Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Thoracoscopic transdiaphragmatic approach for ventral decompression and reconstruction of metastatic spine disease

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Vertebral Body Replacement ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Minimal Incision ◽  
Spine Disease ◽  
Treatment Surgery

The management of metastatic spine disease is complex, but usually involves radiation therapy and/or surgical treatment. Surgery followed by radiation has a significant role in select patients presenting with metastatic spinal cord compression. Ventral decompression can be achieved through several surgical approaches including posterior, posterolateral, and anterior surgical approaches. Although open thoracotomy is the most common approach for ventral decompression, it is associated with significant spinal access morbidity. This video illustrates a thoracoscopic transdiaphragmatic approach for symptomatic L-1 metastatic spinal cord compression. This approach allows for a minimal incision in the diaphragm to expose the thoracolumbar junction and allows for corpectomy, spinal canal decompression, vertebral body replacement, and spinal stabilization via four small incisions along the chest wall. The step-by-step technique illustrates operative nuances and surgical pearls to safely perform this approach in a patient with thoracolumbar L-1 metastatic spinal cord compression. The video can be found here: http://youtu.be/w8fanV9bq-E.

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 Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

2017 ◽  
Vol 7 (3) ◽  
pp. 272-279 ◽  
Author(s):  
Gordon D. Skeoch ◽  
Matthew K. Tobin ◽  
Sajeel Khan ◽  
Andreas A. Linninger ◽  
Ankit I. Mehta
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Treatment Modalities ◽  
High Dose ◽  
Dexamethasone Treatment ◽  
Corticosteroid Administration

Study Design: Narrative review. Objective: Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic. Methods: A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials. Results: Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable. Conclusions: It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug’s efficacy.

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).

Surgical treatment of tumors involving the cervicothoracic junction

2003 ◽  
Vol 15 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Hoang Le ◽  
Raju Balabhadra ◽  
Jon Park ◽  
Daniel Kim
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Effective Treatment ◽  
Neurological Status ◽  
Cord Compression ◽  
Surgical Approaches ◽  
Surgical Experience ◽  
Cervicothoracic Junction ◽  
High Propensity ◽  
Polyaxial Screws

Object Tumors involving the cervicothoracic junction can have a high propensity for causing instability, with kyphosis and spinal cord compression resulting. Treatment with decompression only can lead to further instability and worsening neurological status. In this article, the authors review their surgical experience in the treatment of 19 patients with tumors involving the cervicothoracic junction. The various approaches and instrumentation techniques involved in decompression and stabilization of the cervicothoracic junction are also reviewed. Methods Aggressive instrumentation-augmented fusion after decompression of the cervicothoracic region can provide for immediate stabilization and early rehabilitation. Recent development of new hardware such as dual-diameter transition rods, polyaxial screws, and interlocking devices have enhanced the ability to fashion a strong construct for stabilization of the cervicothoracic junction. Conclusions Familiarity with complex instrumentation techniques and various surgical approaches to the cervicothoracic junction will be required for effective treatment of tumors causing instability of this region.

Thoracic arachnoid cyst resection

2014 ◽  
Vol 37 (v2supplement) ◽  
pp. Video4 ◽  
Author(s):  
Harel Deutsch
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Surgical Techniques ◽  
Mass Effect ◽  
Cord Compression ◽  
Arachnoid Cysts ◽  
Mri Scan ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Thin Walled

Arachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts may exert mass effect on the thoracic spinal cord and lead to pain and myelopathy symptoms. Arachnoid cysts may be difficult to visualize on an MRI scan because the thin walled arachnoid may not be visible. Focal displacement of the thoracic spinal cord and effacement of the spinal cord with apparent widening of the cerebrospinal fluid space is seen. This video demonstrates surgical techniques to remove a dorsal arachnoid cyst causing spinal cord compression. The surgery involves a thoracic laminectomy. The dura is opened sharply with care taken not to open the arachnoid so that the cyst can be well visualized. The thickened arachnoid walls of the cyst are removed to alleviate the compression caused by the arachnoid cyst.The video can be found here: http://youtu.be/pgUrl9xvsD0.

scholarly journals Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossa approaches

2012 ◽  
Vol 33 (3) ◽  
pp. E9 ◽  
Author(s):  
Roukoz Chamoun ◽  
Joel MacDonald ◽  
Clough Shelton ◽  
William T. Couldwell
Keyword(s):  
Surgical Techniques ◽  
Vestibular Schwannomas ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Team Approach ◽  
Middle Fossa ◽  
Optimal Outcome

