Abordaje anterior y anterolateral en el tratamiento de la compresión medular metastásica a nivel torácico y lumbar

López, Antonio José Vargas; Carballal, Carlos Fernández; Useros, T. Panadero; González, Cristina Aracil; Vidorreta, José Manuel Garbizu; Rodrigálvarez, Rosario González

doi:10.1016/j.neucir.2014.11.003

Cited by 6 publications

(3 citation statements)

References 52 publications

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“…Besides, postoperative complications after surgery for spine metastasis hold remarkable challenges for surgeons because they may exacerbate or trigger surgical morbidities, worsen pain, and even further aggravate the existing functional deficits 18. Notably, researchers have shown that 12.1%–26.6% of patients with spine metastasis or bone metastasis developed postoperative complications after open surgery,2,9–13 which led to the significantly impaired quality of remaining life. In the present study, the worst pain, average pain, and pain interference showed improvement when preoperative and postoperative pain scores were compared at each time point, which suggested that decompressive surgery for painful malignant spinal cord compression was found to be effective regarding pain controls.…”

Section: Discussionmentioning

confidence: 99%

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Surgical results and clinical risks of postoperative complications in patients with painful malignant spinal cord compression after decompressive surgery

Wang

et al. 2018

JPR

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IntroductionThis study aims to analyze clinical outcome in patients with painful malignant spinal cord compression due to advanced cancers after the decompressive surgery and identify risk factors for postoperative complications in these patients. Furthermore, we created a scoring model to predict the risk of postoperative complications based on identified significant risk factors.MethodsWe retrospectively analyzed survival outcomes, pain outcomes, and postoperative complications of patients with painful malignant spinal cord compression who were surgically treated in our department. Identification of risk factors for postoperative complications was also performed, and significant factors according to the multiple logistic regression models were included in the scoring model.ResultsAs a result, 105 patients were enrolled. The overall median survival time was 9.1 months (95% CI, 7.1–11.4 months). The mean worst pain score was 8.0 in a 24-hour period before surgery, while it decreased to 6.0, 5.0, 3.5, 3.3, and 3.6 (all P<0.01, when compared with baseline date) at 1 week, 1 month, 3, 6, and 12 months after surgery, respectively. Similar decreases were also observed in the average pain and the pain interference. Thirty-one complications occurred within 4 weeks after operation in 26 patients (24.8%, 26/105). Based on multiple logistic regression models, age (P=0.03), Karnofsky performance status (P<0.01), and Charlson Comorbidity Index (P=0.04) were significantly associated with postoperative complications and were included in the scoring model. Three risk groups were created based on the complication rates of each scoring points. The corresponding postoperative complication rates of the three groups were 7.7% in group A (0–3 points), 26.7% in group B (4–6 points), and 60.9% in group C (7–10 points), respectively (OR, 4.32, 95% CI: 2.24–8.31, P<0.01).ConclusionDecompressive surgery for painful malignant spinal cord compression was found to be useful for pain control with a tolerable rate of complications. We created a scoring model to predict the risk of postoperative complications in patients with painful malignant spinal cord compression after surgery. This scoring model may guide doctors to choose the appropriate care strategies to realize better pain management.

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Section: Discussionmentioning

confidence: 99%

“…Operation site infection was the most common complication. Studies showed that 12.1%–26.6% of patients developed postoperative complications after open surgery in patients with spine or bone metastasis,2,9–13 and operation site infection was up to 25% 2. Importantly, complications worsen the pain outcome.…”

Section: Introductionmentioning

confidence: 99%

Surgical results and clinical risks of postoperative complications in patients with painful malignant spinal cord compression after decompressive surgery

Wang

et al. 2018

JPR

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“…After determining vertebral screw length, its location and direction are also key factors that affect fixation. According to Kaneda et al and Rao et al [7,8], the ideal location of the vertebral screw should be as follows: the screw does not pass into the spinal canal and should be parallel to the upper and lower cartilage endplates of the corresponding vertebra and coronal plane of the spine and the screw tip just penetrates into the contralateral cortical bone; therefore, the transverse diameter of vertebra determines the vertebral screw length. A vertebral screw that is too long can damage the contralateral tissues and organs, while one that is too short cannot reach the contralateral cortical bone, which will impair the orthopedic force and internal fixation effects [9,10].…”

Section: Discussionmentioning

confidence: 99%

Digital Anatomical Measurement for Anterolateral Fixation of Middle and Lower Thoracic Vertebrae

Zhang

et al. 2016

Med Sci Monit

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BackgroundThe key to its successful application is to determine the best entry point for the vertebral screw(s). This study aimed to provide a reference for clinical anterolateral fixation through digital measurement of computed tomography (CT) data to identify relevant anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults.Material/MethodsWe performed digital measurement of anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults. Abbreviations: Left height of vertebral body, LHV; Right height of vertebral body, RHV; Anterior height of vertebral body, AHV; Middle height of vertebral body, MHV; Posterior height of vertebral body, PHV; Superior sagittal diameter of vertebral body, SSDV; Superior transverse diameter of vertebral body, STDV; inferior sagittal diameter of vertebral body, ISDV; Inferior transverse diameter of vertebral body, ITDV; (1) Left (right) height of vertebral body, [L(R)HV]; Anterior (middle, posterior) height of vertebral body [A(M,P)HV]; Superior (inferior) sagittal diameter of vertebral body, [S(I)SDV]; Superior (inferior) transverse diameter of vertebral body, [S(I)TDV].ResultsThe transverse diameters of vertebral bodies were always larger than the sagittal diameter for 3~4 mm. The distance between 2 vertebrae (interval of 1 vertebra) range were (52–56) mm for T4–T7 and (44–48) mm for T8–T12, and the surgeons could collate these data to choose a suitable stick length.ConclusionsBone graft should prune into laterigrade cuboid, it can recover A-P and bilateral physiological functions load, and the height of the vertebral body increased from T4 to T12.

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Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis

et al. 2016

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Abordaje anterior y anterolateral en el tratamiento de la compresión medular metastásica a nivel torácico y lumbar

Cited by 6 publications

References 52 publications

Surgical results and clinical risks of postoperative complications in patients with painful malignant spinal cord compression after decompressive surgery

Surgical results and clinical risks of postoperative complications in patients with painful malignant spinal cord compression after decompressive surgery

Digital Anatomical Measurement for Anterolateral Fixation of Middle and Lower Thoracic Vertebrae

Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis

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