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. 2020 Jul 15;45(14):E820-E828.
doi: 10.1097/BRS.0000000000003450.

Transpedicular Vertebrectomy With Circumferential Spinal Cord Decompression and Reconstruction for Thoracic Spine Metastasis: A Consecutive Case Series

Tarush Rustagi  1   2 , Hazem Mashaly  1   3 , Ranjit Ganguly  1 , Asad Akhter  1 , Ehud Mendel  1
Affiliations

Transpedicular Vertebrectomy With Circumferential Spinal Cord Decompression and Reconstruction for Thoracic Spine Metastasis: A Consecutive Case Series

Tarush Rustagi et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective case series.

Objective: To study the feasibility, outcomes, and complications of transpedicular vertebrectomy (TPV), and reconstruction for metastatic lesions to the thoracic spine.

Summary of background data: Metastatic lesions to the thoracic spine may need surgical treatment requiring anterior-posterior decompression/stabilization. Anterior reconstruction may be performed using poly methyl meth acrylate (PMMA) cement or cages. Use of cement has been reported to be associated with complications.

Methods: From 2008 to 2016, consecutive cases (single surgeon) undergoing TPV for thoracic spine metastasis (T2-12) were included. Demographic, surgical, and clinical data were collected through chart review. MRI, CT, positron emission tomography images were used to identify extent of disease, epidural spinal cord compression (ESCC), and degree of vertebral body collapse. Hall-Wellner confidence band was used for the survival curve.

Results: Ninety six patients were studies with a median age 60 years. Most patients 56 (58%) presented with mechanical pain. 29% cases had lung metastasis. Single level TPV was performed in 73 patients (76%). Anterior reconstruction included PMMA in 78 patients (81.25%), and titanium cage in 18 patients (18.25%). Frankel grade improvement was seen in 16 cases (P = 0.013). ESCC improved by a median of 5.9 mm (P < 0.001). Kyphosis reduced by median of 7.5° (P < 0.001). VAS improved by median of seven (P < 0.001). Total 59 deaths were observed. The median survival time was estimated to be 6 months (95% CI: 5, 10). Surgical outcome and complication rates are similar between the two construct types. Correction of kyphosis was seen to be slightly better with the use of PMMA. Overall 29.16% cases developed complications (11.4% major). Two cases developed neurological deficit following epidural hematoma requiring surgery. One case had instrumentation failure from cement migration, needing revision.

Conclusion: The result of our study shows significantly improved clinical and radiological outcomes for TPV for thoracic metastatic lesions. We also discuss some important steps for use of PMMA to avoid complications.

Level of evidence: 4.

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References

    1. Falicov A, Fisher CG, Sparkes J, et al. Impact of surgical intervention on quality of life in patients with spinal metastases. Spine (Phila Pa 1976) 2006; 31:2849–2856.
    1. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366:643–648.
    1. Cho DC, Sung JK. Palliative surgery for metastatic thoracic and lumbar tumors using posterolateral transpedicular approach with posterior instrumentation. Surg Neurol 2009; 71:424–433.
    1. Eap C, Tardieux E, Goasgen O, et al. Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases. Orthop Traumatol Surg Res 2015; 101:483–488.
    1. Barzilai O, Laufer I, Robin A, et al. Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery. Oper Neurosurg (Hagerstown) 2019; 16:310–318.