Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis

Object The object of this study was to evaluate an alternative surgical approach to degenerative thoracolumbar deformity in adults. The authors present their early experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placing interbody grafts and providing anterior column support for adult degenerative deformity. Methods The authors retrospectively reviewed a prospectively acquired database of all patients with adult thoracolumbar degenerative deformity treated with the minimally invasive, lateral retroperitoneal transpsoas approach at our institution. All patient data were recorded including demographics, preoperative evaluation, procedure used, postoperative follow-up, operative time, blood loss, length of hospital stay, and complications. The Oswestry Disability Index and visual analog scale (for pain) were also administered pre- and postoperatively as early outcome measures. All patients were scheduled for follow-up postoperatively at weeks 2, 6, 12, and 24, and at 1 year. Results The authors identified 25 patients with adult degenerative deformity who were treated using the minimally invasive, lateral retroperitoneal transpsoas approach. All patients underwent discectomy and lateral interbody graft placement for anterior column support and interbody fusion. The mean total blood loss was 53 ml per level. The average length of stay in the hospital was 6.2 days. Mean follow-up was 11 months (range 3–20 months). A mean improvement of 5.7 points on visual analog scale scores and 23.7% on the Oswestry Disability Index was observed. Perioperative complications include 1 patient with rhabdomyolysis requiring temporary hemodialysis, 1 patient with subsidence, and 1 patient with hardware failure. Three patients (12%) experienced transient postoperative anterior thigh numbness, ipsilateral to the side of approach. In this series, 20 patients (80%) were identified who had more than 6 months of follow-up and radiographic evidence of fusion. The minimally invasive, lateral retroperitoneal transpsoas approach, without the use of osteotomies, did not correct the sagittal balance in approximately one-third of the patients. Conclusions Degenerative scoliosis of the adult spine is secondary to asymmetrical degeneration of the discs. Surgical decompression and correction of the deformity can be performed from an anterior, posterior, or combined approach. These procedures are often associated with long operative times and a high incidence of complications. The authors' experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placement of a large interbody graft for anterior column support, restoration of disc height, arthrodesis, and realignment is a feasible alternative to these procedures.

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STANDARD OPEN MICRODISCECTOMY VERSUS MINIMAL ACCESS TROCAR MICRODISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000311075.56486.c5 ◽

2008 ◽

Vol 62 (1) ◽

pp. 174-182 ◽

Cited By ~ 71

Author(s):

Yu-Mi Ryang ◽

Markus F. Oertel ◽

Lothar Mayfrank ◽

Joachim M. Gilsbach ◽

Veit Rohde

Keyword(s):

Blood Loss ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Operative Time ◽

Short Form ◽

Lumbar Disc ◽

Complication Rates ◽

Minimal Access ◽

Analog Scale ◽

Short Form 36

Abstract OBJECTIVE Minimal access surgery as a less invasive alternative to standard macro- and microsurgical approaches is becoming increasingly popular in the management of traumatic and degenerative spine diseases. However, data is lacking if minimal access spine surgery is indeed beneficial. This prospective randomized study was conducted to compare efficiency, safety, and outcome of standard open microsurgical discectomy (SOMD) for lumbar disc herniation with microsurgical discectomy using an 11.5 mm trocar system for minimal access to the spine. METHODS Sixty patients were randomized to two groups of 30 patients each. Group 1 was treated by SOMD, and Group 2 was treated by minimal access microsurgical discectomy (MAMD). Perioperative parameters and pre- and postoperative clinical findings including sensory or motor deficits and pain according to the visual analog scale, Oswestry Disability Index scores, and Short Form-36 results were assessed. All patients were followed for at least 6 months postoperatively (mean, 16 mo). RESULTS Preoperatively, no statistically significant intergroup differences could be detected proving the comparability of both groups. Postoperatively, significant improvement of neurological symptoms and pain as measured by the visual analog scale, Oswestry Disability Index, and Short Form-36 scores could be achieved in both groups. In regard to operative time, intraoperative blood loss, and complication rate, slightly better results were observed in the MAMD group. CONCLUSION SOMD and MAMD allow achievement of significant improvement of pain and neurological deficits in patients with lumbar disc herniations. Differences in operative time, blood loss, and complication rates were statistically not significant in MAMD compared with SOMD, indicating that, at least in lumbar disc surgery, minimal access trocar techniques are a viable alternative to standard spinal approaches.

