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Kow CY, Castle-Kirszbaum M, Kam JK, Goldschlager T. Advances in Surgery for Metastatic Disease of the Spine: An Update for Oncologists. Global Spine J 2024:21925682231155847. [PMID: 39069655 DOI: 10.1177/21925682231155847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Metastatic spine disease is an increasingly common clinical challenge that requires individualised multidisciplinary care from spine surgeons and oncologists. In this article, the authors describe the recent surgical advances in patients presenting with spinal metastases. METHODS We present an overview of the presentation, assessment, and management of spinal metastases from the perspective of the spine surgeon, highlighting advances in surgical technology and techniques, to facilitate multidisciplinary care for this complex patient group. Neither institutional review board approval nor patient consent was needed for this review. RESULTS Advances in radiotherapy delivery and systemic therapy (including immunotherapy and targeted therapy) have refined operative indications for decompression of neural structures and spinal stabilisation, while advances in surgical technology and technique enable these goals to be achieved with reduced morbidity. Formulating individualised management strategies that optimise outcome, while meeting patient goals and expectations, requires a comprehensive understanding of the factors important to patient management. CONCLUSION Spinal metastases require prompt diagnosis and expert management by a multidisciplinary team. Improvements in systemic, radiation, and surgical therapies have broadened operative indications and increased operative candidacy, and future advances are likely to continue this trend.
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Affiliation(s)
- Chien Yew Kow
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
| | - Jeremy Kt Kam
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
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Eltahawy H, Halalmeh DR, Rapp A, Grauer J, Rajah G. Unilateral Minimally Invasive Across-Midline Vertebral Column Resection Partially Corrects Thoracolumbar Kyphosis - A Case Series. World Neurosurg 2023; 178:e394-e402. [PMID: 37482088 DOI: 10.1016/j.wneu.2023.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The goal of this study was to describe the indirect and partial correction of spine kyphotic deformities (secondary to various pathologies) achieved by minimally invasive posterolateral extracavitary approach (MIS PLECA) for corpectomy. METHODS The authors retrospectively reviewed a consecutive case series of 12 patients undergoing MIS PLECA in a single institution. Perioperative data were collected and follow-up computed tomographies and radiographs were reviewed to assess for interbody arthrodesis. RESULTS The mean age was 60.7 ± 20.8 years (58.4% males). The etiologies of deformity included pathological fracture (41.6%), acute trauma (30%), and infection. An expandable cage was used in 66.7% of patients for anterior reconstruction. The mean total estimated blood loss was 764.1 ± 332.9 ml. The mean operative time was 413.3 ± 98.8 minutes. The average length of hospital stay was 5.8 ± 2.5 days. A consistent degree of focal correction of sagittal alignment was seen in all patients with a mean correction of sagittal angle of 7.4 ± 4.3° (P < 0.0001). The mean duration of rehabilitation was 8.5 ± 6.7 days. All patients remained neurologically stable at the last follow-up with a mean follow-up period of 20.1 ± 12.8 months. Successful fusion was achieved in 91.7% at the last follow-up. CONCLUSIONS MIS PLECA for corpectomy appears to be a feasible, safe, and effective MIS technique for select patients, particularly those who cannot tolerate the traditional open approach. Additionally, a focal sagittal deformity correction can be achieved using MIS corpectomy.
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Affiliation(s)
- Hazem Eltahawy
- Neurosurgery and Spine Care Center, Birmingham, Michigan, USA; Department of Neurosurgery, Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
| | - Aaron Rapp
- Department of Neurosurgery, Oakland University-William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Jordan Grauer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Gary Rajah
- Department of Neurosurgery, Munson Medical Center, Traverse City, Michigan, USA
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Latka K, Kolodziej W, Pawlak K, Sobolewski T, Rajski R, Chowaniec J, Olbrycht T, Tanaka M, Latka D. Fully Endoscopic Spine Separation Surgery in Metastatic Disease-Case Series, Technical Notes, and Preliminary Findings. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050993. [PMID: 37241225 DOI: 10.3390/medicina59050993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
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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Affiliation(s)
- Kajetan Latka
- Department of Neurosurgery, St. Hedwig's Regional Specialist Hospital, ul.Wodociagowa 4, 45-221 Opole, Poland
| | - Waldemar Kolodziej
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Al.Witosa 26, 45-401 Opole, Poland
| | - Kornel Pawlak
- Department of Radiotherapy, Opole Center of Oncology, ul.Katowicka 66a, 45-061 Opole, Poland
| | - Tomasz Sobolewski
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Al.Witosa 26, 45-401 Opole, Poland
| | - Rafal Rajski
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Al.Witosa 26, 45-401 Opole, Poland
| | - Jacek Chowaniec
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Al.Witosa 26, 45-401 Opole, Poland
| | - Tomasz Olbrycht
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Al.Witosa 26, 45-401 Opole, Poland
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan
| | - Dariusz Latka
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, Al.Witosa 26, 45-401 Opole, Poland
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Tannoury C, Beeram I, Singh V, Saade A, Bhale R, Tannoury T. The Role of Minimally Invasive Percutaneous Pedicle Screw Fixation for the Management of Spinal Metastatic Disease. World Neurosurg 2021; 159:e453-e459. [DOI: 10.1016/j.wneu.2021.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
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5
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Cui Y, Shi X, Mi C, Wang B, Pan Y, Lin Y. Comparison of Minimally Invasive Tubular Surgery with Conventional Surgery in the Treatment of Thoracolumbar Metastasis. Cancer Manag Res 2021; 13:8399-8409. [PMID: 34795525 PMCID: PMC8593345 DOI: 10.2147/cmar.s332985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022] Open
Abstract
Background This study aimed to evaluate the perioperative safety and efficacy of minimally invasive tubular surgery for patients with spinal metastasis. Methods A total of 161 consecutive patients with spinal metastasis between June 2017 and June 2020 were retrospectively reviewed. A total of 36 patients were included in this study, 14 patients underwent minimally invasive tubular surgery (M), and 22 patients underwent conventional surgery (C). T-test and chi-square tests were used to evaluate demographic and perioperative data differences between the two groups. Results Baseline characteristics did not differ significantly between M and C groups except for the SINS (p=0.002) and preoperative Alb (p=0.026). There was no significant difference in operative time and complications between M and C groups (p<0.05). The M group had less mean blood loss than the C group (1275 vs 718mL, p=0.045). Blood transfusion was comparable between the two groups (p<0.05). The mean amount and drainage time were lower than the C group (141 vs 873mL, p<0.001; 3.1 vs 7.0 days, P<0.001). The mean postoperative hospitalization of the M group was 8.8 days, which was lower than the C group (11.3 days, p=0.045). Sub-analysis showed that for patients with hyper-vascular tumor, the M group had less mean amount and time of drainage compared with the C group (p<0.05); for patients with hypo-vascular tumor, the mean blood loss and amount of blood transfusion were also reduced in M group (p<0.05). The mean blood loss and drainage time of patients with hypo-vascular tumors were less than patients with hyper-vascular tumors in the M group (p<0.05). Conclusion In selected cases, minimally invasive tubular surgery is safe and effective for patients with spinal metastasis. Patients with hypo-vascular tumors were more suitable for this technique with less blood loss, fewer blood transfusions, minor drainage, and shorter postoperative hospitalization.
