Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Wiggins, Gregory C.; Mirza, Sadia; Bellabarba, Carlo; West, G. Alexander; Chapman, Jens R.; Shaffrey, Christopher I.

doi:10.3171/foc.2001.11.6.5

Cited by 51 publications

(38 citation statements)

References 66 publications

(80 reference statements)

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“…Anterior-only approaches were comparable to posterior approaches in terms of EBL (475 vs 500 ml); however, anterior-posterior approaches had significantly higher EBL than the posterior approach (2500 vs 500 ml). Wiggins et al 18 reported on 47 patients, with 29 undergoing costotransversectomies and 18 undergoing thoracolumbar or combined approaches. They did not find a significant difference in complication rates between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

Lau²,

Lee³

et al. 2010

SPI

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A nterior spinal pathological entities of the thoracolumbar spine have traditionally been treated by an anterior transthoracic, thoracolumbar, or retroperitoneal approach. Also used has been a posterior surgery via costotransversectomy or extracavitary approaches. The transpedicular corpectomy is a variant of the costotransversectomy and extracavitary approaches in that the rib head is preserved as the corpectomy is being performed, and the corpectomy is performed through the pedicles. Various techniques have been described to deal with the rib head to perform anterior spinal reconstruction. [4][5][6] With advances in surgical techniques, many operations that traditionally have been performed through anterior spinal approaches (including multilevel corpectomies) are now being performed via posterior approaches. We wished to evaluate whether one approach was superior to the other with regard to complications, neurological outcome, morbidity, and other perioperative factors. Object. Whereas standard anterior approaches for thoracolumbar corpectomies have commonly been used, the transpedicular technique is increasingly used to perform corpectomies from a posterior approach. The authors conducted a study to analyze whether there was a difference in outcomes by comparing transpedicular corpectomies to standard anterior thoracolumbar corpectomies. MethodsMethods. The senior author performed thoracolumbar corpectomies in 80 patients between 2004 and 2008. The authors reviewed medical records and follow-up data, consisting of clinic visits, radiographs, or telephone interviews. Neurological outcome, complications, operative times, revision surgery rates, and estimated blood loss (EBL) were evaluated.Results. Thirty-four patients underwent transpedicular corpectomies, and 46 patients underwent anterior thoracolumbar approaches. Single-level transpedicular corpectomies appear to be comparable to anterior-only corpectomies in terms of EBL, operative time, and complication rates. There was a higher complication rate, increased EBL, and longer operative time with anterior-posterior corpectomies compared with transpedicular corpectomies. Patients undergoing transpedicular corpectomies had a greater recovery of neurological function than those in whom anteriorapproach corpectomies were performed.Conclusions. The transpedicular corpectomy appears to have a comparable morbidity rate to anterior-only corpectomies, but its morbidity rate is lower than that of anterior-posterior corpectomies.

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Section: Discussionmentioning

confidence: 99%

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

Lau²,

Lee³

et al. 2010

SPI

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“…Class III evidence was provided by the 3 retrospective studies. In a retrospective comparison study, Wiggins et al 35 evaluated outcomes after performing 29 PCTs (Group 1) and 18 thoracolumbar or combined approaches (Group 2) as initial operations for thoracic neoplasms. The outcomes reported were mean Frankel grade at discharge (4.1 vs 4.7, respectively, p = 0.74) and mean ASIA motor score at discharge (90.4 [range 50-100] vs 98.3 [range 75-100], respectively, p = 0.04).…”

Section: Costotransversectomymentioning

confidence: 99%

“…These papers provided results on neurological outcomes, survival, recurrence, pain, and complication rates. There was 1 prospective cohort trial, 32 1 retrospective case-control study, 35 and 2 retrospective case series. 11,23 Class I evidence on the use of PCT was not available from any of the selected articles.…”

Section: Costotransversectomymentioning

confidence: 99%

“…32 The retrospective case-control study reported 38% for Group 1 versus 39% for Group 2 (p = 0.95). 35 The 2 retrospective case series reported 8.1% 23 and 7%.…”

mentioning

confidence: 99%

“…The PCT approach was used in these studies because of tumor location, 11,23,32,35 severity of disease, patient health, 11,23,32,35 surgeon's familiarity with the approach and reconstructive options, 11,23,32,35 and patient comorbidities. 11,32,35 In Wiggins et al, PCT was selected if the tumor extended into the posterior elements or paraspinal musculature.…”

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confidence: 99%

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Posterior approaches for symptomatic metastatic spinal cord compression

Molina

Goodwin

Abu-Bonsrah

et al. 2016

FOC

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Surgical interventions for spinal metastasis are commonly performed for mechanical stabilization, pain relief, preservation of neurological function, and local tumor reduction. Although multiple surgical approaches can be used for the treatment of metastatic spinal lesions, posterior approaches are commonly performed. In this study, the role of posterior surgical procedures in the treatment of spinal metastases was reviewed, including posterior laminectomy with and without instrumentation for stabilization, transpedicular corpectomy, and costotransversectomy. A review of the literature from 1980 to 2015 was performed using Medline, as was a review of the bibliographies of articles meeting preset inclusion criteria, to identify studies on the role of these posterior approaches among adults with spinal metastasis. Thirty-four articles were ultimately analyzed, including 1 randomized controlled trial, 6 prospective cohort studies, and 27 retrospective case reports and/or series. Some of the reviewed articles had Level II evidence indicating that laminectomy with stabilization can be recommended for improvement in neurological outcome and reduction of pain in selected patients. However, the use of laminectomy alone should be carefully considered. Additionally, transpedicular corpectomy and costotransversectomy can be recommended with the expectation of improving neurological outcomes and reducing pain in properly selected patients with spinal metastases. With improvements in the treatment paradigms for patients with spinal metastasis, as well as survival, surgical therapy will continue to play an important role in the management of spinal metastasis. While this review presents a window into determining the utility of posterior approaches, future prospective studies will provide essential data to better define the roles of the various options now available to surgeons in treating spinal metastases.

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Fifty‐year history of the evolution of spinal metastatic disease management

Newman

Bilsky

2022

Journal of Surgical Oncology

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Spine metastases are a significant source of morbidity in oncology. Treatment of these spine metastases largely remains palliative, but advances over the past 50 years have improved the effectiveness of interventions for preserving functional status and obtaining local control while minimizing morbidity. While the field began with conventional external beam radiation as the primary treatment modality, a series of paradigm shifts and technological advances in the 2000s led to a change in treatment patterns. These advances allowed for an increased role of surgical decompression of neural elements, a shift in the stereotactic capabilities of radiation oncologists, and an improved understanding of the radiobiology of metastatic disease. The result was improved local control while minimizing treatment morbidity. These advances fit within the larger framework of metastatic spine tumor management known as the Neurologic, Oncologic, Mechanical, and Systemic disease decision framework. This dynamic framework takes into account the neurological function of the patient, the radiobiology of their tumor, their degree of mechanical instability, and their systemic disease control and treatment options to help determine appropriate interventions based on the individual patient. Herein, we describe the 50-year evolution of metastatic spine tumor management and the impact of various advances on the field.

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Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors

Cited by 51 publications

References 66 publications

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

Posterior approaches for symptomatic metastatic spinal cord compression

Fifty‐year history of the evolution of spinal metastatic disease management

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