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Healos graft carrier with bone marrow aspirate instead of allograft as adjunct to local autograft for posterolateral fusion in degenerative lumbar scoliosis: a minimum 2-year follow-up study

Journal of Neurosurgery Spine ◽

10.3171/2010.3.spine09603 ◽

2010 ◽

Vol 13 (2) ◽

pp. 211-215 ◽

Cited By ~ 26

Author(s):

Avraam Ploumis ◽

Todd J. Albert ◽

Zoe Brown ◽

Amir A. Mehbod ◽

Ensor E. Transfeldt

Keyword(s):

Bone Marrow ◽

Oswestry Disability Index ◽

Bone Marrow Aspirate ◽

Posterolateral Fusion ◽

Degenerative Lumbar Scoliosis ◽

Analog Scale ◽

Degenerative Scoliosis ◽

Group B ◽

Cancellous Allograft

Object The objective of this study was to examine the efficacy and safety of Healos graft carrier with bone marrow aspirate and local autograft compared with the results of allograft in patients with lumbar degenerative scoliosis undergoing posterolateral fusion. Methods Twenty-eight patients with degenerative scoliosis underwent posterolateral instrumented fusion and decompression. Patients were grouped according to the graft used. Group A consisted of 12 cases in which the authors used a Healos graft carrier, bone marrow aspirate, and local autograft, and Group B consisted of 16 cases in which the authors used cancellous allograft and local autograft. Patients were followed for a minimum of 2 years postoperatively in terms of pain (visual analog scale), function (Oswestry Disability Index), curve magnitude (Cobb angle), and fusion status (plain and dynamic radiographs). The 2 groups did not differ statistically significantly (p > 0.05) in age, sex, smoking habits, magnitude of preoperative visual analog scale score, Oswestry Disability Index score, Cobb angle, or number of levels requiring decompression and fusion. Results The groups had similar (p > 0.05) results in terms of pain, function, curve progression, and fusion rates at the 2-year follow-up examination. Radiographic fusion was achieved in all but 2 cases, 1 in each group, in which the patients were asymptomatic. Patients in the allograft group (Group B) showed evidence of fusion earlier than in the Healos group (p < 0.05). No toxicity from Healos graft was recorded. Conclusions The combination of Healos hydroxyapatite sponge and bone marrow aspirate plus local allograft had significantly slower fusion rates but equal clinical outcomes compared with cancellous allograft plus local autograft when used for posterolateral fusion in patients with degenerative lumbar scoliosis.

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Coronal balance with circumferential minimally invasive spinal deformity surgery for the treatment of degenerative scoliosis: are we leaning in the right direction?

Journal of Neurosurgery Spine ◽

10.3171/2020.8.spine201147 ◽

2021 ◽

pp. 1-9

Author(s):

Corey T. Walker ◽

Jakub Godzik ◽

Santiago Angel ◽

Juan Pedro Giraldo ◽

Jay D. Turner ◽

...

Keyword(s):

Minimally Invasive ◽

Visual Analog Scale ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Type A ◽

Type B ◽

Analog Scale ◽

Degenerative Scoliosis ◽

Type C ◽

The Right

OBJECTIVE Coronal malalignment (CM) in adult spinal deformity is associated with poor outcomes and remains underappreciated in the literature. Recent attempts at classifying CM indicate that some coronal shifts may be more difficult to treat than others. To date, outcomes for circumferential minimally invasive surgery (cMIS) of the spine in the context of these new CM classifications are unreported. METHODS A retrospective evaluation of patients with degenerative scoliosis (Cobb angle > 20°) consecutively treated with cMIS at a single institution was performed. Preoperative and 1-year postoperative standing radiographs were used to make the comparisons. Clinical outcome measures were compared. Patients were subgrouped according to the preoperative distance between their C7 plumb line and central sacral vertical line (C7-CSVL) as either coronally aligned (type A, C7-CSVL < 3 cm); shifted ≥ 3 cm toward the concavity (type B); or shifted ≥ 3 cm toward the convexity (type C) of the main lumbar curve. RESULTS Forty-two patients were included (mean age 67.7 years). Twenty-six patients (62%) were classified as type A, 5 patients (12%) as type B, and 11 patients (26%) as type C. An average of 4.9 segments were treated. No type A patients developed postoperative CM. All type B patients had CM correction. Six of the 11 type C patients had CM after surgery. Overall, there was an improvement in the C7-CSVL (from 2.4 to 1.8 cm, p = 0.04). Among subgroups, only type B patients improved (from 4.5 to 0.8 cm, p = 0.002); no difference was seen for type A patients (from 1.2 to 1.4 cm, p = 0.32) or type C patients (from 4.3 to 3.1 cm, p = 0.11). Comparing type C patients with postoperative CM versus those without postoperative CM, patients with CM had worse visual analog scale back scores at 1 year (5 vs 1, p = 0.01). Moreover, they had higher postoperative L4 tilt angles (11° vs 5°, p = 0.01), indicating inadequate correction of the lumbosacral fractional curve. CONCLUSIONS cMIS improved coronal alignment, curve magnitudes, and clinical outcomes among patients with degenerative scoliosis. It did not result in CM in type A patients and was successful at improving the C7-CSVL in type B patients. Type C patients remain the most difficult to treat coronally, with worse visual analog scale back pain scores in those with postoperative CM. Regional coronal restoration of the lumbosacral fracture curve should be the focus of correction in cMIS for these patients.