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Affiliation(s)
- Yunpeng Cui
- Department of Orthopaedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Xuedong Shi
- Department of Orthopaedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Chuan Mi
- Department of Orthopaedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Bing Wang
- Department of Orthopaedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Yuanxing Pan
- Department of Orthopaedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Yunfei Lin
- Department of Orthopaedics, Peking University First Hospital, Beijing, People's Republic of China
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Huangxs S, Christiansen PA, Tan H, Smith JS, Shaffrey ME, Uribe JS, Shaffrey CI, Yen CP. Mini-Open Lateral Corpectomy for Thoracolumbar Junction Lesions. Oper Neurosurg (Hagerstown) 2021; 18:640-647. [PMID: 31605108 DOI: 10.1093/ons/opz298] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Neoplastic, traumatic, infectious, and degenerative pathologies affecting the thoracolumbar junction pose a unique challenge to spine surgeons. Posterior or anterior approaches have traditionally been utilized to treat these lesions. Although minimally invasive surgeries through a lateral approach to the thoracic or lumbar spine have gained popularity, lateral access to the thoracolumbar junction remains technically challenging due to the overlying diaphragm positioned at the interface of the peritoneum and pleura. OBJECTIVE To describe a mini-open lateral retropleural retroperitoneal approach for pathologies with spinal cord/cauda equina compression at the thoracolumbar junction. METHODS A mini-open lateral corpectomy is described in detail in a patient with an L1 metastatic tumor. RESULTS Satisfactory decompression and spinal column reconstruction were achieved. The patient obtained neural function recovery following the procedure with no intra- or postoperative complications. CONCLUSION The morbidities associated with traditional posterior or anterior approaches to thoracolumbar junction pathologies have led to a growing interest in minimally invasive alternatives. The mini-open lateral approach allows for a safe and efficacious corpectomy and reconstruction for thoracolumbar junction pathologies. Thorough understanding of the anatomy, particularly of the diaphragm, is critical. This approach will have expanded roles in the management of patients with thoracolumbar neoplasms, fractures, infections, deformities, or degenerative diseases.
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Affiliation(s)
- Shengbin Huangxs
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.,Department of Orthopedics, Guigang City People's Hospital, Guigang, Guangxi, People's Republic of China
| | - Peter A Christiansen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Haitao Tan
- Department of Orthopedics, Guigang City People's Hospital, Guigang, Guangxi, People's Republic of China
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Mark E Shaffrey
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Christopher I Shaffrey
- Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chun-Po Yen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Spiessberger A, Dietz N, Arvind V, Nasim M, Gruter B, Nevzati E, Hofer S, Cho SK. Spondylectomy in the treatment of neoplastic spinal lesions - A retrospective outcome analysis of 582 patients using a patient-level meta-analysis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:107-116. [PMID: 34194155 PMCID: PMC8214243 DOI: 10.4103/jcvjs.jcvjs_211_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/31/2021] [Indexed: 01/23/2023] Open
Abstract
This study aims at identifying predictors of postoperative complications, lesion recurrence, and overall survival in patients undergoing en bloc spondylectomy (EBS) for spinal tumors. For this purpose a systematic review of the literature was conducted and patient-level data extracted. Linear-regression models were calculated to predict postoperative complications, lesion recurrence and overall survival based on age, tumor etiology, surgical approach, mode of resection (extra- vs. intralesional), tumor extension, and number of levels treated. A total of 582 patients were identified from the literature: 45% of females, median age 46 years (5-78); most common etiologies were: sarcoma (46%), metastases (31%), chordoma (11%); surgical approach was anterior (2.5%), combined (45%), and posterior (52.4%); 68.5% underwent EBS; average levels resected were 1.6 (1-6); average survival was 2.6 years; Complication rate was 17.7%. The following significant correlations were found: postoperative complications and resection mode (Odds ratio [OR] 1.35) as well as number of levels treated (OR 1.35); tumor recurrence and resection mode (OR 0.78); 5-year survival and age (OR 0.79), tumor grade (OR 0.65), tumor stage at diagnosis (OR 0.79), and resection mode (OR 1.68). EBS was shown to improve survival, decreases recurrence rates but also has a higher complication rate. Interestingly, the complication rate was not influenced by tumor extension or tumor etiology.
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Affiliation(s)
- Alexander Spiessberger
- Department of Orthopedic Surgery, Icahn School of Medicine - Mount Sinai Hospital, NY, USA.,Department of Neurosurgery, Hofstra School of Medicine, North Shore University Hospital, NY, USA
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - Varun Arvind
- Department of Orthopedic Surgery, Icahn School of Medicine - Mount Sinai Hospital, NY, USA
| | - Mansoor Nasim
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra Northwell, NY, USA
| | - Basil Gruter
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Silvia Hofer
- Department of Medical Oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine - Mount Sinai Hospital, NY, USA
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8
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Porras JL, Pennington Z, Hung B, Hersh A, Schilling A, Goodwin CR, Sciubba DM. Radiotherapy and Surgical Advances in the Treatment of Metastatic Spine Tumors: A Narrative Review. World Neurosurg 2021; 151:147-154. [PMID: 34023467 DOI: 10.1016/j.wneu.2021.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
Spine tumors encompass a wide range of diseases with a commensurately broad spectrum of available treatments, ranging from radiation for spinal metastases to highly invasive en bloc resection for primary vertebral column malignancies. This high variability in treatment approaches stems both from variability in the goals of surgery (e.g., oncologic cure vs. symptom palliation) and from the significant advancements in surgical technologies that have been made over the past 2 decades. Among these advancements are improvements in surgical technique, namely minimally invasive approaches, increased availability of focused radiation modalities (e.g., proton therapy and linear accelerator devices), and new surgical technologies, such as carbon fiber-reinforced polyether ether ketone rods. In addition, several groups have described nonsurgical interventions, such as vertebroplasty and kyphoplasty for spinal instability secondary to pathologic fracture, and lesion ablation with spinal laser interstitial thermoablation, radiofrequency ablation, or cryoablation. We provide an overview of the latest technological advancements in spinal oncology and their potential usefulness for modern spinal oncologists.
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Affiliation(s)
- Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bethany Hung
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
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9
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Barzilai O, Robin AM, O'Toole JE, Laufer I. Minimally Invasive Surgery Strategies: Changing the Treatment of Spine Tumors. Neurosurg Clin N Am 2020; 31:201-209. [PMID: 32147011 DOI: 10.1016/j.nec.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Innovation in surgical technique and contemporary spinal instrumentation paired with intraoperative navigation/imaging concepts allows for safer and less-invasive surgical approaches. The combination of stereotactic body radiotherapy, contemporary surgical adjuncts, and less-invasive techniques serves to minimize blood loss, soft tissue injury, and length of hospital stay without compromising surgical efficacy, potentially enabling patients to begin adjuvant treatment sooner.
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Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA.
