Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

2008 ◽  
Vol 25 (2) ◽  
pp. E8 ◽  
Author(s):  
Peter Kan ◽  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Thoracic Spine ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Thoracoscopic Approach ◽  
Small Series ◽  
Spinal Cord Decompression ◽  
Invasive Techniques ◽  
Spine Disease

Object The choices available in the management of metastatic spine disease are complex, and the role of surgical therapy is increasing. Recent studies have indicated that patients treated with direct surgical decompression and stabilization before radiation have better functional outcomes than those treated with radiation alone. The most common anterior surgical approach for direct spinal cord decompression and stabilization in the thoracic spine is open thoracotomy; however, thoracotomy for spinal access is associated with morbidity that can be avoided with minimally invasive techniques like thoracoscopy. Methods A minimally invasive thoracoscopic approach was used for the surgical treatment of thoracic and thoracolumbar metastatic spinal cord compression. This technique allows ventral decompression via corpectomy, inter-body reconstruction with expandable cages, and stabilization with an anterolateral plating system designed specifically for minimally invasive implantation. This technique was performed in 5 patients with metastatic disease of the thoracic spine, including the thoracolumbar junction. Results All patients had improvement in preoperative symptoms and neurological deficits. No complications occurred in this small series. Conclusions The minimally invasive thoracoscopic approach can be applied to the treatment of thoracic and thoracolumbar metastatic spine disease in an effort to reduce access morbidity. Preliminary results have indicated that adequate decompression, reconstruction, and stabilization can be achieved with this technique.

scholarly journals Descompresión medular mediante abordaje lateral transtorácico mínimamente invasivo. Reporte de un caso. [Spinal cord decompression by minimally invasive transthoracic lateral approach. Case report]

2019 ◽  
Vol 84 (1) ◽  
pp. 70-74
Author(s):  
Augusto Esteban Martínez ◽  
Felipe Jose Lanari Subiaur ◽  
Carlos María Mounier ◽  
José Ricardo Prina ◽  
Ramiro Gutiérrez ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Thoracic Spine ◽  
Cord Compression ◽  
Lateral Approach ◽  
Thoracic Vertebra ◽  
Advantages And Disadvantages ◽  
Spinal Cord Decompression ◽  
Invasive Techniques

Existen múltiples técnicas para la descompresión medular en la columna torácica, cada una con sus ventajas y desventajas y con distintos requerimientos de destrezas quirúrgicas. Se han desarrollado técnicas mínimamente invasivas que disminuyen las tasas de morbilidad, con buenos resultados funcionales. Se presenta el caso de un hombre de 64 años, con clínica de compresión medular, una hernia de disco central, calcificada a nivel del quinto disco torácico, migrada hasta el borde inferior de la sexta vértebra torácica, con franca compresión medular. Se realizó un abordaje lateral transpleural mínimamente invasivo, con una corpectomía parcial posterior de la sexta vértebra, sin fijación adicional. El paciente tuvo una buena evolución, sin progresión del cuadro neurológico ni dolor costal residual.Los abordajes laterales mínimamente invasivos son técnicas válidas para tratar patologías compresivas de la columna torácica, con bajas tasas de morbimortalidad y una rápida recuperación. AbstractThere are multiple techniques for spinal cord decompression in the thoracic spine, each with its advantages and disadvantages, and requiring different surgical skills. Recently, minimally invasive techniques have been developed, reducing morbidity rates and achieving good functional results.We present the case of a 64-year-old male with spinal compression symptoms, central disc herniation calcified at the fifth thoracic vertebra, which migrated to the lower end of the sixth thoracic vertebra. Diagnosis was clear for spinal cord compression. Partial posterior corpectomy of the sixth vertebra was performed with a minimally invasive transthoracic transpleural lateral approach and without additional fixation. The patient had a good outcome on follow-up, without progression of neurological symptoms or residual rib pain.Minimally invasive lateral approaches are valid techniques for the treatment of compression disorders of the thoracic spine, with low rates of morbidity and mortality, and a rapid recovery.

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.

scholarly journals Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Kathrin Hering ◽  
Anke Bresch ◽  
Donald Lobsien ◽  
Wolf Mueller ◽  
Rolf-Dieter Kortmann ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Thoracic Spine ◽  
Primary Melanoma ◽  
Cord Compression ◽  
Long Term Follow Up ◽  
Intradural Extramedullary ◽  
Lower Thoracic Spine ◽  
Spinal Cord Decompression

Background Context.Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up.Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation.Study Design. Case report.Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine.Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms.Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable.

