Simultaneous anterior—posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization

2001 ◽  
Vol 94 (2) ◽  
pp. 232-244 ◽  
Author(s):  
Daryl R. Fourney ◽  
Dima Abi-Said ◽  
Laurence D. Rhines ◽  
Garrett L. Walsh ◽  
Frederick F. Lang ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Posterior Approach ◽  
Malignant Tumors ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Rank Test ◽  
Content Type ◽  
Thoracic And Lumbar Spine ◽  
Anterior Posterior ◽  
Fine Print

Object. Thoracic or lumbar spine malignant tumors involving both the anterior and posterior columns represent a complex surgical problem. The authors review the results of treating patients with these lesions in whom surgery was performed via a simultaneous anterior—posterior approach. Methods. The hospital records of 26 patients who underwent surgery via simultaneous combined approach for thoracic and lumbar spinal tumors at our institution from July 1994 to March 2000 were reviewed. Surgery was performed with the patients in the lateral decubitus position for the procedure. The technical details are reported. The mean survival determined by Kaplan—Meier analysis was 43.4 months for the 15 patients with primary malignant tumors and 22.5 months for the 11 patients with metastatic spinal disease. At 1 month after surgery, 23 (96%) of 24 patients who complained of pain preoperatively reported improvements (p < 0.001, Wilcoxon signed-rank test), and eight (62%) of 13 patients with preoperative neurological deficits were functionally improved (p = 0.01). There were nine major complications, five minor complications, and no deaths within 30 days of surgery. Two patients (8%) later underwent surgery for recurrent tumor. Conclusions. The simultaneous anterior—posterior approach is a safe and feasible alternative for the exposure tumors of the thoracic and lumbar spine that involve both the anterior and posterior columns. Advantages of the approach include direct visualization of adjacent neurovascular structures, the ability to achieve complete resection of lesions involving all three columns simultaneously (optimizing hemostasis), and the ability to perform excellent dorsal and ventral stabilization in one operative session.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Texas Scottish Rite Hospital rod instrumentation for thoracic and lumbar spine trauma

1991 ◽  
Vol 75 (3) ◽  
pp. 382-387 ◽  
Author(s):  
Edward C. Benzel ◽  
Lee Kesterson ◽  
Erich P. Marchand
Keyword(s):  
Lumbar Spine ◽  
Treatment Plan ◽  
Spine Trauma ◽  
Content Type ◽  
Spinal Implant ◽  
Thoracic And Lumbar Spine ◽  
Long Rod ◽  
Instrumentation Failure ◽  
Texas Scottish Rite Hospital ◽  
Fine Print

✓ The authors present their experience with 28 patients who had incurred unstable thoracic or lumbar spine fractures and who were intraoperatively stabilized with the Texas Scottish Rite Hospital (TSRH) universal instrumentation system. These patients were treated over a 1-year period and reflect an evolving insight into the treatment of thoracic and lumbar spine trauma with universal instrumentation. The TSRH instrumentation system appears equivalent to the more established Cotrel-Dubousset system in most respects. The construct design of the TSRH system facilitates the safe application of a rigid spinal implant. No cases of instability or pseudoarthrosis were observed during an average follow-up period of 9 months, (minimum 3 months). As the surgical treatment plan evolved, shorter and more compact constructs were increasingly utilized. There were no cases of instrumentation failure, regardless of the number of spinal levels fused or the number of levels instrumented. The value of using short rods when possible is emphasized: they may decrease the incidence of delayed instability and discomfort related to loosening at the hook/bone interface compared to that observed when long-rod systems are used in association with short spine fusions causing a fusion/instrumentation mismatch.

Total en bloc lumbar spondylectomy

2001 ◽  
Vol 95 (2) ◽  
pp. 264-269 ◽  
Author(s):  
Eric Marmor ◽  
Laurence D. Rhines ◽  
Jeffrey S. Weinberg ◽  
Ziya L. Gokaslan
Keyword(s):  
Lumbar Spine ◽  
Posterior Approach ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Neurological Injury ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Content Type ◽  
Bloc Spondylectomy ◽  
Anterior Posterior

✓ The authors describe a technique for total en bloc spondylectomy that can be used for lesions involving the lumbar spine. The technique involves a combined anterior—posterior approach and takes into account the unique anatomy of the lumbar spine. This technique allows for the en bloc resection of lumbar vertebral tumors, thus optimizing outcome while minimizing the risk of neurological injury. The technique is described in detail with the aid of neuroimaging studies, photographs of gross pathological specimens, and illustrations, and a discussion of other authors' experiences is provided for comparison.