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10
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Novel use of intraoperative cone-beam imaging with on-table angiography for excision of an occipitocervical tumour: A technical note and its feasibility. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Telfeian AE, Oyelese A, Fridley J, Doberstein C, Gokaslan ZL. Endoscopic surgical treatment for symptomatic spinal metastases in long-term cancer survivors. JOURNAL OF SPINE SURGERY 2020; 6:372-382. [PMID: 32656374 DOI: 10.21037/jss.2019.10.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background To evaluate the feasibility of awake transforaminal endoscopic surgery in the management of symptomatic spinal metastases. Methods Transforaminal endoscopic spine procedures were performed by 1 surgeon in 325 patients over a period of 4 years from 2014 to 2018. Four of these patients suffered from radicular pain secondary to nerve compression from metastatic spine disease and are the basis of our analysis. Data was evaluated retrospectively in these patients with a minimum follow up of 1 year. Results All 4 patients treated with transforaminal endoscopic spine surgery for decompression of their metastatic spine disease had successful resolution of their symptoms without any perioperative complications and only brief recovery periods required. Conclusions Awake endoscopic surgery for the treatment of symptomatic metastatic spine disease is an effective outpatient surgical option for the treatment of patients suffering from radicular pain due to nerve compression from metastatic spine disease.
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Affiliation(s)
- Albert E Telfeian
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adetokunbo Oyelese
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jared Fridley
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Cody Doberstein
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Hawks C, Herrera-Nicol S, Pruzansky ME, Jenkins AL. Minimally Invasive Resection of Symptomatic Cervical Rib for Treatment of Thoracic Outlet Syndrome. World Neurosurg 2020; 139:219-222. [PMID: 32194276 DOI: 10.1016/j.wneu.2020.03.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurogenic thoracic outlet syndrome treatments have high morbidity and recurrence rates. We present for the first time to our knowledge a minimally invasive spine surgery technique for complete resection of a cervical rib via a costotransversectomy approach. CASE DESCRIPTION A patient with an 8-year history of progressive thoracic outlet syndrome presented with right C8 pain, weakness, and atrophy of her right forearm and thenar eminence. After neurogenic thoracic outlet syndrome was confirmed via electromyography and imaging revealed bilateral cervical ribs (right more than left), the patient underwent a minimally invasive spine surgery resection of the rib via a costotransversectomy and was discharged home the same day. The patient's pain and weakness gradually improved over a 2-year follow-up period. CONCLUSIONS Resection of a cervical rib via minimally invasive spine surgery costotransversectomy is safe and well tolerated compared with existing surgical treatments such as transaxillary, supraclavicular, and infraclavicular approaches.
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Affiliation(s)
| | - Sarah Herrera-Nicol
- Jenkins NeuroSpine, New York, New York, USA; Department of Neurosurgery, Icahn School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Mark E Pruzansky
- HandSport Surgery Institute, New York, New York, USA; Department of Orthopedics, The Mount Sinai Hospital, New York, New York, USA
| | - Arthur L Jenkins
- Jenkins NeuroSpine, New York, New York, USA; Department of Orthopedics, The Mount Sinai Hospital, New York, New York, USA; Department of Neurosurgery, Icahn School of Medicine, The Mount Sinai Hospital, New York, New York, USA.
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13
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Spiessberger A, Arvind V, Gruter B, Cho SK. Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing the outcome of seven different surgical approaches. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:248-256. [DOI: 10.1007/s00586-019-06179-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/15/2019] [Accepted: 10/05/2019] [Indexed: 01/16/2023]
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14
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Sadrameli SS, Jafrani R, Staub BN, Radaideh M, Holman PJ. Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws. Int J Spine Surg 2018; 12:650-658. [PMID: 30619667 PMCID: PMC6314338 DOI: 10.14444/5081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Standard fluoroscopic navigation and stereotactic computed tomography-guided lumbar pedicle screw instrumentation traditionally relied on the placement of Kirshner wires (K-wires) to ensure accurate screw placement. The use of K-wires, however, is associated with a risk of morbidity due to potential ventral displacement into the retroperitoneum. We report our experience using a computer image-guided, wireless method for pedicle screw placement. We hypothesize that minimally invasive, wireless pedicle screw placement is as accurate and safe as the traditional technique using K-wires while decreasing operative time and avoiding potential complications associated with K-wires. METHODS We conducted a retrospective review of 42 consecutive patients who underwent a stereotactic-guided, wireless lumbar pedicle screw placement. All screws were placed to provide fixation to a variety of interbody fusion constructs including anterior lumbar interbody fusion, lateral interbody fusion, and transforaminal lumbar interbody fusion. The procedures were performed using the O-arm intraoperative imaging system with StealthStation navigation (Medtronic, Memphis, TN) and Medtronic navigated instrumentation. After placing a percutaneous navigation frame into the posterior superior iliac spine or onto an adjacent spinous process, an intraoperative O-arm image was obtained to allow subsequent StealthStation navigation. Para-median incisions were selected to allow precise percutaneous access to the target pedicles. The pedicles were cannulated using either a stereotactic drill or a novel awl-tipped tap along with a low-speed/high-torque power driver. The initial trajectory into the pedicle was recorded on the Medtronic StealthStation prior to removal of the drill or awl-tap, creating a "virtual" K-wire rather than inserting an actual K-wire to allow subsequent tapping and screw insertion. Accurate screw placement is achieved by following the virtual path as an exact computer-aided design model of the screw traversing the pedicle is projected onto the display and by using audible and tactile feedback. A second O-arm scan was obtained to confirm accuracy of screw placement. RESULTS A total of 20 women and 22 men (average age = 56 years) underwent a total of 182 pedicle screw placements using the stereotactic, wireless technique. The total breach rate was 9.9%, with a clinically significant breach rate of 0% (defined as >2 mm medial breach or >4 mm lateral breach) and a clinical complication rate of 0%. CONCLUSIONS Wireless, percutaneous placement of lumbar pedicle screws using computed tomography-guided stereotactic navigation is a safe, reproducible technique with very high accuracy rates.