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Cost minimization in treatment of adult degenerative scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine14560 ◽

2015 ◽

Vol 23 (6) ◽

pp. 798-806 ◽

Cited By ~ 29

Author(s):

Omar M. Uddin ◽

Raqeeb Haque ◽

Patrick A. Sugrue ◽

Yousef M. Ahmed ◽

Tarek Y. El Ahmadieh ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

Cost Minimization ◽

Degenerative Scoliosis ◽

Adult Degenerative Scoliosis ◽

Vas Scores

OBJECT Back pain is an increasing concern for the aging population. This study aims to evaluate if minimally invasive surgery presents cost-minimization benefits compared with open surgery in treating adult degenerative scoliosis. METHODS Seventy-one patients with adult degenerative scoliosis received 2-stage, multilevel surgical correction through either a minimally invasive spine surgery (MIS) approach with posterior instrumentation (n = 38) or an open midline (Open) approach (n = 33). Costs were derived from hospital and rehabilitation charges. Length of stay, blood loss, and radiographic outcomes were obtained from electronic medical records. Functional outcomes were measured with Oswestry Disability Index (ODI) and visual analog scale (VAS) surveys. RESULTS Patients in both cohorts were similar in age (AgeMIS = 65.68 yrs, AgeOpen = 63.58 yrs, p = 0.28). The mean follow-up was 18.16 months and 21.82 months for the MIS and Open cohorts, respectively (p = 0.34). MIS and Open cohorts had an average of 4.37 and 7.61 levels of fusion, respectively (p < 0.01). Total inpatient charges were lower for the MIS cohort ($269,807 vs $391,889, p < 0.01), and outpatient rehabilitation charges were similar ($41,072 vs $49,272, p = 0.48). MIS patients experienced reduced length of hospital stay (7.03 days vs 14.88 days, p < 0.01) and estimated blood loss (EBL) (EBLMIS = 470.26 ml, EBLOpen= 2872.73 ml, p < 0.01). Baseline ODI scores were lower in the MIS cohort (40.03 vs 48.04, p = 0.03), and the cohorts experienced similar 1-year improvement (ΔODIMIS = −15.98, ΔODIOpen = −21.96, p = 0.25). Baseline VAS scores were similar (VASMIS = 6.56, VASOpen= 7.10, p = 0.32), but MIS patients experienced less reduction after 1 year (ΔVASMIS = −3.36, ΔVASOpen = −4.73, p = 0.04). Preoperative sagittal vertical axis (SVA) were comparable (preoperative SVAMIS = 63.47 mm, preoperative SVAOpen = 71.3 mm, p = 0.60), but MIS patients had larger postoperative SVA (postoperative SVAMIS = 51.17 mm, postoperative SVAOpen = 28.17 mm, p = 0.03). CONCLUSIONS Minimally invasive surgery demonstrated reduced costs, blood loss, and hospital stays, whereas open surgery exhibited greater improvement in VAS scores, deformity correction, and sagittal balance. Additional studies with more patients and longer follow-up will determine if MIS provides cost-minimization opportunities for treatment of adult degenerative scoliosis.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Banana-Shaped and Straight Cages: Radiological and Clinical Results from a Prospective Randomized Clinical Trial

Neurosurgery ◽

10.1093/neuros/nyx212 ◽

2017 ◽

Vol 82 (3) ◽

pp. 289-298 ◽

Cited By ~ 14

Author(s):