Treatment of Refractory Low Back Pain Caused by Degenerative Spine Disease with Minimally Invasive Techniques

2014 ◽  
Vol 4 (1_suppl) ◽  
pp. s-0034-1376724-s-0034-1376724
Author(s):  
K. Vladimirovich Tyulikov ◽  
K. Korostelev ◽  
V. Manukovsky ◽  
V. Litvinenko ◽  
V. Badalov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Minimally Invasive ◽  
Low Back ◽  
Minimally Invasive Techniques ◽  
Degenerative Spine ◽  
Degenerative Spine Disease ◽  
Invasive Techniques ◽  
Spine Disease

scholarly journals Is there a right time for surgery in paraplegic patients secondary to non traumatic spinal cord compression?

2012 ◽  
Vol 10 (4) ◽  
pp. 508-511 ◽  
Author(s):  
Leonardo Giacomini ◽  
Roger Neves Mathias ◽  
Andrei Fernandes Joaquim ◽  
Mateus Dal Fabbro ◽  
Enrico Ghizoni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factor ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Indication For Surgery ◽  
Sensory Deficits ◽  
Sensory Involvement ◽  
Spinal Cord Decompression

Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.

scholarly journals Spinal Cord Compression by Ligamentum Flavum Hematoma in the Thoracic Spine

Spine ◽  
2009 ◽  
Vol 34 (25) ◽  
pp. E942-E944 ◽  
Author(s):  
Hideki Sudo ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Yoshihisa Kotani ◽  
Masahiko Takahata ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Thoracic Spine ◽  
Ligamentum Flavum ◽  
Cord Compression

scholarly journals Neurospinal Surgery Innovations

2017 ◽  
Vol 3 (3) ◽  
pp. 121-122
Author(s):  
James Wang
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Treatment Plan ◽  
Invasive Technique ◽  
Surgical Trauma ◽  
The Past ◽  
The World ◽  
Spine Diseases ◽  
Invasive Techniques ◽  
Important Branch

Over the past few decades, majority of neurosurgeons only specialize in spinal cord diseases. However, with the advances in spine surgery, more and more neurosurgeons focus on spine diseases. Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery. As traditional surgery has been gradually replaced by precision surgery, open surgery has been gradually replaced by minimally invasive surgery (MIS), the diagnosis and treatment of spine diseases has been benefiting from minimally invasive techniques. With minimal surgical trauma, precise localization, MIS has become the inevitable trend of new neurosurgery. The model of multidisciplinary team is gradually becoming universal in the world in order to make the best treatment plan for the patient with spine diseases on the basis of the comprehensive disciplinary opinion.

scholarly journals Surgery for Metastatic Epidural Spinal Cord Compression in Thoracic Spine, Anterior or Posterior Approach?

2019 ◽  
Author(s):  
Jen Chung Liao
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Spinal Cord Compression ◽  
Thoracic Spine ◽  
Posterior Approach ◽  
Cord Compression ◽  
Thoracic Vertebrae ◽  
Neurologic Status ◽  
Significant Difference ◽  
Group A

Abstract Background: The most commonly encounter tumor of the spine is metastasis, and thoracic spine is the most commonly metastatic spine. Controversy exists regarding the optimal surgical approach for this kind of patient. The author conducted a study to assess the differences between anterior thoracotomy and posterior approach in patients with malignant epidural cord compression in the thoracic spine. Methods: Between January 2003 and December 2015, patients with metastatic thoracic lesion underwent surgery at our department were stratified into two groups according to different approach method to the lesion site. Group A mean anterior thoracotomy, decompression and fixation. Group P represented posterior decompression and fixation. Survival was defined as months since surgery to last tractable times. American Spinal Injury Association grade was used to assess preoperative and postoperative neurologic status. Days at intensive care unit (ICU) were compared. Every complication by surgery or during admission was documented. Results: Group A had 25 patients and Group P had 67 patients. Lung cancer was ther most commonly origin cancer in both groups. The most commonly surgical level was the 9th thoracic vertebrae in Group A and the 10th thoracic vertbrae in Group P. Both gropus had a similar preoperative neurologic (p=0.959). One patients in Group A and two in the Group P sustained neurologic deterioation immediately after surgery. Group A took more operation time (213.0 vs 199.2 minutes, p=0.380) and had more blood loss (912.5 vs 834.4 ml, p=0.571). 6 patients in Group A (24%) and 10 patients in Group P (13.9%) developed complications immediately or postoperatively. Patients in Group A need more days of care at ICU (2.36 vs 0.19 days, p<0.001). The longer survival was seen in the goup P (15.4 vs 11.2 months) but without significant differnce. Conclusion: Patients in Group P required significantly less days of care at ICU. Besides, posterior approach also took a shorter surgical time, and had a less blood loss during surgery, although without statistically significant difference. According to the results, the author would prefer posterior approach by decompression and fixation for those with thoracic metastatic tumor with epidural compression. Keywords: Thoracic spine; metastatic epidural spinal cord compression; anterior thoracotomy; posterior approach; survivorship; neurologic status; complications.

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.

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