Anterior decompression and stabilization using a microsurgical endoscopic technique for metastatic tumors of the thoracic spine

Abstract

It is well accepted that the treatment of spinal tumors that threaten neurological integrity comprises resection, vertebral body reconstruction, and stabilization if the patient's condition is suitable. In spite of the excellent results reported using thoracotomy, the majority of investigators recommend posterolateral techniques because of lower morbidity, shorter hospitalization time, and the possibility of performing dorsal stabilization via the same incision. To overcome some of the disadvantages of thoracotomy, the authors developed an anterior procedure that permits vertebrectomy, reconstruction, and stabilization to be performed entirely by endoscopic technique. Microsurgical endoscopy and stabilization were performed in four patients with metastatic disease of the thoracic spine. All were ambulatory after surgery and at follow up; preoperative neurological and neurophysiological deficits improved as well. No complications occurred in this small series. Microsurgical endoscopy achieves a substantial reduction in trauma, use of analgesic medications, and hospitalization time. Early results seem to indicate that adequate decompression, stabilization and reduction of surgical morbidity can be achieved with this technique.

Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

“…Our initial clinical and operative results appear at least comparable with the results of open procedures and other thoracoscopic studies in patients with metastatic spine disease. 15,34,37 A proper comparative evaluation with larger series of patients will be required to definitively compare the results of minimally invasive endoscopic spine surgery with open procedures in patients with tumors.…”

“…10,28,34 The limiting factor in these authors' experiences was the absence of an internal fixation system that can be applied endoscopically. Another disadvantage was the lack of an ideal interbody device.…”

Neurological outcome following laminectomy in spinal metastases

“…1,4,7,14 Due to the heterogeneous group of patients with varying prognoses, 2,6,7,16,18,19 the therapeutic method of choice is often dicult and is subject to controversy among the authors. In 1980, Young and co-workers found no signi®cant dierence in clinical prognosis between laminectomy followed by radiotherapy and radiotherapy only in 29 patients.…”

Endoscopic approaches to the thoracic spine

“…The main advantage of endoscopy is that the upper thoracic spine (T2-T4) and the thoracolumbar junction (T11-L2) can be approached with no disinsertion of the scapula or minimal disinsertion of the diaphragm, enabling complex reconstructions without additional trauma [6,15,16].…”

“…At the beginning of the 1990s, thoracoscopic procedures were extensively reported by cardiothoracic surgeons in the treatment of a variety of affections that involved the thoracic cavity [2,9,10,13]. Following adaptation of the equipment and refinement of the technique, and as a natural evolution of this trend, the first reports dealing with endoscopic spine surgery of the thoracic spine were published at the beginning of the 1990s [6,[14][15][16]. Because these approaches make use of endoscopic instruments, they gained popularity under the term "minimally invasive spine surgery".…”