Single-stage Posterolateral Vertebrectomy for the Management of Metastatic Disease of the Thoracic and Lumbar Spine

Abstract

Appropriate surgical management of spinal metastases combines maximal neural decompression with simultaneous immediate spinal column stabilization in the context of a paliative operation undertaken to improve patients' quality of life. We have used a single-stage posterolateral vertebrectomy (SPLV) for disease of the lumbar spine, combined with bilateral costotransversectomies in the thoracic spine, for these challenging cases. In this prospective cohort study of 96 consecutive patients with metastatic disease of the spinal column for we describe our surgical technique in detail, we examine our learning curve in its use and we analyze the long-term surgical and "quality of life" results in 42 patients who underwent SPLV. The mean and maximum operative blood loss was significantly lower for the SPLV group when compared with combined approaches. All patients either remained neurologically stable or had improved with surgery. Both the mean and the range visual analog scale scores were significantly improved after the SPLV. The SPLV was the only surgical approach to demonstrate a statistically significant improvement in Eastern Cooperative Oncology Group scores at 3 months after the surgery. Seventy-five percent of patients were alive at 6 months and 50% of patients survived for more than 12 months after the surgery. Eleven patients had a major complication (26%) with 9 (21%) patients required early reoperation, 7 of them for wound failure. Our data demonstrates that the SPLV represents a technically achievable improvement in surgical approach to spinal metastases when key parameters are examined. On the basis of these results, we recommend that the SPLV should be considered in all cases where resection of thoracic or lumbar spinal metastatic disease and reconstruction is contemplated.

Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

“…Street et al [13] reported that out of 37 patients with ASIA cord deficit, who underwent a single-stage posterolateral vertebrectomy, nearly half of the patients improved one ASIA grade at the end of the follow-up. All the patients presented with an isolated root deficit and a single patient who was presented with Cauda Equina syndrome had made a complete recovery.…”

“…Three patients (3/134, 2.2 %) died from complications. In a series of 42 patients, who underwent the posterolateral vertebrectomy approach reported by street et al [13], 20 patients suffered with one or more complications for an overall patient complication rate of 47 %. Eleven patients had a major complication (26 %).…”

Spinal extradural arachnoid cyst following percutaneous vertebroplasty

“…Because of their immunocompromised [17,30,33,34]. For these patients with limited life expectancies, the appropriate treatment is to achieve relief of pain and to regain function, thus improving the quality of the life as quickly as possible.…”

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

“…Street et al 17 reported on 66 patients undergoing either anterior-posterior (24 cases) and posterolateral (42 cases) corpectomies for metastatic disease, with an overall complication rate of 47%. They found that EBL was significantly higher in anterior-only or anteriorposterior corpectomies compared with posterolateral corpectomies.…”