Won-Suh Choi ◽

Jin-Sung Kim ◽

Jung-Woo Hur ◽

Ji-Hoon Seong

Keyword(s):

Minimally Invasive ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Disc Height ◽

Lumbar Interbody Fusion ◽

Analog Scale ◽

Significant Difference ◽

Cage Group

Abstract BACKGROUND In minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), cage type and position play important roles in fusion achievement and sagittal alignment correction. However, no prospective randomized comparison of the results using different types of cage has been reported to date. OBJECTIVE To compare the radiological and clinical outcomes of unilateral MIS-TLIF using 2 types of cage. METHODS All candidates for single-level MIS-TLIF were randomized into banana-shaped cage and straight-cage groups. Plain radiographs and computed tomography scans were used for assessment of cage positions, fusion status, disc height, segmental lordotic angle, cage subsidence, and pelvic parameters. Clinical outcome was assessed using visual analog scale and Oswestry Disability Index scores. RESULTS Forty-four and 40 consecutive patients were operated on using banana-shaped and straight cages, respectively. Cage position was more anterior and lateral in the straight-cage group and more medial and posterior in the banana-shaped cage group. Solid fusion was achieved in 95.2% and 96.6% of the 2 groups, respectively, at 12 mo. The change in disc height and segmental lordotic angle postoperatively was significantly greater in the banana-shaped cage group. The incidence of subsidence during follow-up was significantly higher in the banana-shaped cage group (P < .04). Clinically, the visual analog scale and Oswestry Disability Index scores decreased significantly after surgery in both groups, with no significant difference between the groups. CONCLUSION Our preliminary outcomes suggest that the subsidence rate may be higher using banana-shaped cages in MIS-TLIF, possibly due to their more medial final position.

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Combined “Hybrid” Open and Minimally Invasive Surgical Correction of Adult Thoracolumbar Scoliosis

Neurosurgery ◽

10.1227/neu.0b013e31827b9d55 ◽

2012 ◽

Vol 72 (2) ◽

pp. 151-159 ◽

Cited By ~ 10

Author(s):

Paul Park ◽

Frank La Marca

Keyword(s):

Minimally Invasive ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Tissue Injury ◽

Scoliosis Surgery ◽

Lumbar Region ◽

Minimally Invasive Techniques ◽

Analog Scale ◽

The Mean ◽

Invasive Techniques

Abstract BACKGROUND: Surgery for scoliosis requires extensive exposure, resulting in significant tissue injury and longer recovery times. To minimize morbidity in scoliosis surgery, several studies have shown successful application of a combination of minimally invasive techniques; however, the extent of scoliosis treated has been modest. OBJECTIVE: To achieve some of the benefits of minimally invasive surgery and yet treat curves of greater degree, we have used a combined approach, incorporating both open and minimally invasive techniques. METHODS: We analyzed a prospectively acquired database in addition to reviewing electronic records of patients undergoing hybrid surgery for thoracolumbar scoliosis. Nine patients were identified. The minimally invasive portion involved the lumbar region in all cases. Pain was assessed by the visual analog scale and disability was measured by the Oswestry Disability Index. RESULTS: Mean preoperative scoliosis was 47.8 degrees, which was corrected to a mean 15.2 degrees. An average of 7.8 spinal levels was treated. Estimated blood loss averaged 1094.4 mL, and length of hospital stay averaged 7.2 days. Acute complications occurred in 2 patients. Longer term complications occurred in 2 patients, consisting of adjacent segment disease. The mean improvement in the visual analog scale score was 3.7 and the mean improvement on the Oswestry Disability Index was 30.5. Average follow-up was 29.2 months. CONCLUSION: The hybrid approach for the treatment of scoliosis results in acceptable radiographic and clinical outcomes. Complications did not appear increased compared with those expected with scoliosis surgery. Although decreased adjacent tissue injury was achieved with the minimally invasive component of the procedure, a larger comparative study is required to determine magnitude of this benefit.

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MINIMALLY INVASIVE LUMBAR SPINAL DECOMPRESSION IN THE ELDERLY

Neurosurgery ◽

10.1227/01.neu.0000255332.87909.58 ◽

2007 ◽

Vol 60 (3) ◽

pp. 503-510 ◽

Cited By ~ 122

Author(s):

David S. Rosen ◽

John E. O'Toole ◽

Kurt M. Eichholz ◽

Melody Hrubes ◽

Dezheng Huo ◽

...

