Modified Rib Sparing Direct Lateral Minimally Invasive Vertebrectomy for Treatment of Metastatic Spinal Cord Compression

Abstract

Objective: Metastatic spinal cord compression (MSCC) is a common complication of metastatic disease with neurological morbidity in the thoracic and upper lumbar spine. We describe a modified rib-sparing direct lateral minimally invasive (MIS) approach. for the purpose of vertebrectomy. This technique obviates the need for rib resection and chest drain, facilitating early mobilisation. This is especially applicable to a sub-group of patients who may not be well enough for an open approach. Method: Technical note and retrospective case series in a single centre over a 5 year period. Results: 14 patients were identified who underwent the MIS approach vertebrectomy for MSCC. 12/14 underwent posterior fixation, and 2 underwent vertebroplasty. 11/14 (79%) had less than 1L blood loss during the procedure. The mean duration of the procedure was 5 hours 51 minutes. 5/14 (36%) avoided high dependency unit (HDU) care, and the median duration of time spent in HDU was 1.5 days. The median length of stay in hospital was 16 days, and 4/14 (29%) were discharged within 1 week. There were 1/14 major complications requiring revision surgery. Conclusion: A modified rib-sparing MIS approach for vertebrectomy is well tolerated in the treatment of MSCC and is associated with low blood loss and short hospital stays. This may be an option in patients who otherwise may not be considered for an anterior reconstruction.