Minimally Invasive Circumferential Spinal Decompression and Stabilization for Symptomatic Metastatic Spine Tumor

Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. E620-E622 ◽  
Author(s):  
Alexander Taghva ◽  
Khan W. Li ◽  
John C. Liu ◽  
Ziya L. Gokaslan ◽  
Patrick C. Hsieh
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Spinal Cord Compression ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Pedicle Screw Fixation ◽  
Lower Extremity Weakness ◽  
Hardware Failure ◽  
Minimally Invasive Surgical ◽  
Potential Benefits

Abstract OBJECTIVE Metastatic epidural spinal cord compression is a potentially devastating complication of cancer and is estimated to occur in 5% to 14% of all cancer patients. It is best treated surgically. Minimally invasive spine surgery has the potential benefits of decreased surgical approach–related morbidity, blood loss, hospital stay, and time to mobilization. CLINICAL PRESENTATION A 36-year-old man presented with worsening back pain and lower extremity weakness. Workup revealed metastatic adenocarcinoma of the lung with spinal cord compression at T4 and T5. INTERVENTION AND TECHNIQUE T4 and T5 vertebrectomy with expandable cage placement and T1–T8 pedicle screw fixation and fusion were performed using minimally invasive surgical techniques. RESULT The patient improved neurologically and was ambulatory on postoperative day 1. At the 9-month follow-up point, he remained neurologically intact and pain free, and there was no evidence of hardware failure. CONCLUSION Minimally invasive surgical circumferential decompression may be a viable option for the treatment of metastatic epidural spinal cord compression.

scholarly journals Strategies for posterior-only minimally invasive surgery in thoracolumbar metastatic epidural spinal cord compression

2020 ◽  
Vol 11 ◽  
pp. 462
Author(s):  
Mohammed Abdul Alshareef ◽  
Gibson Klapthor ◽  
Stephen R. Lowe ◽  
Jessica Barley ◽  
David Cachia ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Spinal Cord Compression ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Partial Corpectomy ◽  
Length Of Hospitalization ◽  
Frankel Grade

Background: Metastatic epidural spinal cord compression (MESCC) is a debilitating sequela of cancer. Here, we evaluated various subtypes of posterior-only minimally invasive spinal (MIS) procedures utilized to address different cancers. Methods: Within this retrospective review, we analyzed the treatment of thoracolumbar MESCC treated with three MIS techniques: decompression and fusion (Subgroup A), partial corpectomy (Subgroup B), and full corpectomy (Subgroup C). Results: There were 51 patients included in the study; they averaged 58.7 years of age, and 51% were females. Most tumors were in the thoracic spine (51%). The average preoperative Frankel grade was D (62.7%); 69% (35) improved postoperatively. The patients were divided as follows: subgroup A (15 patients = 29.4%), B (19 patients = 37.3%), and C (17 patients = 33.3%). The length of hospitalization was similar (~5.4 days) for all groups. The overall complication rate was 31%, while blood loss was lower in Subgroups A and B versus C. Conclusion: Different MIS surgical techniques were utilized in patients with thoracic and/or lumbar MESCC. Interestingly, clinical outcomes were similar between MIS subgroups, in this study, with a trend toward higher complications and greater blood loss associated with those undergoing more aggressive MIS procedures (e.g., full corpectomy and fusion).

scholarly journals Separation surgery for metastatic epidural spinal cord compression: comparison of a minimally invasive versus open approach

2021 ◽  
Vol 50 (5) ◽  
pp. E10
Author(s):  
Murray Echt ◽  
Ariel Stock ◽  
Rafael De la Garza Ramos ◽  
Evan Der ◽  
Mousa Hamad ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Local Recurrence ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Spinal Cord Compression ◽  
Open Surgery ◽  
Cord Compression ◽  
Open Group ◽  
Hardware Failure ◽  
Surgery Group

OBJECTIVE The aim of this study was to compare outcomes of separation surgery for metastatic epidural spinal cord compression (MESCC) in patients undergoing minimally invasive surgery (MIS) versus open surgery. METHODS A retrospective study of patients undergoing MIS or standard open separation surgery for MESCC between 2009 and 2019 was performed. Both groups received circumferential decompression via laminectomy and a transpedicular approach for partial corpectomy to debulk ventral epidural disease, as well as instrumented stabilization. Outcomes were compared between the two groups. RESULTS There were 17 patients in the MIS group and 24 in the open surgery group. The average age of the MIS group was significantly older than the open surgery group (65.5 vs 56.6 years, p < 0.05). The preoperative Karnofsky Performance Scale score of the open group was significantly lower than that of the MIS group, with averages of 63.0% versus 75.9%, respectively (p = 0.02). This was also evidenced by the higher proportion of emergency procedures performed in the open group (9 of 24 patients vs 0 of 17 patients, p = 0.004). The average Spine Instability Neoplastic Score, number of levels fused, and operative parameters, including length of stay, were similar. The average estimated blood loss difference for the open surgery versus the MIS group (783 mL vs 430 mL, p < 0.05) was significant, although the average amount of packed red blood cells transfused was not significantly different (325 mL vs 216 mL, p = 0.39). Time until start of radiation therapy was slightly less in the MIS than the open surgery group (32.8 ± 15.6 days vs 43.1 ± 20.3 days, p = 0.069). Among patients who underwent open surgery with long-term follow-up, 20% were found to have local recurrence compared with 12.5% of patients treated with the MIS technique. No patients in either group developed hardware failure requiring revision surgery. CONCLUSIONS MIS for MESCC is a safe and effective approach for decompression and stabilization compared with standard open separation surgery, and it significantly reduced blood loss during surgery. Although there was a trend toward a faster time to starting radiation treatment in the MIS group, both groups received similar postoperative radiotherapy doses, with similar rates of local recurrence and hardware failure. An increased ability to perform MIS in emergency settings as well as larger, prospective studies are needed to determine the potential benefits of MIS over standard open separation surgery.

