Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Minimally Invasive Option Using Percutaneous Pedicle Screw for Instability of Metastasis Involving Thoracolumbar and Lumbar Spine : A Case Series in a Single Center

  • Park, Ho-Young (Department of Neurosurgery, SSamsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Sun-Ho (Department of Neurosurgery, SSamsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Se-Jun (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Eun-Sang (Department of Neurosurgery, SSamsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Chong-Suh (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eoh, Whan (Department of Neurosurgery, SSamsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2014.04.25
  • Accepted : 2014.08.13
  • Published : 2015.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods : This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion : Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.

Keywords

References

  1. Bailar JC 3rd, Gornik HL : Cancer undefeated. N Engl J Med 336 : 1569-1574, 1997 https://doi.org/10.1056/NEJM199705293362206
  2. Bartels RH, Feuth T, van der Maazen R, Verbeek AL, Kappelle AC, Andre Grotenhuis J, et al. : Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer 110 : 2042-2049, 2007 https://doi.org/10.1002/cncr.23002
  3. Cunha MV, Al-Omair A, Atenafu EG, Masucci GL, Letourneau D, Korol R, et al. : Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT) : analysis of predictive factors. Int J Radiat Oncol Biol Phys 84 : e343-e349, 2012 https://doi.org/10.1016/j.ijrobp.2012.04.034
  4. Di Martino A, Vincenzi B, Denaro L, Barnaba SA, Papalia R, Santini D, et al. : 'Internal bracing' surgery in the management of solid tumor metastases of the thoracic and lumbar spine. Oncol Rep 21 : 431-435, 2009
  5. Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF : Impact of surgical intervention on quality of life in patients with spinal metastases. Spine (Phila Pa 1976) 31 : 2849-2856, 2006 https://doi.org/10.1097/01.brs.0000245838.37817.40
  6. Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, et al. : Spinal instability neoplastic score : an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29 : 3072-3077, 2011 https://doi.org/10.1200/JCO.2010.34.3897
  7. Gerszten PC, Monaco EA 3rd : Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique. Neurosurg Focus 27 : E9, 2009
  8. Huang TJ, Hsu RW, Li YY, Cheng CC : Minimal access spinal surgery (MASS) in treating thoracic spine metastasis. Spine (Phila Pa 1976) 31 : 1860-1863, 2006 https://doi.org/10.1097/01.brs.0000225995.56028.46
  9. Ibrahim A, Crockard A, Antonietti P, Boriani S, Bunger C, Gasbarrini A, et al. : Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine 8 : 271-278, 2008 https://doi.org/10.3171/SPI/2008/8/3/271
  10. Kim CH, Chung CK, Sohn S, Lee S, Park SB : Less invasive palliative surgery for spinal metastases. J Surg Oncol 108 : 499-503, 2013 https://doi.org/10.1002/jso.23418
  11. Le Huec JC, Lesprit E, Guibaud JP, Gangnet N, Aunoble S : Minimally invasive endoscopic approach to the cervicothoracic junction for vertebral metastases : report of two cases. Eur Spine J 10 : 421-426, 2001 https://doi.org/10.1007/s005860100281
  12. Mobbs RJ, Nakaji P, Szkandera BJ, Teo C : Endoscopic assisted posterior decompression for spinal neoplasms. J Clin Neurosci 9 : 437-439, 2002 https://doi.org/10.1054/jocn.2001.1064
  13. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. : Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer : a randomised trial. Lancet 366 : 643-648, 2005 https://doi.org/10.1016/S0140-6736(05)66954-1
  14. Rodriguez-Ruiz ME, San Miguel I, Gil-Bazo I, Perez-Gracia JL, Arbea L, Moreno-Jimenez M, et al. : Pathological vertebral fracture after stereotactic body radiation therapy for lung metastases. Case report and literature review. Radiat Oncol 7 : 50, 2012 https://doi.org/10.1186/1748-717X-7-50
  15. Schneider F, Greineck F, Clausen S, Mai S, Obertacke U, Reis T, et al. : Development of a novel method for intraoperative radiotherapy during kyphoplasty for spinal metastases (Kypho-IORT). Int J Radiat Oncol Biol Phys 81 : 1114-1119, 2011 https://doi.org/10.1016/j.ijrobp.2010.07.1985
  16. Singh K, Samartzis D, Vaccaro AR, Andersson GB, An HS, Heller JG : Current concepts in the management of metastatic spinal disease. The role of minimally-invasive approaches. J Bone Joint Surg Br 88 : 434-442, 2006
  17. Tancioni F, Navarria P, Pessina F, Marcheselli S, Rognone E, Mancosu P, et al. : Early surgical experience with minimally invasive percutaneous approach for patients with metastatic epidural spinal cord compression (MESCC) to poor prognoses. Ann Surg Oncol 19 : 294-300, 2012 https://doi.org/10.1245/s10434-011-1894-x
  18. Thomas KC, Nosyk B, Fisher CG, Dvorak M, Patchell RA, Regine WF, et al. : Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression. Int J Radiat Oncol Biol Phys 66 : 1212-1218, 2006 https://doi.org/10.1016/j.ijrobp.2006.06.021
  19. Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J : A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 30 : 2186-2191, 2005 https://doi.org/10.1097/01.brs.0000180401.06919.a5
  20. Tomita K, Kawahara N, Murakami H, Demura S : Total en bloc spondylectomy for spinal tumors : improvement of the technique and its associated basic background. J Orthop Sci 11 : 3-12, 2006 https://doi.org/10.1007/s00776-005-0964-y
  21. Weber BR, Grob D, Dvorak J, Muntener M : Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine (Phila Pa 1976) 22 : 1765-1772, 1997 https://doi.org/10.1097/00007632-199708010-00017
  22. Yamashita T, Aota Y, Kushida K, Murayama H, Hiruma T, Takeyama M, et al. : Changes in physical function after palliative surgery for metastatic spinal tumor : association of the revised Tokuhashi score with neurologic recovery. Spine (Phila Pa 1976) 33 : 2341-2346, 2008 https://doi.org/10.1097/BRS.0b013e3181878733
  23. Zairi F, Arikat A, Allaoui M, Marinho P, Assaker R : Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis. J Neurosurg Spine 17 : 19-23, 2012 https://doi.org/10.3171/2012.4.SPINE111108