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Affiliation(s)
- Saeed S Sadrameli
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Ryan Jafrani
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Blake N Staub
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Majdi Radaideh
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
| | - Paul J Holman
- Houston Methodist Neurosurgical Spine Center, Houston Methodist Neurological Institute, Houston, Texas
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Yuan L, Mao Y. [Advance of Treatment for Superior Sulcus Tumor of the Lung]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:493-497. [PMID: 29945709 PMCID: PMC6022026 DOI: 10.3779/j.issn.1009-3419.2018.06.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤, 是非小细胞肺癌(non-small cell lung cancer, NSCLC)的一个独特的临床亚型, 占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。近几十年, 肺上沟瘤的治疗取得了不断的进展, 最新发布的几个临床试验证实了同期放化疗加手术切除能够改善肿瘤的完整切除率、局部控制率和病理缓解率, 延长患者的总生存时间。已经成为肺上沟瘤的治疗最为有效的方式, 并成为美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)和美国胸科医师协会(American College of Chest Physicians, ACCP)指南推荐的肺上沟瘤治疗方案。本文回顾国内外相关文献, 简要介绍肺上沟瘤手术治疗及综合治疗的进展情况。
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Affiliation(s)
- Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Kumar N, Malhotra R, Maharajan K, Zaw AS, Wu PH, Makandura MC, Po Liu GK, Thambiah J, Wong HK. Metastatic Spine Tumor Surgery: A Comparative Study of Minimally Invasive Approach Using Percutaneous Pedicle Screws Fixation Versus Open Approach. Clin Spine Surg 2017; 30:E1015-E1021. [PMID: 27352374 DOI: 10.1097/bsd.0000000000000400] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Prospective cohort study. SUMMARY OF BACKGROUND DATA Minimally invasive spinal surgery (MISS) has been gaining recognition in patients with metastatic spine disease (MSD). The advantages are reduction in blood loss, hospital stay, and postoperative morbidity. Most of the studies were case series with very few comparing the outcomes of MISS to open approaches. OBJECTIVE To evaluate and compare the clinical and perioperative outcomes of MISS versus open approach in patients with symptomatic MSD, who underwent posterior spinal stabilization and/or decompression. PATIENTS AND METHODS Our study included 45 MSD patients; 27 managed by MISS and 18 by open approach. All patients had MSD presenting with symptoms of neurological deficit, spinal instability, or both. Preoperative, intraoperative, and postoperative data were collected for comparison of the 2 approaches. All patients were followed up until the end of study period (maximum up to 4 years from time of surgery) or till their demise. The clinical outcome measures were pain control, neurological and functional status, whereas perioperative outcomes were blood loss, operative time, length of hospital stay, and time taken to initiate radiotherapy/chemotherapy after index surgery. RESULTS Majority of patients in both groups showed improvement in pain, neurological status, independent ambulation, and ECOG score in the postoperative period with no significant differences between the 2 groups. There was a significant reduction in intraoperative blood loss (621 mL less, P<0.001) in the MISS group. The average time to initiate radiotherapy after surgery was 13 days (range, 12-16 d) in MISS and 24 days (range, 16-40 d) in the open group. This difference was statistically significant (P<0.001). Operative time and duration of hospital stay were also favorable in the MISS group, although the differences were not significant. CONCLUSIONS MISS is comparable with open approach demonstrating similar improvements in clinical outcomes, that is pain control, neurological and functional status. MISS approaches have also shown promising results due to lesser intraoperative blood loss and allowing earlier radiotherapy/chemotherapy.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
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17
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Nasser R, Drazin D, Nakhla J, Al-Khouja L, Brien E, Baron EM, Kim TT, Patrick Johnson J, Yassari R. Resection of spinal column tumors utilizing image-guided navigation: a multicenter analysis. Neurosurg Focus 2017; 41:E15. [PMID: 27476839 DOI: 10.3171/2016.5.focus16136] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of intraoperative stereotactic navigation has become more available in spine surgery. The authors undertook this study to assess the utility of intraoperative CT navigation in the localization of spinal lesions and as an intraoperative tool to guide resection in patients with spinal lesions. METHODS This was a retrospective multicenter study including 50 patients from 2 different institutions who underwent biopsy and/or resection of spinal column tumors using image-guided navigation. Of the 50 cases reviewed, 4 illustrative cases are presented. In addition, the authors provide a description of surgical technique with image guidance. RESULTS The patient group included 27 male patients and 23 female patients. Their average age was 61 ± 17 years (range 14-87 years). The average operative time (incision to closure) was 311 ± 188 minutes (range 62-865 minutes). The average intraoperative blood loss was 882 ± 1194 ml (range 5-7000 ml). The average length of hospitalization was 10 ± 8.9 days (range 1-36 days). The postoperative complications included 2 deaths (4.0%) and 4 radiculopathies (8%) secondary to tumor burden. CONCLUSIONS O-arm 3D imaging with stereotactic navigation may be used to localize lesions intraoperatively with real-time dynamic feedback of tumor resection. Stereotactic guidance may augment resection or biopsy of primary and metastatic spinal tumors. It offers reduced radiation exposure to operating room personnel and the ability to use minimally invasive approaches that limit tissue injury. In addition, acquisition of intraoperative CT scans with real-time tracking allows for precise targeting of spinal lesions with minimal dissection.
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Affiliation(s)
- Rani Nasser
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York;
| | | | - Jonathan Nakhla
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York;
| | | | - Earl Brien
- Orthopedics, Cedars-Sinai Medical Center, Los Angeles; and
| | | | - Terrence T Kim
- Departments of 2 Neurosurgery and.,Orthopedics, Cedars-Sinai Medical Center, Los Angeles; and
| | - J Patrick Johnson
- Departments of 2 Neurosurgery and.,Department of Neurosurgery, University of California, Davis, California
| | - Reza Yassari
- Department of Neurosurgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York;
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Turel MK, Kerolus MG, O'Toole JE. Minimally invasive "separation surgery" plus adjuvant stereotactic radiotherapy in the management of spinal epidural metastases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:119-126. [PMID: 28694595 PMCID: PMC5490345 DOI: 10.4103/jcvjs.jcvjs_13_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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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Affiliation(s)
- Mazda K Turel
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Zairi F, Karnoub MA, Vieillard MH, Bouras A, Marinho P, Allaoui M, Devos P, Assaker R. Evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic spine metastasis from lung cancer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:4052-4059. [PMID: 26821552 DOI: 10.1007/s00586-016-4397-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The management of spine metastases is an increasing concern for spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of spine metastases, there is a lack of studies focusing on lung cancer alone. PURPOSE To assess the effectiveness and safety of surgery in the management of symptomatic spine metastases from lung cancer. METHODS We retrospectively reviewed all patients (n = 53) who underwent surgery for spine metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered "surgical success". RESULTS No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of spine metastases (p = 0.0216). CONCLUSION A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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Affiliation(s)
- Fahed Zairi
- Department of Neurosurgery, CHRU de Lille, 59000, Lille, France.
| | | | | | - Alkis Bouras
- Department of Neurosurgery, CHRU de Lille, 59000, Lille, France
| | - Paulo Marinho
- Department of Neurosurgery, CHRU de Lille, 59000, Lille, France
| | - Mohamed Allaoui
- Department of Neurosurgery, CHRU de Lille, 59000, Lille, France
| | - Patrick Devos
- Department of Biostatistics, Univ Lille, CHU Lille, EA2694, 59000, Lille, France
| | - Richard Assaker
- Department of Neurosurgery, CHRU de Lille, 59000, Lille, France
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When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease. Spine (Phila Pa 1976) 2016; 41 Suppl 20:S246-S253. [PMID: 27753784 PMCID: PMC5551976 DOI: 10.1097/brs.0000000000001824] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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. LEVEL OF EVIDENCE N/A.
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Abi Lahoud G, Abi Jaoude S. [Role of surgery in the management of vertebral metastases. General revue]. Cancer Radiother 2016; 20:484-92. [PMID: 27614512 DOI: 10.1016/j.canrad.2016.07.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/12/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
The spine is the most common site of skeletal metastases. Treatment decisions for patients with spinal metastases can be challenging and greatly depend on survival prognosis. Surgery remains a valuable weapon in the therapeutic arsenal. A review of the literature describing the role of surgery, the various surgical approaches and the prognostic scores available for the management of spinal metastases was performed and summarized. Surgery for spinal metastases has 3 main objectives: management of pain, achievement of mechanical stability and preservation or restoration of neurological function. A variety of surgical approaches are available and depend on location of tumor, presence of instability, neurological status, oncologic prognosis, general performance status and subsequent treatment measures. The goal of any therapeutic course for a spinal metastasis is the best oncologic and functional result with the least aggressive treatment. Novelty surgical and adjunctive measures allow a multidisciplinary approach to the metastatic spine.
