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Less invasive palliative surgery for spinal metastases.

Chi Heon Kim¹, Chun Kee Chung, Seil Sohn

¹Department of Neurosurgery, Seoul National University Hospital and College of Medicine, Seoul, South Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.

Journal of Surgical Oncology

|August 29, 2013

Summary

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Percutaneous pedicle screw fixation (PPSF) combined with radiotherapy/chemotherapy improved quality of life for fragile spinal metastasis patients. This multidisciplinary approach enhanced mobility and pain scores in patients ineligible for other treatments.

Area of Science:

Orthopedic Surgery
Oncology
Neurosurgery

Background:

Spinal metastasis presents treatment challenges for patients unsuitable for vertebroplasty/kyphoplasty or open surgery.
Percutaneous pedicle screw fixation (PPSF) offers a potential solution to bridge this treatment gap.

Purpose of the Study:

To evaluate the effectiveness of PPSF in conjunction with radiotherapy and chemotherapy for patients with spinal metastasis.
To assess improvements in pain, functional status, and survival.

Main Methods:

Sixteen patients with spinal metastasis and specific criteria (Tomita score ≥ 5, limited life expectancy, minimal tumor extension, Nurick grade < 3) underwent PPSF.
Vertebroplasty was performed in 14 patients post-fixation.
Patients received concurrent radiotherapy (8) or chemotherapy (10).

Keywords:

Tomita instrumentation less invasive neoplasm metastasis palliative spine

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Main Results:

Significant pain reduction (NRS 8.2 to 3.8) and improved Eastern Cooperative Oncology Group (ECOG) performance status in 81% at 1 month.
Patients achieved early ambulation (discharge days 4-7) and had median ambulation and survival times of 207 and 222 days, respectively.

Conclusions:

A multidisciplinary approach integrating PPSF with radiotherapy/chemotherapy can enhance the quality of life for fragile patients with spinal metastasis.
PPSF provides a viable treatment option for selected patients with spinal tumors who are not candidates for conventional surgical or minimally invasive procedures.