Strategies for posterior-only minimally invasive surgery in thoracolumbar metastatic epidural spinal cord compression

Mohammed Abdul Alshareef; Gibson Klapthor; Stephen R Lowe; Jessica Barley; David Cachia; Bruce M Frankel

doi:10.25259/SNI_815_2020

Strategies for posterior-only minimally invasive surgery in thoracolumbar metastatic epidural spinal cord compression

Surg Neurol Int. 2020 Dec 22:11:462. doi: 10.25259/SNI_815_2020. eCollection 2020.

Authors

Mohammed Abdul Alshareef¹, Gibson Klapthor², Stephen R Lowe³, Jessica Barley⁴, David Cachia¹, Bruce M Frankel¹

Affiliations

¹ Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, United States.
² Department of Radiology, Wake Forest University, Winston-Salem, North Carolina, United States.
³ Department of Neurosurgery, H. Lee Moffitt Cancer Center, Tampa, Florida, United States.
⁴ Department of Clinical Neurophysiology, Medical University of South Carolina, Charleston, South Carolina, United States.

Abstract

Background: Metastatic epidural spinal cord compression (MESCC) is a debilitating sequela of cancer. Here, we evaluated various subtypes of posterior-only minimally invasive spinal (MIS) procedures utilized to address different cancers.

Methods: Within this retrospective review, we analyzed the treatment of thoracolumbar MESCC treated with three MIS techniques: decompression and fusion (Subgroup A), partial corpectomy (Subgroup B), and full corpectomy (Subgroup C).

Results: There were 51 patients included in the study; they averaged 58.7 years of age, and 51% were females. Most tumors were in the thoracic spine (51%). The average preoperative Frankel grade was D (62.7%); 69% (35) improved postoperatively. The patients were divided as follows: subgroup A (15 patients = 29.4%), B (19 patients = 37.3%), and C (17 patients = 33.3%). The length of hospitalization was similar (~5.4 days) for all groups. The overall complication rate was 31%, while blood loss was lower in Subgroups A and B versus C.

Conclusion: Different MIS surgical techniques were utilized in patients with thoracic and/or lumbar MESCC. Interestingly, clinical outcomes were similar between MIS subgroups, in this study, with a trend toward higher complications and greater blood loss associated with those undergoing more aggressive MIS procedures (e.g., full corpectomy and fusion).

Keywords: Corpectomy; Metastasis; Metastatic epidural spinal cord compression; Minimally invasive spine; Spine surgery; Thoracolumbar.