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Affiliation(s)
- G Abi Lahoud
- Unité de chirurgie de la colonne vertébrale et de la moelle épinière, service de neurochirurgie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - S Abi Jaoude
- Unité de chirurgie de la colonne vertébrale et de la moelle épinière, service de neurochirurgie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
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Molina C, Rory Goodwin C, Abu-Bonsrah N, Elder BD, De la Garza Ramos R, Sciubba DM. Posterior approaches for symptomatic metastatic spinal cord compression. Neurosurg Focus 2016; 41:E11. [DOI: 10.3171/2016.5.focus16129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgical interventions for spinal metastasis are commonly performed for mechanical stabilization, pain relief, preservation of neurological function, and local tumor reduction. Although multiple surgical approaches can be used for the treatment of metastatic spinal lesions, posterior approaches are commonly performed. In this study, the role of posterior surgical procedures in the treatment of spinal metastases was reviewed, including posterior laminectomy with and without instrumentation for stabilization, transpedicular corpectomy, and costotransversectomy. A review of the literature from 1980 to 2015 was performed using Medline, as was a review of the bibliographies of articles meeting preset inclusion criteria, to identify studies on the role of these posterior approaches among adults with spinal metastasis. Thirty-four articles were ultimately analyzed, including 1 randomized controlled trial, 6 prospective cohort studies, and 27 retrospective case reports and/or series. Some of the reviewed articles had Level II evidence indicating that laminectomy with stabilization can be recommended for improvement in neurological outcome and reduction of pain in selected patients. However, the use of laminectomy alone should be carefully considered. Additionally, transpedicular corpectomy and costotransversectomy can be recommended with the expectation of improving neurological outcomes and reducing pain in properly selected patients with spinal metastases. With improvements in the treatment paradigms for patients with spinal metastasis, as well as survival, surgical therapy will continue to play an important role in the management of spinal metastasis. While this review presents a window into determining the utility of posterior approaches, future prospective studies will provide essential data to better define the roles of the various options now available to surgeons in treating spinal metastases.
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Kumar N, Zaw AS, Khine HE, Maharajan K, Wai KL, Tan B, Mastura S, Goy R. Blood Loss and Transfusion Requirements in Metastatic Spinal Tumor Surgery: Evaluation of Influencing Factors. Ann Surg Oncol 2016; 23:2079-86. [DOI: 10.1245/s10434-016-5092-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Indexed: 11/18/2022]
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Mobbs RJ, Park A, Maharaj M, Phan K. Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours. J Clin Neurosci 2015; 23:88-94. [PMID: 26422600 DOI: 10.1016/j.jocn.2015.05.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/22/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Abstract
We investigated the clinical and radiological results of percutaneous pedicle screw fixation in the management of spinal trauma and metastatic tumours. A retrospective analysis was performed on a series of 14 patients who were operated on from March 2009 to November 2011 by a single surgeon (RJM). Following a radiological review (CT scan/MRI), six patients underwent short segment fixation, while the remaining underwent long segment fixation. All patients had routine follow-ups at 4, 6, 12months, and annually thereafter. Clinical examinations were conducted preoperatively and postoperatively, and the length of operation, blood loss, and postoperative pain relief were recorded. There was a single patient with an incision site complication. The mean blood loss was 269mL. All of the parameters demonstrated no significant differences between the trauma and the tumour groups (p=0.10). The neurological power scores improved for all patients, with the largest increase being from a score of 2 to 4. At follow-up, the majority of patients had returned to their previous activities and had reduced pain scores. One patient suffered high pain levels from other medical conditions that were not related to the operation. Minimally invasive pedicle screw fixation is a suitable option for patients with spinal tumours and fractures, with acceptable safety and efficacy in this small retrospective patient series. We have seen favourable results in our patients, who have experienced an increased quality of life following their surgery.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia.
| | - Ashley Park
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kevin Phan
- NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia
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Moussazadeh N, Rubin DG, McLaughlin L, Lis E, Bilsky MH, Laufer I. Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability. Spine J 2015; 15:1609-17. [PMID: 25828478 DOI: 10.1016/j.spinee.2015.03.037] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/19/2015] [Accepted: 03/20/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pathologic vertebral compression fractures (VCFs) represent a major source of morbidity and diminished quality of life in the spinal oncology population. Procedures with low morbidity that effectively treat patients with pathologic fractures are especially important in the cancer population where life expectancy is limited. Vertebroplasty and kyphoplasty are often not effective for mechanically unstable pathologic fractures extending into the pedicle and facet joints. Combination of cement augmentation and percutaneous instrumented stabilization represents a minimally invasive treatment option that does not delay radiation and systemic therapy. PURPOSE The objective of the study was to evaluate the safety and efficacy of cement-augmented short-segment percutaneous posterolateral instrumentation for tumor-associated VCF with pedicle and joint involvement. METHODS Forty-four consecutive patients underwent cement-augmented percutaneous spinal fixation for unstable tumors between 2011 and 2014. Retrospective analysis of prospectively collected data, including visual analog pain scale (VAS) response score and procedural complications, was performed. RESULTS Patients with a median composite Spinal Instability Neoplastic Scale score of 10 (range=8-15) were treated with constructs spanning one to four disk spaces (median of two spaces, constituting 84% of all cases). The proportion of patients with severe pain decreased from 86% preoperatively to 0%; 65% of patients reported no referable instability pain postoperatively. There was one adjacent-level fracture responsive to kyphoplasty, and one case of asymptomatic screw pullout. Two patients subsequently required decompression in the setting of disease progression despite radiation; there was no perioperative morbidity. CONCLUSIONS Percutaneous cement-augmented posterolateral spinal fixation is a safe and effective option for palliation of appropriately selected mechanically unstable VCF that extends into pedicle and/or joint.
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Affiliation(s)
- Nelson Moussazadeh
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA
| | - David G Rubin
- Legacy Spine & Neurological Associates, 5800 W. 10th St, Little Rock, AR, USA
| | - Lily McLaughlin
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA
| | - Mark H Bilsky
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA
| | - Ilya Laufer
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA.
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Zairi F, Vieillard MH, Assaker R. Spine metastases: are minimally invasive surgical techniques living up to the hype? CNS Oncol 2015; 4:257-64. [PMID: 26095003 DOI: 10.2217/cns.15.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Surgery is still considered the mainstay treatment of spine metastases. However, conventional surgery is associated with a high complication rate that may delay the initiation of adjuvant therapies and make some patients not eligible. Minimally invasive surgical techniques have been developed to overcome these drawbacks while providing the same benefits than standard open surgery. In recent years, there has been a flourishing enthusiasm demonstrating the advantages of these various techniques. Although, it is clear that these techniques have greatly improved the treatment of spine metastases, each has its own limitations. In this report, we list the main minimally invasive surgical techniques emphasizing their advantages and drawbacks.