Short-segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two-claw technique

1993 ◽  
Vol 79 (3) ◽  
pp. 335-340 ◽  
Author(s):  
Edward C. Benzel
Keyword(s):  
Lumbar Spine ◽  
Fracture Site ◽  
Spine Fractures ◽  
Short Segment ◽  
Content Type ◽  
Scoliotic Deformity ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
Fine Print

✓ The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3°. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6°. Two patients had a preoperative scoliotic deformity at the fracture site. and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable. however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.

Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors

2002 ◽  
Vol 96 (1) ◽  
pp. 131-134 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Chang Hun Rhee ◽  
Seung Hoon Lee
Keyword(s):  
Vertebral Column ◽  
Screw Fixation ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Complete Relief ◽  
Content Type ◽  
Vertebral Bodies ◽  
The Mean ◽  
Fine Print

✓ Screw fixation augmented with polymethylmethacrylate (PMMA) or some other biocompatible bone cement has been used in patients with osteoporosis requiring spinal fusion. No clinical studies have been conducted on PMMA-augmented screw fixation for stabilization of the vertebral column in patients with metastatic spinal tumors. The purpose of this study was to determine whether screw fixation augmented with PMMA might be suitable in patients treated for multilevel metastatic spinal tumors. Ten patients with metastatic spinal tumors involving multiple vertebral levels underwent stabilization procedures in which PMMA was used to augment screw fixation after decompression of the spinal cord. Within 15 days, partial or complete relief from pain was obtained in all patients postoperatively. Two of four patients in whom neurological deficits caused them to be nonambulatory before surgery were able to ambulate postoperatively. Neither collapse of the injected vertebral bodies nor failure of the screw fixation was observed during the mean follow-up period of 6.7 months. Screw fixation augmented with PMMA may offer stronger stabilization and facilitate the instrumentation across short segments in the treatment of multilevel metastatic spinal tumors.

Management of atlantoaxial metastases with posterior occipitocervical stabilization

2003 ◽  
Vol 98 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Daryl R. Fourney ◽  
Julie E. York ◽  
Zvi R. Cohen ◽  
Dima Suki ◽  
Laurence D. Rhines ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Spinal Metastases ◽  
Neurological Deficits ◽  
Rank Test ◽  
Cancer Center ◽  
Content Type ◽  
University Of Texas ◽  
Signed Rank Test ◽  
Fine Print

Object. The treatment of atlantoaxial spinal metastases is complicated by the region's unique biomechanical and anatomical characteristics. Patients most frequently present with pain secondary to instability; neurological deficits are rare. Recently, some authors have performed anterior approaches (transoral or extraoral) for resection of upper cervical metastases. The authors review their experience with a surgical strategy that emphasizes posterior stabilization of the spine and avoidance of poorly tolerated external orthoses such as the rigid cervical collar or halo vest. Methods. The authors performed a retrospective review of 19 consecutively treated patients with C-1 or C-2 metastases who underwent surgery at The University of Texas M. D. Anderson Cancer Center between 1994 and 2001. Visual analog pain scores were reduced at 1 and 3 months (p < 0.005, Wilcoxon signed-rank test); however, evaluation of pain at 6 months and 1 year was limited by the remaining number of surviving patients. Analgesic medication consumption was unchanged. There were no cases of neurological decline or sudden death secondary to residual or recurrent atlantoaxial disease during the follow-up period. One patient underwent revision of hardware at 11 months. The mean follow-up period was 8 months (range 1–32 months). Median survival determined by Kaplan—Meier analysis was 6.1 months (95% confidence interval 2.99–9.21). Conclusions. Occipitocervical stabilization provided durable pain relief and preservation of ambulatory status over the remaining life span of patients. Because of the palliative goals of surgery, the authors have not found an indication for anterior-approach tumor resection in these patients. Successful stabilization obviates the need for an external orthosis.