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Oswestry Disability Index ◽

Short Form ◽

The Elderly ◽

Surgical Decompression ◽

Analog Scale ◽

Pain Scores ◽

Lumbar Spinal

Abstract OBJECTIVE Lumbar spinal stenosis and spondylosis are major causes of morbidity among the elderly. Surgical decompression is an effective treatment, but many elderly patients are not considered as candidates for surgery based on age or comorbidities. Minimally invasive surgical techniques have recently been developed and used successfully for the treatment of lumbar spinal disease. Our objective was to examine the safety and efficacy of minimally invasive lumbar spinal surgery for elderly patients. METHODS We reviewed demographic information, pre- and postoperative Visual Analog Scale pain scores, Oswestry Disability Index scores, and Short-Form 36 scores of prospectively accrued patients who underwent minimally invasive decompression of lumbar degenerative disease at two institutions between January 2002 and December 2005. Data from patients who were at least 75 years old were selected. Statistical analysis methods included paired t test, multiple linear regression, and linear mixed effects modeling. RESULTS Fifty-seven patients with a mean age of 81 years met the study criteria (median follow-up period, 7 mo; mean follow-up period, 10 mo). No major complications or deaths occurred. Fifty patients had sufficient outcomes data for analysis. Visual Analog Scale pain scores decreased from 5.7 to 2.2 for back pain and from 5.7 to 2.3 for symptomatic leg pain (P < 0.05). Oswestry Disability Index scores decreased from 48 to 27; Short-Form 36 Body Pain and Physical Function scores also showed statistically significant improvements after surgery (P < 0.05). The longitudinal analysis demonstrated durability of the symptom relief. CONCLUSION Minimally invasive lumbar spine decompression is a safe and efficacious treatment for elderly patients with spinal stenosis and spondylosis. Elderly patients should be considered good candidates for lumbar surgical decompression using minimally invasive techniques.

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COMPARATIVE STUDY OF UNILATERAL AND BILATERAL CAGES WITH RESPECT TO CLINICAL OUTCOMES AND STABILITY IN INSTRUMENTED POSTERIOR LUMBAR INTERBODY FUSION

Neurosurgery ◽

10.1227/01.neu.0000335077.62599.f0 ◽

2008 ◽

Vol 63 (1) ◽

pp. 109-114 ◽

Cited By ~ 13

Author(s):

Ji-Ho Lee ◽

Jae Hyup Lee ◽

Kang-Sup Yoon ◽

Seung-Baik Kang ◽

Chris H. Jo

Keyword(s):

Blood Loss ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Postoperative Blood Loss ◽

Lumbar Interbody Fusion ◽

Analog Scale ◽

Fusion Level

ABSTRACT OBJECTIVE We sought to compare the clinical and radiological results of instrumented posterior lumbar interbody fusion (PLIF) using unilateral or bilateral polyetheretherketone cages and pedicle screws. METHODS One hundred eighty-seven cases of degenerative spine that had been followed for at least 18 months were reviewed retrospectively. In 88 cases (147 levels), one cage was inserted, and in 99 cases (152 levels), two cages were inserted. Visual analog scale, Oswestry disability index, and functional rating indices were measured. Lumbar lordosis, lumbar scoliotic and fusion level scoliotic angles, and stable fixation were determined before surgery and 12 months postoperatively on standing x-rays. Amounts of intra- and postoperative blood loss, total quantities transfused, and operation times were also evaluated. RESULTS No significant differences were found between the two groups in terms of visual analog scale, Oswestry disability index, functional rating indices, lumbar lordosis, lumbar scoliotic angles, fusion level scoliotic angles, or fixation stabilities. However, the amounts of postoperative blood loss, total blood loss, and total transfusion for two-level PLIF using a unilateral cage were statistically smaller than those for two-level PLIF using bilateral cages. Times required for PLIF using a unilateral cage were also significantly shorter than those for PLIF using bilateral cages. CONCLUSION Unilateral cage and bilateral pedicle screw insertion may be a good alternative surgical option because it provides adequate alignment, balance, and mechanical stability in addition to reducing operative time, blood loss, and transfusion requirements.

