Three-Dimensional Endoscopy-Assisted Excision and Reconstruction for Metastatic Disease of the Dorsal and Lumbar Spine: Early Results

Abstract

Background: The aim of this study was to explore the role of three-dimensional (3D) endoscopy in surgical management of metastatic disease of the dorsal and lumbar spine.

Methods: This is a prospective study on 33 patients (15 men and 18 women, mean age of 61.6 ± 8.9 years) with biopsy-proven metastatic disease of the spine managed by sequential/staged posterior decompression-stabilization, followed by 3D endoscopy-assisted anterior corpectomy and stabilization with a mesh cage. All patients had significant extradural compression or spinal instability or both. Sixteen patients had neurological deficits. Visual analog scale (VAS), Frenkel grade (neurological deficits), Karnofsky performance status scale, and the 36-item short-form health survey (SF-36) were used for assessment preoperatively and at 3, 6, and 12 months from surgery.

Results: At a mean follow-up of 1.7 ± 0.7 years from surgery, 18 patients were alive. VAS showed significant improvement at the latest follow-up compared to preoperative levels (4.39 vs. 6.61, p = 0.001). Karnofsky status did not show any significant improvement. Frenkel grade improved in 5 patients, deteriorated in 4 patients, and remained unchanged in 24 patients. Regarding SF-36 parameters, general health showed deterioration, but role functioning-physical, role functioning-emotional, social functioning, and body pain showed statistically significant improvement. There was no change in physical health, viability, and mental health. Subjectively the surgeons felt better depth perception and smoother surgical experience with the 3D optics technology. The only complication was delayed wound healing in three patients who had a previous history of radiotherapy to the surgical site.

Conclusions: 3D endoscopy is a valuable tool in the management of metastatic spinal disease requiring excision and reconstruction using the combined posterior and anterior approaches. These early results warrant confirmation with more data and longer follow-ups.

Keywords: Corpectomy; Spinal metastasis; Spine endoscopy; Thoracoscopy; Three dimensional endoscopy.

Fig. 1. Preoperative imaging of a 70-year-old male patient with a history of bronchogenic carcinoma with metastatic fracture of D9 vertebra with pain (visual analog scale score 9) and neurological deficits (Frenkel grade C). (A) Magnetic resonance imaging, sagittal section. (B) Computed tomography, axial section.

Fig. 2. Three-dimensional endoscopic view of the anterior defect following posterior decompression, stabilization, and endoscopic corpectomy.

Fig. 3. Bridging of the defect with a carbon mesh cage.

Fig. 4. Imaging at 3 months from surgery. (A) Computed tomography, sagittal section. (B) Computed tomography, coronal section. (C) Magnetic resonance imaging, sagittal section.

Fig. 5. Clinical results at 3 months from surgery (visual analog scale score 6, Frenkel grade D). The patient was ambulant till he succumbed to progressive metastatic disease at 10 months from surgery.