Single-Stage Posterolateral Transpedicular Approach With 360-Degree Stabilization and Vertebrectomy in Primary and Metastatic Tumors of the Spine

Gezercan, Yurdal; Çavuş, Gökhan; Ökten, Ali İhsan; Menekşe, Güner; Çikili, Mustafa; Adamhasan, Fulya; Arslan, Ali; Açık, Vedat

doi:10.1016/j.wneu.2016.08.007

Cited by 19 publications

(9 citation statements)

References 26 publications

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“…Using the extensive posterolateral approach enabled us to achieve maximal tumor resection and spine instrumentation in a one-step procedure. Similar results were achieved in other recent clinical studies that addressed the posterolateral approach (6)(7)(8)(9)(10)(11)(12). Despite its relative invasiveness, we confirmed that such an approach is safe and predictable as it is more familiar to neurosurgeons than the transthoracic approach, that usually requires the assistance of thoracic surgeons as well.…”

Section: Discussionsupporting

confidence: 90%

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Ravnik

Stangelj

Košar

2021

ama

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Objective. Our objective was to determine the safety, efficacy, and surgical outcome of an extensive posterolateral approach for giant spinal epidural tumors.Materials and Methods. Our clinical study included 12 patients with various giant primary tumors and metastases of the spine, who underwent surgery between 2008 and 2019. The surgical procedure consisted of costotransversectomy, laminectomy, corpectomy, tumor resection, spinal column stabilization, and reconstruction. Neurological status examination and pain assessment were recorded at the time of admission, upon discharge and at outpatient check-up.Results. In our clinical sample, there were no major perioperative complications. All patients were discharged from the intensive care unit back to the hospital department within a week after the surgery. Postoperative follow-up showed no deterioration of neurological status. Furthermore, there was a moderate to significant improvement of paraparesis in all patients for weeks after surgery. The most notable improvement was significant pain relief in all the patients. None of the patients had issues with failure of the implanted hardware. Two patients died less than six months after the surgery due to the progression of the primary malignant process.Conclusion. An extensive posterolateral approach to giant spinal epidural tumors is an effective one-step approach. It presents a good compromise between invasiveness and sufficient exposure for both tumor resection and spinal column reconstruction. Good short-term clinical improvement can be achieved, but the long term results depend on the advancement of the initial disease. Careful evaluation and selection of patients are necessary to achieve clinical improvement and prolonged life expectancy, and the best results are achieved with a multidisciplinary approach.

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Section: Discussionsupporting

confidence: 90%

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Ravnik

Stangelj

Košar

2021

ama

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“…If the anterior approach is chosen for an anterior lesion with neoplastic infi ltration into the pedicle or posterior elements, a second posterior approach is often necessary [8,9]. Moreover, if there is a tumor invasion superior to 50% of the vertebral body, even if an adequate decompression is performed from an anterior approach, supplemental posterior fi xation is recommended [10,11].…”

Section: Discussionmentioning

confidence: 99%

Total vertebrectomy through posterior approach for thoracic tumors

Soares¹,

Lucio²,

Ferreira³

et al. 2021

Open J Orthop Rheumatol

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Objective: To demonstrate the benefi ts and complications of the single posterior approach through bilateral costotransversectomy in the treatment of neoplastic disease of the thoracic spine.Methods: Twelve consecutive patients with thoracic spine tumors, who underwent single posterior approach with bilateral costotransversectomies were reviewed. Through posterior extrapleural access, total vertebrectomy and reconstruction were performed. In reconstruction, a cage was used anteriorly, and a pedicular screw fi xation was used posteriorly. The minimum follow-up was sixteen months. The parameters analyzed were pain, neurological and functional capacity, survival time, fi xation stability, and complications.Results: All patients had improvement in their pain or in their functional capability. Among those with a preoperative neurological defi cit, 71.4% showed improvement of at least one degree at postoperative evaluation. There was no functional or neurological decline in any patient. The observed complications were: one adult respiratory stress syndrome, one excessive bleeding, one pneumothorax, one infection and one local recurrence. All but one of these complications was reversed with appropriate treatment. Conclusion:The posterolateral approach through costotransversectomy was safe and secure method for the resection and reconstruction of thoracic vertebrae affected by neoplastic disease.

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“…In case of spinal stenosis due to tumor the decompression of neural structures is reached via laminectomy and tumor debulking [13,29,43,46,47,50,[52][53][54][55] . According to Tomita et al [19] palliative anterior surgery with vertebral body replacement (VBR) [ Figures 1-3] can be recommended in patients with a life expectancy > 12 months [46,47,58,59] . Highly invasive surgical options like en-bloc spondylectomy in Tomita technique or vertebral column resection with a mandatory 360 reconstruction [ Figure 4] mark curative treatment options in case of solitary spinal metastases [46,47,58,59] .…”

Section: Therapeutic Options Regarding Spinal Metastasesmentioning

confidence: 99%

Operative treatment of metastatic breast cancer in the spine with regard to molecular phenotypes

Adler¹,

Pepke²,

Akbar³

2019

JCMT

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With more than one million new diseases per year breast cancer is the most common malignancy in women. Metastatic breast cancer remains an incurable disease and the spinal column is most likely affected by metastases. A significantly prolonged patient survival is the consequence of modern oncologic treatment options in the last decade. Surgical treatment of vertebral metastases has become an increasing focus for spine surgeons. With the turn of the millennium it was possible to classify breast cancer into four intrinsic phenotypes with various survival rates. Well known scoring systems help surgeons to evaluate the patient´s prognosis and to choose adequate treatment options. However, tumor entities are differentiated without regard to the molecular subtypes. In this article we describe surgical treatment options in metastatic lesions to the spine with regard to molecular phenotypes of breast cancer malignancy. It is crucial to correctly estimate the expected survival time to plan invasiveness of therapy regarding metastatic spine surgery.

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Single-Stage Posterolateral Transpedicular Approach With 360-Degree Stabilization and Vertebrectomy in Primary and Metastatic Tumors of the Spine

Cited by 19 publications

References 26 publications

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Total vertebrectomy through posterior approach for thoracic tumors

Operative treatment of metastatic breast cancer in the spine with regard to molecular phenotypes

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