Simultaneous anterior—posterior approach for excision of malignant paraspinal tumor and subsequent reconstruction

1999 ◽  
Vol 91 (2) ◽  
pp. 236-240 ◽  
Author(s):  
Kazuhiro Hasegawa ◽  
Akira Ogose ◽  
Hiroto Kobayashi ◽  
Tetsuro Morita ◽  
Yasuharu Hirata
Keyword(s):  
Posterior Approach ◽  
Malignant Tumors ◽  
Lateral Position ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Content Type ◽  
Spinal Reconstruction ◽  
The Right ◽  
Anterior Posterior

✓ In cases of primary malignant extradural tumors of the spine, the main goal of the surgery is en bloc resection and reconstruction of the spine. After placing the patient in the lateral position, an en bloc resection of a chondrosarcoma that arose from the right seventh rib head and invaded the adjacent vertebra was performed using a simultaneous anterior—posterior approach followed by spinal reconstruction. The technical details are reported. Paraspinal malignant tumors of the thoracic spine can be safely removed en bloc and the spine reconstructed using this approach.

The sequential hook insertion technique for universal spine instrumentation application

1993 ◽  
Vol 79 (4) ◽  
pp. 608-611 ◽  
Author(s):  
Edward C. Benzel ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
Erich P. Marchand
Keyword(s):  
Lumbar Spine ◽  
Operative Time ◽  
Deformity Correction ◽  
Insertion Technique ◽  
Content Type ◽  
Spine Instrumentation ◽  
Thoracic And Lumbar Spine ◽  
A New Technique ◽  
Texas Scottish Rite Hospital ◽  
Fine Print

✓ A new technique of universal spine instrumentation insertion for the management of thoracic and lumbar spine instability is presented and the results in 10 patients are described. The technique involves the sequential insertion of Texas Scottish Rite Hospital (TSRH) central-post hooks, followed by hook fixation to the rod; force is then applied with correction of deformity, if needed. This allows for methodical, safe, and rapid instrumentation insertion. The new TSRH central-post hook configuration permits manipulation of the hook/rod relationships to the advantage of the surgeon (and patient) by providing more room for both hook insertion and hook/rod fixation. This technique has reduced operative time, facilitated case of deformity correction, and provided uniformly acceptable early postsurgical results.

scholarly journals Approaches to Thoracic and Lumbar Spine: Our 10 Years Review

2019 ◽  
Vol 7 (08) ◽  
Author(s):  
Parthasarahi Datta
Keyword(s):  
Lumbar Spine ◽  
Retrospective Analysis ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Perioperative Complications ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Posterior Aspect ◽  
Thoracic And Lumbar Spine

Background: Lesions of the Thoracic and lumbar spine (TL) are numerous. These lesions affect one or more columns (anterior, middle and posterior) of the spine and compress the spinal cords either from anterior and posterior, giving rise to the features of radiculo-myelopathy. These lesions can be approached either from the anterior or posterior aspect of the spine. We present our last 10 years experience regarding the comparison between two approaches. Methods: Retrospective analysis of records of all patients with thoracic and lumbar lesion treated in our hospital between January 2005 and June 2014 was performed. Over the last 10 years, we came across 186 patients of thoracic and lumbar lesion lesion who were operated either by anterior or posterior approach and were the focus of this study. Follow up ranged from 6 months to 7 years. Results: All the patients presented with neurological deficits. They were evaluated with investigation protocol of our hospital. Anterior approach was done in 38 cases (n = 38) and posterior approach was done in 148 cases (n = 148). We compared between the two groups in terms of perioperative complications, recovery, persisting symptoms and mortality. Conclusion: Complete recovery is better in the posterior approach (74.3%) v/s 52.6%) and morality is more in the anterior approach (7.9% v/s 1.3%). Keywords: Columns, radiculo-myelopathy, thoracic, lumbar

Surgical treatment of lumbar ossification of the posterior longitudinal ligament

2005 ◽  
Vol 3 (3) ◽  
pp. 230-233 ◽  
Author(s):  
Mutsuhiro Tamura ◽  
Masafumi Machida ◽  
Daisuke Aikawa ◽  
Kentaro Fukuda ◽  
Hitoshi Kono ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Posterior Longitudinal Ligament ◽  
The Other ◽  
Content Type ◽  
Posterior Surgery ◽  
The Individual ◽  
Single Posterior Approach ◽  
Anterior Posterior ◽  
Fine Print

✓ The authors report two cases of patients with lumbar ossification of the posterior longitudinal ligament (OPLL). One patient underwent surgery via the single posterior approach, and the other patient underwent combined anterior—posterior surgery. The authors consider the anterior approach for excision of the ossified lesion to be the most reasonable for treatment of lumbar OPLL. It is extremely important, however, to select the surgical procedure according to the individual patient's condition.

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