Posterior approaches for symptomatic metastatic spinal cord compression.
Surgical interventions for spinal metastasis are commonly performed for mechanical stabilization, pain relief, preservation of neurological function, and local tumor reduction. Although multiple surgical approaches can be used for the treatment of metastatic spinal lesions, posterior approaches are commonly performed. In this study, the role of posterior surgical procedures in the treatment of spinal metastases was reviewed, including posterior laminectomy with and without instrumentation for stabilization, transpedicular corpectomy, and costotransversectomy. A review of the literature from 1980 to 2015 was performed using Medline, as was a review of the bibliographies of articles meeting preset inclusion criteria, to identify studies on the role of these posterior approaches among adults with spinal metastasis. Thirty-four articles were ultimately analyzed, including 1 randomized controlled trial, 6 prospective cohort studies, and 27 retrospective case reports and/or series. Some of the reviewed articles had Level II evidence indicating that laminectomy with stabilization can be recommended for improvement in neurological outcome and reduction of pain in selected patients. However, the use of laminectomy alone should be carefully considered. Additionally, transpedicular corpectomy and costotransversectomy can be recommended with the expectation of improving neurological outcomes and reducing pain in properly selected patients with spinal metastases. With improvements in the treatment paradigms for patients with spinal metastasis, as well as survival, surgical therapy will continue to play an important role in the management of spinal metastasis. While this review presents a window into determining the utility of posterior approaches, future prospective studies will provide essential data to better define the roles of the various options now available to surgeons in treating spinal metastases.
ASIA = American Spinal Injury Association; I/M = patients with improved or maintained; MSCC = metastatic spinal cord compression; NAWPO = nonambulatory patients at presentation who walked postoperatively; PCT = posterolateral costotransversectomy approach; PL = posterior (approach) laminectomy; PTA = posterolateral transpedicular approach; RCT = randomized controlled trial; RR = recurrence rate; RT = radiotherapy; SC = surgical complication; SRS = stereotactic radiosurgery; VAS = visual analog scale; WPO = patients who could walk postoperatively; costotransversectomy; fusion; laminectomy; posterior approach; spine metastasis; transpedicular corpectomy
Categories: Spine and Peripheral nerve