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Affiliation(s)
- Fahed Zairi
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | | | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
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Donnelly DJ, Abd-El-Barr MM, Lu Y. Minimally Invasive Muscle Sparing Posterior-Only Approach for Lumbar Circumferential Decompression and Stabilization to Treat Spine Metastasis--Technical Report. World Neurosurg 2015; 84:1484-90. [PMID: 26100166 DOI: 10.1016/j.wneu.2015.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Palliative tumor resection and subsequent stabilization are important for maximizing function and quality of life for patients suffering from spinal metastases. However, traditional operative techniques for spinal metastases with vertebral body destruction involve extensive soft tissue dissection. In the lumbar spine, open 2-staged spine procedures are routinely required with an anterior retroperitoneal approach for corpectomy and cage insertion and posterior decompression and stabilization with pedicle screws and rods. Both stages require extensive soft tissue dissection that results in significant surgical morbidity, long recovery time, and subsequent delay in initiating postoperative chemoradiotherapy, as well as initially hampering patients' overall quality of life. A minimally invasive approach is desirable for achieving spinal stability, pain control, functional recovery, rapid initiation of adjuvant therapies, and overall patient satisfaction, especially in patients whose medical and surgical therapies are aimed at palliation rather than cure. PRESENTATION A 59-year-old man with renal cell carcinoma and a known L1 vertebral body metastasis presented with severe progressive low back pain and was found to have a pathologic L1 vertebral body fracture with focal kyphosis. INTERVENTION Here, we describe a minimally invasive muscle-sparing, posterior-only approach for L1 transpedicular hemicorpectomy and expandable cage placement, L1 laminectomy, and T11-L3 posterior instrumented stabilization. The surgical corridor was achieved through the Wiltse muscle plane between the multifidus and longissimus muscles so that minimal muscle detachment was required to achieve transpedicular access to the anterior and middle spinal columns. The L1 nerve root was completely skeletonized to allow adequate lumbar hemicorpectomy, tumor resection, and expandable titanium cage insertion. Lastly, percutaneous pedicle screws and rods were inserted from T11 to L3 for stabilization. RESULT The patient tolerated the procedure well with no complications and less than 200 mL estimated blood loss. Postoperative computed tomography revealed restoration of intervertebral height and adequate tumor resection with excellent placement of the expandable cage and posterior construct. The patient was discharged on postoperative day 4 and had nearly no back pain 3 weeks after surgery. Adjuvant therapies were started soon after. At the 6-month follow-up, the patient required minimal narcotic pain medication. Computed tomography scan demonstrated stable hardware with no evidence of failure. CONCLUSION A minimally invasive muscle-sparing, posterior-only approach is a promising surgical strategy for 360-degree decompression and stabilization for the treatment of lumbar spinal metastases with minimized blood loss, muscle detachment and postoperative pain, and fast postoperative recovery and initiation of adjuvant therapy.
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Affiliation(s)
- Dustin J Donnelly
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Rao PJ, Thayaparan GK, Fairhall JM, Mobbs RJ. Minimally invasive percutaneous fixation techniques for metastatic spinal disease. Orthop Surg 2015; 6:187-95. [PMID: 25179352 DOI: 10.1111/os.12114] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/08/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Surgical treatment of spinal metastasis is generally a palliative procedure. Although minimally invasive surgical (MIS) techniques are supposedly less morbid than open techniques, there is a lack of stratification of MIS techniques based on anticipated longevity. A simple stratification into three percutaneous surgical techniques based on modified Tokuhashi score is here proposed. METHODS Patients recommended for spinal surgery for metastatic spinal disease between 2009 and 2012 and operated on by the senior author (RJM) were retrospectively reviewed. One of three MIS techniques was offered based on estimated survival using a modified Tokuhashi score. Technique #1 is suitable for patients with predicted short longevity (<6 months). Using a mini-open midline or paramedian decompression and percutaneous screw fixation, the goal here is for rapid mobilization and minimization of hospitalization. Technique #2 is suitable for patients with predicted medium longevity (6-12 months). They are suitable for decompression and/or cement vertebral body replacement and a two levels stabilization. Technique #3 is suitable for patients with predicted long term survival survival (>12 months). In these patients, the primary goal of surgery is a wide local or marginal resection of tumor, decompression of the neurological elements and a robust stabilization construct. They are suitable for an open 360°decompression, vertebral body reconstruction and a multilevel stabilization. RESULTS The study included eight patients with a mean age of 59 years (range, 36-72 years). Mean modified Tokuhashi score was 10 (range, 7-13) with three patients in the short term, two in the medium term and three in the long term survival category. Mean blood loss was 700 mL (range, 100-1200 mL), mean operating time 280 min (range, 120-360 min) and length of stay in the hospital was on average 13 days (range, 3-30 days). CONCLUSION The authors present three minimally invasive technique options for the management of spinal metastatic disease corresponding to three clinical prognostic categories. In this small series, MIS techniques resulted in speedy recovery, minimal morbidity and no mortality.
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Affiliation(s)
- Prashanth J Rao
- Neurospine Clinic, Prince of Wales Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia
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Spitz SM, Sandhu FA, Voyadzis JM. Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time. J Neurosurg Spine 2015; 22:422-31. [DOI: 10.3171/2014.11.spine14181] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Percutaneous pedicle screws are used to provide rigid internal fixation in minimally invasive spinal procedures and generally require the use of Kirchner wires (or K-wires) as a guide for screw insertion. K-wires can bend, break, advance, or pull out during the steps of pedicle preparation and screw insertion. This can lead to increased fluoroscopic and surgical times and potentially cause neurological, vascular, or visceral injury. The authors present their experience with a novel “K-wireless” percutaneous pedicle screw system that eliminates the inherent risks of K-wire use.
METHODS
A total of 100 screws were placed in 28 patients using the K-wireless percutaneous screw system. Postoperative dedicated spinal CT scans were performed in 25 patients to assess the accuracy of screw placement. Screw placement was graded A through D by 2 independent radiologists: A = within pedicle, B = breach < 2 mm, C = breach of 2–4 mm, and D = breach > 4 mm. Screw insertion and fluoroscopy times were also recorded in each case. Clinical complications associated with screw insertion were documented.
RESULTS
A total of 100 K-wireless percutaneous pedicle screws were placed into the lumbosacral spine in 28 patients. Postoperative CT was performed in 25 patients, thus the placement of only 90 screws was assessed. Eighty-seven screws were placed within the pedicle confines (Grade A), and 3 violated the pedicle (2 Grade B [1 lateral, 1 medial] and 1 Grade D [medial]) for an overall accuracy rate of 96.7%. One patient required reoperation for screw repositioning due to a postoperative L-5 radiculopathy secondary to a Grade D medial breach at L-5. This patient experienced improvement of the radiculopathy after reoperation. Average screw insertion and fluoroscopy times were 6.92 minutes and 22.7 seconds per screw, respectively.
CONCLUSIONS
The results of this study demonstrate that the placement of K-wireless percutaneous pedicle screws is technically feasible and can be performed accurately and safely with short procedure and fluoroscopy times.
