Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis

Object. Spinal metastasis with spinal cord involvement is a frequent complication in cancer patients. As the spinal compression frequently occurs ventrally, performing a simple posterior laminectomy alone is generally ineffective and dangerous. Many aggressive surgical strategies have been developed to improve outcomes for patients with metastatic spine disease. These strategies are associated with high morbidity and complication rates, especially in patients with numerous neoplasm-associated comorbidities, which can limit their indication in patients with a limited life expectancy. The authors performed a prospective evaluation of minimally invasive decompression and stabilization for the palliative management of symptomatic thoracolumbar spine metastasis. Methods. Ten patients with metastasis to the thoracolumbar spine and neurological compromise underwent minimally invasive transpedicular vertebrectomy and spinal cord decompression through a tubular expandable retractor. Percutaneous stabilization was also systematically performed to ensure spinal stability. Results. No complications during the procedure were reported. The mean operative duration was 170 minutes and the mean estimated blood loss was 400 ml. The postoperative course of all patients was uneventful, with the exception of 1 benign urinary tract infection. Eight patients (80%) improved at least 1 Frankel grade. Conclusions. Minimally invasive treatment of thoracolumbar spine metastasis is a safe and effective palliative option in patients with limited life expectancy, to limit morbidity and preserve quality of life. (http://thejns.org/doi/abs/10.3171/2012.4.SPINE111108)