Surgical removal remains one of the key treatment modalities for vestibular schwannomas. A team approach between a neurotologist and a neurosurgeon offers the patient the expertise of both specialties and maximizes the chances for an optimal outcome. Vestibular schwannomas can typically be resected through 1 of 3 main surgical approaches: the translabyrinthine, the retrosigmoid, or the middle fossa approaches. In this report and videos, the authors describe and illustrate the indications and surgical techniques for the removal of these tumors.

scholarly journals Impact of local treatment on survival from hematological malignancies causing spinal cord compression

2020 ◽  
Vol 11 ◽  
pp. 352
Author(s):  
Hela Ghedira ◽  
Khaled Radhouane ◽  
Essia Mezni ◽  
Safia Yahiaoui ◽  
Hela Stambouli ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Multiple Myeloma ◽  
Spinal Cord Compression ◽  
Hematological Malignancies ◽  
Local Treatment ◽  
Cord Compression ◽  
Decompressive Surgery ◽  
Treatment Modalities ◽  
Aggressive Lymphoma ◽  
Indolent Lymphoma

Background: Various hematological malignancies, including multiple myeloma, plasmacytoma, aggressive lymphoma, and indolent lymphoma, rarely result in spinal cord compression. Methods: Here, we retrospectively analyzed 32 patients with multiple myeloma (50%), plasmacytoma (13%), aggressive lymphoma (28%), and indolent lymphoma (9%), resulting in spinal cord compression (2004 and 2016). Patients averaged 57 years of age and presented with the indolent onset of spinal cord compression (91% of cases) resulting mostly in motor deficits (69%). Results: Local treatment modalities included radiotherapy (RT) (28%) alone, decompressive surgery (28%) alone, or decompressive surgery with consolidation RT (40%). The 1-year overall survival was 70%, and the progression-free survival frequency was 62%. Conclusion: This study highlighted the importance of standardizing the indications for RT alone versus RT with surgery depending on the patient’s underlying pathological diagnosis, neurological deficits, and radiological findings.

The potential role of modern radiotherapy techniques in the treatment of malignant spinal cord compression: a dose planning study

2015 ◽  
Vol 14 (4) ◽  
pp. 418-424 ◽  
Author(s):  
Lotte S. Fog ◽  
Deborah Schut ◽  
Per Sjøgren ◽  
Marianne C. Aznar
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Dose Reduction ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Treatment Modalities ◽  
High Dose ◽  
Lumbar Region ◽  
Field Technique ◽  
Time Required

AbstractAimTo investigate the doses given to the kidneys and the small intestines for three radiation therapy techniques [anterior–posterior (APPA) fields, three fields and volumetric-modulated arc therapy (VMAT)] for spinal cord compression (SCC) patients with metastatic disease in the lower thoracic or lumbar spine and to monitor the time spent by clinicians and dose planners.IntroductionRadiation therapy is one of the main treatment modalities for SCC. Typical palliative radiation therapy techniques have used APPA fields or a three-field technique.However, as delivery techniques have evolved dramatically over the past decades, VMAT has gained wide acceptance. VMAT allows for a dose reduction in the organs at risk. Such a dose reduction may result in less toxicity.The use of the VMAT technique may require more time for contouring and planning compared with the APPA and three-field techniques. Any potential dosimetric benefit of VMAT must not be outweighed by large amounts of extra time spent by clinicians and dose planners.Materials and methodsFor 20 patients treated with radiation therapy for SCC at our hospital, we created a VMAT plan, and the more traditionally used APPA and three-field plans. The mean kidney doses and the volume of bowel, which received 20 Gy, were extracted for each plan. The correlations between parameters for three techniques were determined.Furthermore, the time required for contouring targets for five patients; and the time required to plan five patients, was recorded.ResultsVMAT lead to the most conformal distributions: the high-dose areas were restricted to the target volume, whereas the healthy tissue, especially the bowel, received a lower dose. In contrast, the APPA plan lead to a larger volume of bowel being irradiated, whereas the three-field technique spared the bowel at the expense of a higher dose to the kidneys.The average contouring time was 16 minutes, the average planning time was 38 minutes.ConclusionPatients treated for SCC in the lower thoracic or lumbar region may benefit from VMAT treatment, as it reduces the dose to the bowel and kidneys compared with APPA or three-field treatments.

Metastatic spinal tumors

2001 ◽  
Vol 11 (6) ◽  
pp. 1-9 ◽  
Author(s):  
Robert F. Heary ◽  
Christopher M. Bono
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
External Beam Radiotherapy ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Surgical Approaches ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Intractable Pain ◽  
Primary Malignancy

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.

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