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Kumar N, Zaw AS, Reyes MR, Malhotra R, Wu PH, Makandura MC, Thambiah J, Liu GKP, Wong HK. Versatility of Percutaneous Pedicular Screw Fixation in Metastatic Spine Tumor Surgery: A Prospective Analysis. Ann Surg Oncol 2014; 22:1604-11. [DOI: 10.1245/s10434-014-4178-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/28/2022]
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Saigal R, Wadhwa R, Mummaneni PV, Chou D. Minimally Invasive Extracavitary Transpedicular Corpectomy for the Management of Spinal Tumors. Neurosurg Clin N Am 2014; 25:305-15. [DOI: 10.1016/j.nec.2013.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tredway TL. Minimally Invasive Approaches for the Treatment of Intramedullary Spinal Tumors. Neurosurg Clin N Am 2014; 25:327-36. [DOI: 10.1016/j.nec.2013.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Park MS, Deukmedjian AR, Uribe JS. Minimally invasive anterolateral corpectomy for spinal tumors. Neurosurg Clin N Am 2014; 25:317-25. [PMID: 24703449 DOI: 10.1016/j.nec.2013.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Traditional open anterior and posterior approaches for the thoracic and thoracolumbar spine are associated with approach-related morbidity and limited surgical access to the level of abnormality. This article describes the minimally invasive anterolateral corpectomy for the treatment of spinal tumors, and reviews the current literature.
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Affiliation(s)
- Michael S Park
- Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA.
| | - Armen R Deukmedjian
- Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA
| | - Juan S Uribe
- Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA
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Abstract
The multiplicity of clinical presentations and the lack of consensus explain that the treatment of spine metastasis remains controversial. Optimal treatment requires a truly multidisciplinary approach, involving oncologists, interventional radiologists, radiation oncologists, rheumatologists and spine surgeons. Recent progress in all these areas have allowed to provide safe and effective therapeutic solutions tailored to each situation. We remind, in this work, the main progress in the surgical field, specifying the role of surgery in the current therapeutic arsenal.
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Nouvelles avancées dans la prise en charge chirurgicale des métastases vertébrales symptomatiques. Bull Cancer 2013; 100:435-41. [DOI: 10.1684/bdc.2013.1748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Minimally invasive thoracic corpectomy: surgical strategies for malignancy, trauma, and complex spinal pathologies. Minim Invasive Surg 2012; 2012:213791. [PMID: 22888418 PMCID: PMC3409553 DOI: 10.1155/2012/213791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/07/2012] [Indexed: 11/17/2022] Open
Abstract
The rapid expansion of minimally invasive techniques for corpectomy in the thoracic spine provides promise to redefine treatment options in this region. Techniques have evolved permitting anterior, lateral, posterolateral, and midline posterior corpectomy in a minimally invasive fashion. We review the numerous techniques that have been described, including thoracoscopy, tubular retraction, and various instrumentation techniques. Minimally invasive techniques are compared to their open predecessors from a technical and complication standpoint. Advantages and disadvantages of different approaches are also considered, with an emphasis on surgical strategies and nuance.
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Abstract
Minimally invasive spine surgery (MISS) techniques were developed to address morbidities associated with open spinal surgery approaches. MISS was initially applied for indications such as the microendoscopic decompression of stenosis (MEDS)-an operation that has become widely implemented in modern spine surgery practice. Minimally invasive surgery for MEDS is an excellent example of how an MISS technique has improved outcomes compared with the use of traditional open surgical procedures. In parallel with reports of surgeon experience, accumulating clinical evidence suggests that MISS is favoured over open surgery, and one could argue that the role of MISS techniques will continue to expand. As the field of minimally invasive surgery has developed, MISS has been implemented for the treatment of increasingly difficult and complex pathologies, including trauma, spinal malignancies and spinal deformity in adults. In this Review, we present the accumulating evidence in support of minimally invasive techniques for established MISS indications, such as lumbar stenosis, and discuss the need for additional level I and level II data to demonstrate the benefit of MISS over traditional open surgery. The expanding utility of MISS techniques to address an increasingly broad range of spinal pathologies is also highlighted.
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Zairi F, Arikat A, Allaoui M, Marinho P, Assaker R. Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis. J Neurosurg Spine 2012; 17:19-23. [PMID: 22607222 DOI: 10.3171/2012.4.spine111108] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECT Spinal metastasis with spinal cord involvement is a frequent complication in cancer patients. As the spinal compression frequently occurs ventrally, performing a simple posterior laminectomy alone is generally ineffective and dangerous. Many aggressive surgical strategies have been developed to improve outcomes for patients with metastatic spine disease. These strategies are associated with high morbidity and complication rates, especially in patients with numerous neoplasm-associated comorbidities, which can limit their indication in patients with a limited life expectancy. The authors performed a prospective evaluation of minimally invasive decompression and stabilization for the palliative management of symptomatic thoracolumbar spine metastasis. METHODS Ten patients with metastasis to the thoracolumbar spine and neurological compromise underwent minimally invasive transpedicular vertebrectomy and spinal cord decompression through a tubular expandable retractor. Percutaneous stabilization was also systematically performed to ensure spinal stability. RESULTS No complications during the procedure were reported. The mean operative duration was 170 minutes and the mean estimated blood loss was 400 ml. The postoperative course of all patients was uneventful, with the exception of 1 benign urinary tract infection. Eight patients (80%) improved at least 1 Frankel grade. CONCLUSIONS Minimally invasive treatment of thoracolumbar spine metastasis is a safe and effective palliative option in patients with limited life expectancy, to limit morbidity and preserve quality of life.
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Affiliation(s)
- Fahed Zairi
- Department of Neurosurgery, Lille University Hospital, Rue Emile Laine, Lille, France.
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Cata JP, Gottumukkala V. Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know? ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/918938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with solid malignancies who were not candidates for tumor resections in the past are now presenting for extensive oncological resections. Cancer patients are at risk for thromboembolic complications due to an underlying hypercoagulable state; however, some patients may have an increased risk for bleeding due to the effects of chemotherapy, the administration of anticoagulant drugs, tumor-related fibrinolysis, tumor location, tumor vascularity, and extent of disease. A common potential complication of all complex oncological surgeries is massive intra- and postoperative hemorrhage and the subsequent risk for massive blood transfusion. This can be anticipated or unexpected. Several surgical and anesthesia interventions including preoperative tumor embolization, major vessel occlusion, hemodynamic manipulation, and perioperative antifibrinolytic therapy have been used to prevent or control blood loss with varying success. The exact incidence of massive blood transfusion in oncological surgery is largely unknown and/or underreported. The current literature mostly consists of purely descriptive observational studies. Thus, recommendation regarding specific perioperative intervention cannot be made at this point, and more research is warranted.
