are characterized with severe pain and paralysis caused by skeletal-related events. Reduced ADL can also lead to treatment limitations as certain anticancer agents and radiation therapy are not compatible treatments; thus, leading to a shorter life expectancy. Consequently, maintaining ADLs in patients with spinal metastases is paramount, and spine surgeons have an integral role to play in this regard. However, neurosurgeon, orthopedic and spinal surgeons in Japan do not have a proactive treatment approach to spinal metastases, which may prevent them from providing appropriate treatment when needed (clinical inertia). To overcome such endemic inertia, it is essential for 1) spine surgeons to understand and be more actively involved with patients with musculoskeletal disorders (cancer locomo) and cancer patients; 2) the adoption of a multidisciplinary approach (coordination and meetings not only with the attending oncologist but also with spine surgeons, radiologists, rehabilitation specialists, and other professionals) to preemptive treatment such as medication, radiotherapy, and surgical treatment; and 3) the integration of the latest findings associated with minimally invasive spinal treatments that have expanded the indications for treatment of spinal metastases and improved treatment outcomes. This heralds a new era in the management of spinal metastases.

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Separation Surgery in the Treatment of Spinal Metastasis

Cited by 8 publications

References 46 publications

Fully Endoscopic Spine Separation Surgery in Metastatic Disease—Case Series, Technical Notes, and Preliminary Findings

Fully Endoscopic Spine Separation Surgery in Metastatic Disease—Case Series, Technical Notes, and Preliminary Findings

Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease

A new era in the management of spinal metastasis

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