scholarly journals Metastatic epidural spinal cord compression

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Spinal Cord Compression ◽  
Scoring Systems ◽  
Cord Compression ◽  
Tumor Burden ◽  
Pedicle Screw Fixation ◽  
Limb Weakness ◽  
Neoplastic Lesion ◽  
Spinal Sagittal Alignment

Abstract Up-to-date management for metastatic epidural spinal cord compression is based on appropriate scoring systems. In this case, separation surgery and stereotactic radiosurgery achieved an optimized outcome. A 75-year-old man had thoracic band-like pain, left lower limb weakness and difficulty ambulating for 6 weeks. Spinal images showed a T4 metastatic epidural spinal cord compression with a pathological fracture of T4 and T10 and L3 lytic lesions. There was no other neoplastic lesion. The metastasized T4 was decompressed by a posterolateral right costotransversectomy, vertebrectomy and insertion of an expandable titanium cage. The spinal sagittal alignment was restored with T1–T7 pedicle screw fixation. Post-operatively the pain and motor power improved significantly so that the patient was discharged home. Separation surgery and adjuvant stereotactic radiosurgery of the spine successfully improved tumor burden, pain control and overall prognosis.

scholarly journals Non-communicating extradural arachnoid cyst: a rare case report with review of literature

2018 ◽  
Vol 32 (1) ◽  
pp. 156-159
Author(s):  
Asheesh Kumar Gupta ◽  
Anand Sharma ◽  
Avdhesh Shukla ◽  
S.N. Iyengar
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Arachnoid Cyst ◽  
Spinal Cord Compression ◽  
Subarachnoid Space ◽  
Cord Compression ◽  
Congenital Defects ◽  
En Bloc ◽  
Lower Extremity Weakness ◽  
Extradural Arachnoid Cyst

Abstract Extradural arachnoid cysts in the spine are uncommon causes of spinal cord compression in the paediatric population that are thought to arise from congenital defects in the duramater. In most literatures it is describe that such cysts communicating with the intrathecal subarachnoid space through a small defect in the dura. In this case report we describe a case of a child who presented with spinal cord compression caused by a large spinal extradural arachnoid cyst that did not communicate with the intradural subarachnoid space. An 9 year-old girl presented with progressive lower-extremity weakness, myelopathy, and severe gait ataxia. Magnetic resonance imaging of the spine demonstrated a large extradural arachnoid cyst extending from T4 to T9. The patient underwent a thoracic laminectomy for en bloc resection of the spinal extradural arachnoid cyst. Intra-operatively, the dura was intact and there was no evidence of communication into the intradural subarachnoid space. Postoperatively, the patient’s motor strength and ambulation improved immediately, and no subsequent cerebrospinal fluid leak occurred.

scholarly journals Impairment-driven cancer rehabilitation in patients with neoplastic spinal cord compression using minimally invasive spine stabilization: A single-center retrospective study

2020 ◽  
Author(s):  
Yukako Ishida ◽  
Hideki Shigematsu ◽  
Shinji Tsukamoto ◽  
Yasuhiko Morimoto ◽  
Eiichiro Iwata ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Tumor Board ◽  
Spine Stabilization ◽  
Minimally Invasive Spine ◽  
Minimally Invasive Spine Stabilization

Abstract Background: Neoplastic spinal cord compression is a cause of severe disability in cancer patients. To prevent irreversible paraplegia, a structured strategy is required to address the various impairments present in cancer patients. Methods: We retrospectively reviewed 27 consecutive patients with neoplastic spinal compression who were treated with minimally invasive spine stabilization (MISt). We classified the impairments of patients through our multidisciplinary tumor board based on spine-specific factors, skeletal instability and tumor growth. The neurological deficits, ambulation status, progress of pathological fracture, incidence of vertebral collapse, postoperative implant failure were examined. Changes of the Barthel index (BI) scores before and after surgery were investigated throughout the clinical courses. Results: The average duration to ambulation was 7.19±11 days, and we observed no collapse or progression of paralysis except in four cases of complete motor paraplegia before the surgery. We noted good functional prognosis in patients capable of ambulation within seven days and in patients who could survive longer than three months after the surgery. Conclusions: In various cancer patients with neoplastic spinal cord compression, skeletal instability as the primary impairment is a good indication for MISt, as the patients showed early ambulation with improved BI scores.

Segmental neurofibromatosis—induced spinal cord compression

2001 ◽  
Vol 95 (2) ◽  
pp. 236-238
Author(s):  
Natarajan Muthukumar
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Peripheral Nerves ◽  
Cord Compression ◽  
Lower Extremity Weakness ◽  
Content Type ◽  
Neuralgic Pain ◽  
History Of ◽  
Intercostal Neuralgia ◽  
The Right

✓ Spinal segmental neurofibromatosis (NF) is a rare entity. To date, patients in reported cases of segmental NF (or NF5) have harbored neurofibromas involving the peripheral nerves only. The author reports a rare case of segmental NF that caused spinal cord compression in a 40-year-old woman who presented with a 6-month history of intercostal neuralgia. Examination revealed mild lower-extremity weakness and dysesthesia in the right-sided T-9 dermatome. Magnetic resonance imaging revealed three neurofibromas involving the T-9 region, which were excised, and the patient's neuralgic pain was resolved postoperatively. Traditionally, it has been believed that segmental NF involved only the peripheral nerves. The present case illustrates that although rare, spinal cord compression can also occur in patients with segmental NF.

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