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Affiliation(s)
- Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 409, Houston, TX 77030, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 409, Houston, TX 77030, USA
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Smith ZA, Li Z, Chen NF, Raphael D, Khoo LT. Minimally invasive lateral extracavitary corpectomy: cadaveric evaluation model and report of 3 clinical cases. J Neurosurg Spine 2012; 16:463-70. [PMID: 22404144 DOI: 10.3171/2012.2.spine11128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this paper, the authors' goal was to demonstrate the clinical and technical nuances of a minimally invasive lateral extracavitary approach (MI-LECA) for thoracic corpectomy and anterior column reconstruction. METHODS A cadaveric feasibility study and the subsequent application of this approach in 3 clinical cases are reported. Six procedures were completed in 3 human cadavers. Minimally invasive, extrapleural thoracic corpectomies were performed with the aid of a 24-mm tubular retraction system, using a posterolateral incision and an oblique approach angle. Fluoroscopy and postprocedural CT scanning, using 3D volumetric averaging software, was used to evaluate the degree of bone removal and decompression. Three clinical cases, including a T-11 burst fracture, a T-7 plasmacytoma, and a T4-5 vertebral body (VB) tuberculosis lesion, were treated using the approach. RESULTS At 6 cadaveric levels, the mean circumferential volumetric decompression was 48% ± 16%, and the mean resection of the VB was 72% ± 13%. The mean change in anterior and posterior vertebral height with expansion of the corpectomy cage was 47 and 61 mm, respectively. There were no violations of the pleura or dura. Pedicle screw reliability was 95.8% (23 of 24 screws) with a single lateral breach. All 3 patients in the clinical cohort had excellent clinical outcomes. There was a single pleural tear requiring chest tube drainage. Operative images and a video clip are provided to illustrate the approach. CONCLUSIONS A minimally invasive lateral extracavitary thoracic corpectomy has the ability to provided excellent spinal cord decompression and VB resection. The procedure can be completed safely and successfully with minimal blood loss and little associated morbidity. This approach has the potential to improve upon established traditional open corridors for posterolateral thoracic corpectomy.
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Affiliation(s)
- Zachary A Smith
- Department of Neurosurgery, Northwestern University, Chicago, IL, USA.
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Smith ZA, Yang I, Gorgulho A, Raphael D, De Salles AAF, Khoo LT. Emerging techniques in the minimally invasive treatment and management of thoracic spine tumors. J Neurooncol 2011; 107:443-55. [DOI: 10.1007/s11060-011-0755-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
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A systematic review of the current role of minimally invasive spine surgery in the management of metastatic spine disease. Int J Surg Oncol 2011; 2011:598148. [PMID: 22312514 PMCID: PMC3263667 DOI: 10.1155/2011/598148] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/30/2011] [Indexed: 02/08/2023] Open
Abstract
Although increasingly aggressive decompression and resection methods have resulted in improved outcomes for patients with metastatic spine disease, these aggressive surgeries are not feasible for patients with numerous comorbid conditions. Such patients stand to benefit from management via minimally invasive spine surgery (MIS), given its association with decreased perioperative morbidity. We performed a systematic review of literature with the goal of evaluating the clinical efficacy and safety of MIS in the setting of metastatic spine disease. Results suggest that MIS is an efficacious means of achieving neurological improvement and alleviating pain. In addition, data suggests that MIS offers decreased blood loss, operative time, and complication rates in comparison to standard open spine surgery. However, due to the paucity of studies and low class of available evidence, the ability to draw comprehensive conclusions is limited. Future investigations should be conducted comparing standard surgery versus MIS in a prospective fashion.
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Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1363-70. [PMID: 21390557 DOI: 10.1007/s00586-011-1738-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 02/15/2011] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
Abstract
Single-stage posterior corpectomy for the management of spinal tumors has been well described. Anterior column reconstruction has been accomplished using polymethylmethacrylate (PMMA) or expandable cages (EC). The aim of this retrospective study was to compare PMMA versus ECs in anterior vertebral column reconstruction after posterior corpectomy for tumors in the lumbar and thoracolumbar spine. Between 2006 and 2009 we identified 32 patients that underwent a single-stage posterior extracavitary tumor resection and anterior reconstruction, 16 with PMMA and 16 with EC. There were no baseline differences in regards to age (mean: 58.2 years) or performance status. Differences between groups in terms of survival, estimated blood loss (EBL), kyphosis reduction (decrease in Cobb's angle), pain, functional outcomes, and performance status were evaluated. Mean overall survival and EBL were 17 months and 1165 ml, respectively. No differences were noted between the study groups in regards to survival (p = 0.5) or EBL (p = 0.8). There was a trend for better Kyphosis reduction in favor of the EC group (10.04 vs. 5.45, p = 0.16). No difference in performance status or VAS improvements was observed (p > 0.05). Seven patients had complications that led to reoperation (5 infections). PMMA or ECs are viable options for reconstruction of the anterior vertebral column following tumor resection and corpectomy. Both approaches allow for correction of the kyphotic deformity, and stabilization of the anterior vertebral column with similar functional and performance status outcomes in the lumbar and thoracolumbar area.
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Chou D, Lu DC. Mini-open transpedicular corpectomies with expandable cage reconstruction. Technical note. J Neurosurg Spine 2010; 14:71-7. [PMID: 21166488 DOI: 10.3171/2010.10.spine091009] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transpedicular corpectomies are frequently used to perform anterior surgery from a posterior approach. Minimally invasive thoracolumbar corpectomies have been previously described, but these are performed through a unilateral approach. Bilateral access must be obtained for a circumferential decompression when using such techniques. The authors describe a technique that allows for a mini-open transpedicular corpectomy, 360° decompression, and expandable cage reconstruction through a single posterior approach. This is performed using percutaneous pedicle screws, the trap-door rib-head osteotomy, and a single midline fascial exposure. The authors describe this technique with intraoperative photos and a video demonstrating the technique.
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Affiliation(s)
- Dean Chou
- Department of Neurosurgery, University of California, San Francisco, California 94143-0112, USA.
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Nourbakhsh A, Chittiboina P, Vannemreddy P, Nanda A, Guthikonda B. Feasibility of thoracic nerve root preservation in posterior transpedicular vertebrectomy with anterior column cage insertion: a cadaveric study. J Neurosurg Spine 2010; 13:630-5. [DOI: 10.3171/2010.5.spine09717] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Transpedicular thoracic vertebrectomy (TTV) is a safe alternative to the more standard transthoracic approach. A TTV is most commonly used to address vertebral body fractures due to tumor or trauma.
Transpedicular reconstruction of the anterior column with cage/bone traditionally requires unilateral thoracic nerve root sacrifice. In a cadaveric model, the authors evaluated the feasibility of transpedicular anterior column reconstruction without nerve root sacrifice. If feasible, this may be a reasonable approach that could be extended to the lumbar spine where nerve root sacrifice is not an option.
Methods
A TTV was performed in 8 fixed cadaveric specimens. In each specimen, an alternate vertebra (either odd or even) was removed so that single-level reconstruction could be evaluated. The vertebrectomy included facetectomy, adjacent discectomies, and laminectomy; however, the nerve roots were preserved. The authors then evaluated the feasibility of inserting a titanium mesh cage (Medtronic Sofamor Danek) without neural sacrifice.
Results
Transpedicular anterior cage reconstruction could be safely performed at all levels of the thoracic spine without nerve root sacrifice. The internerve root space varied from 18 mm at T2–3 to 27 mm at T11–12; thus, the size of the cage that was used also varied with level.
Conclusions
Cage reconstruction of the anterior column could be safely performed via the transpedicular approach without nerve root sacrifice in this cadaveric study. Removal of the proximal part of the rib in addition to a standard laminectomy with transpedicular vertebrectomy provided an excellent corridor for anterior cage reconstruction at all levels of the thoracic spine without nerve root sacrifice.
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