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Posterior approaches for symptomatic metastatic spinal cord compression
Camilo Molina1, C Rory Goodwin1, Nancy Abu-Bonsrah1
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgical Focus
|August 2, 2016
Summary
Posterior surgical approaches for spinal metastasis, including laminectomy and corpectomy, can effectively relieve pain and improve neurological function. Careful patient selection is crucial for optimal outcomes in spinal tumor treatment.
Area of Science:
- Neurosurgery
- Oncology
- Orthopedic Surgery
Background:
- Spinal metastases necessitate surgical intervention for stabilization, pain relief, neurological preservation, and tumor reduction.
- Posterior surgical approaches are frequently employed for treating metastatic spinal lesions.
Purpose of the Study:
- To review the role and efficacy of posterior surgical procedures in managing spinal metastases.
- To analyze posterior laminectomy, transpedicular corpectomy, and costotransversectomy for spinal metastasis treatment.
Main Methods:
- A comprehensive literature review from 1980 to 2015 using Medline and bibliography searches.
- Analysis of 34 articles, including randomized controlled trials, prospective cohort studies, and retrospective case reports.
Main Results:
- Laminectomy with stabilization shows Level II evidence for improving neurological outcomes and reducing pain in selected patients.
- Transpedicular corpectomy and costotransversectomy are recommended for selected patients with spinal metastases, offering improved neurological function and pain reduction.
- Laminectomy alone requires careful consideration due to potential limitations.
Conclusions:
- Posterior surgical approaches are valuable in the multidisciplinary management of spinal metastases.
- Continued research and prospective studies are essential to refine the indications and optimize outcomes for surgical interventions in spinal metastasis.
Keywords:
ASIA = American Spinal Injury AssociationI/M = patients with improved or maintainedMSCC = metastatic spinal cord compressionNAWPO = nonambulatory patients at presentation who walked postoperativelyPCT = posterolateral costotransversectomy approachPL = posterior (approach) laminectomyPTA = posterolateral transpedicular approachRCT = randomized controlled trialRR = recurrence rateRT = radiotherapySC = surgical complicationSRS = stereotactic radiosurgeryVAS = visual analog scaleWPO = patients who could walk postoperativelycostotransversectomyfusionlaminectomyposterior approachspine metastasistranspedicular corpectomy