Cited by

  1. When Less Is More : The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease vol.41, pp.None, 2016, https://doi.org/10.1097/brs.0000000000001824
  2. Complications After Percutaneous Pedicle Screw Fixation for the Treatment of Unstable Spinal Metastases vol.23, pp.7, 2015, https://doi.org/10.1245/s10434-016-5156-9
  3. Characteristics of Patients Who Survived < 3 Months or > 2 Years After Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection? vol.34, pp.25, 2015, https://doi.org/10.1200/jco.2015.65.1497
  4. Bone Cement-Augmented Percutaneous Screw Fixation for Malignant Spinal Metastases : Is It Feasible? vol.60, pp.2, 2015, https://doi.org/10.3340/jkns.2016.0909.003
  5. Minimally invasive spinal surgery for the management of symptomatic spinal metastasis vol.31, pp.5, 2017, https://doi.org/10.1080/02688697.2017.1297374
  6. Comparison of the effects of minimally invasive percutaneous pedicle screws osteosynthesis and open surgery on repairing the pain, inflammation and recovery of thoracolumbar vertebra fracture vol.14, pp.5, 2015, https://doi.org/10.3892/etm.2017.5036
  7. Bioactive pedicle screws prepared by chemical and heat treatments improved biocompatibility and bone-bonding ability in canine lumbar spines vol.13, pp.5, 2015, https://doi.org/10.1371/journal.pone.0196766
  8. Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures vol.13, pp.2, 2015, https://doi.org/10.31616/asj.2018.0129
  9. How do vertebroplasty and kyphoplasty affect the quality of life of patients with multiple myeloma spinal metastasis? vol.30, pp.8, 2015, https://doi.org/10.1007/s00590-020-02721-3