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Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty in the surgical treatment of thoracolumbar osteoporosis fracture

Journal of Neurosurgery Spine ◽

10.3171/2013.3.spine12827 ◽

2013 ◽

Vol 18 (6) ◽

pp. 634-640 ◽

Cited By ~ 20

Author(s):

Yutong Gu ◽

Feng Zhang ◽

Xiaoxing Jiang ◽

Lianshun Jia ◽

Robert McGuire

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Visual Analog Scale ◽

Percutaneous Vertebroplasty ◽

Screw Fixation ◽

Compression Fracture ◽

Pedicle Screw Fixation ◽

Neurological Deficits ◽

Analog Scale

Object The purpose of this study was to evaluate the feasibility and safety of minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty (PVP) for treating acute thoracolumbar osteoporotic vertebral compression fracture (VCF) and preventing secondary VCF after PVP. Methods Twenty patients with a mean age of 73.6 years (range 65–85 years) who sustained fresh thoracic or lumbar osteoporotic VCFs without neurological deficits underwent minimally invasive pedicle screw fixation combined with PVP. Visual analog scale pain scores were recorded, and the Cobb angles and the central and anterior vertebral body (VB) heights were measured on the lateral radiographs before surgery and immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after surgery. Results The patients were followed up for an average of 26 months (range 24–30 months) after sugery. The visual analog scale score was found to be significantly decreased; from 7.3 ± 1.3 before surgery to 1.2 ± 0.7 immediately after surgery and to 0.7 ± 0.7 (p < 0.001) at the end of follow-up. The Cobb angle was 17.0° ± 4.3° before surgery and 6.4° ± 3.6° immediately after surgery. The central VB height that was 44.5% ± 7.6% before surgery increased to 74.6% ± 6.4% of the estimated intact central height immediately after surgery (p < 0.001). The anterior VB height increased from 50.7% ± 7.4% before surgery to 82.5% ± 6.7% of the estimated intact anterior height immediately after surgery (p < 0.001). There were no significant changes in the results obtained over the follow-up time period. There was no occurrence of new fracture in surgically treated or adjacent vertebrae in these patients. Conclusions Minimally invasive pedicle screw fixation combined with PVP is a good choice for the treatment of acute thoracolumbar osteoporotic VCF and can prevent the occurrence of new VCFs after PVP.

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RADIOSURGERY IN THE TREATMENT OF SPINAL METASTASES

Neurosurgery ◽

10.1227/01.neu.0000359315.20268.73 ◽

2009 ◽

Vol 65 (6) ◽

pp. 1052-1062 ◽

Cited By ~ 59

Author(s):

Jason P. Sheehan ◽

Christopher I. Shaffrey ◽

David Schlesinger ◽

Brian J. Williams ◽

Vincent Arlet ◽

...

Keyword(s):

Scale Score ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Spinal Metastases ◽

Visual Analog Scale Score ◽

Analog Scale ◽

Metastatic Tumors ◽

Oswestry Disability Index Score ◽

The Mean

Abstract OBJECTIVE The effectiveness and limitations of spinal radiosurgery using a helical TomoTherapy system for the treatment of spinal metastases are reviewed in this article. METHODS This is a retrospective review of patients who underwent stereotactic radiosurgery for spinal metastases between July 2004 and December 2007. Radiographic follow-up consisted of magnetic resonance imaging to assess tumor growth control as well as pre- and posttreatment x-rays, which were used to measure changes in segmental angulation and deformity. Clinical performance was assessed using the Karnofsky Performance Scale, Oswestry Disability Index, and visual analog scale. RESULTS Forty patients were treated for 110 metastatic tumors (range, 1–6 tumors per patient). The mean age at the time of radiosurgical treatment was 67 years (age range, 35–81 years). Twenty-three patients (57.5%) had undergone previous surgical resection. Pain was the most common presenting symptom, seen in 32 patients (80%). The mean Oswestry Disability Index score at presentation was 43 (range, 20–90), and the mean visual analog scale score was 6.2 (range, 0–10). The mean radiosurgical dose to the tumor was 17.3 Gy (range, 10–24 Gy). At a mean follow-up duration of 12.7 months (range, 4–32 months), decreased or stable tumor volume was seen in 90 (82%) of the tumors treated. There was improvement in pain in 34 patients (85%). The mean postradiosurgical Oswestry Disability Index score was 25 (range, 10–90), whereas the postradiosurgical visual analog scale score was 3.2 (range, 0–9). Progression of kyphosis was the most common radiographic sequela, experienced by 73% of patients alive at 12 months, with a mean change in angulation of 7.3 ± 4.5 degrees. CONCLUSION Radiosurgery is effective as either primary or adjunctive treatment of metastatic tumors of the spine.

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