Skip to main content

Advertisement

SpringerLink
Log in

Versatility of Percutaneous Pedicular Screw Fixation in Metastatic Spine Tumor Surgery: A Prospective Analysis

  • Neuro-Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Posterior percutaneous spinal fixation (PPSF) has evolved to address the problems associated with metastatic spinal disease (MSD). This study was designed to evaluate the feasibility and spectrum of application of PPSF in the management of MSD, highlighting its clinical advantages.

Methods

Twenty-seven consecutive patients with MSD treated with PPSF in our institution from January 2011 to June 2014 were studied. After a multidisciplinary assessment, all patients were considered for surgical intervention due to clinical presentation of either neural deficit, skeletal instability, or both. Some of these patients belonged to the poor prognostic category based on survival prognostic scoring systems. The patients were categorized into seven groups depending on the modality of PPSF used. Demographic data, operative details, and clinical outcomes were investigated for each category and compared pre- and postoperatively.

Results

The median age was 60 years (range 49–78 years). Generally, all patients either maintained or improved their neurological status and achieved pain alleviation. Ambulatory status and Eastern Cooperative Oncology Group (ECOG) scores were improved using any modality of PPSF. The pure-stabilization group had the lowest amount of mean blood loss, shortest operative time, and intensive care unit (ICU) and hospital stays, while the long-construct group was observed to have the greatest amount of blood loss, and longest operative time and ICU stay.

Conclusions

For patients with MSD, even with predicted poor prognosis on survival prognostic scoring systems, it is possible to improve functional outcomes and quality of life with PPSF, keeping surgical morbidity to a minimum. PPSF allows patients with pure spinal instability to be addressed successfully with least morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7(5):459–66.

    Article  PubMed  Google Scholar 

  2. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.

    Article  PubMed  Google Scholar 

  3. Kaloostian PE, Yurter A, Zadnik PL, Sciubba DM, Gokaslan ZL. Current paradigms for metastatic spinal disease: an evidence-based review. Ann Surg Oncol. 2014;21(1):248–62.

    Article  CAS  PubMed  Google Scholar 

  4. Lee CH, Kwon JW, Lee J, et al. Direct decompressive surgery followed by radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression: a meta-analysis. Spine. 2014;39(9):E587–592.

    Article  PubMed  Google Scholar 

  5. Choi D, Crockard A, Bunger C, et al. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J. 2010;19(2):215–22.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Delank KS, Wendtner C, Eich HT, Eysel P. The treatment of spinal metastases. Dtsch Arztebl Int. 2011;108(5):71–9; quiz 80.

  7. Georgy BA. Metastatic spinal lesions: state-of-the-art treatment options and future trends. Am J Neuroradiol. 2008;29(9):1605–11.

    Article  CAS  PubMed  Google Scholar 

  8. Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine. 2005;30(19):2186–91.

    Article  PubMed  Google Scholar 

  9. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine. 2001;26(3):298–306.

    Article  CAS  PubMed  Google Scholar 

  10. Chen Y, Tai BC, Nayak D, et al. Blood loss in spinal surgery for metastatic disease. A meta-analysis. Bone Joint J. 2013;95-B(5):683–688.

  11. Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine. 2001;26(7):818–24.

    Article  CAS  PubMed  Google Scholar 

  12. Pascal-Moussellard H, Broc G, Pointillart V, Siméon F, Vital JM, Senegas J. Complications of vertebral metastasis surgery. Eur Spine J. 1998;7(6):438–44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Molina CA, Gokaslan ZL, Sciubba DM. A systematic review of the current role of minimally invasive spine surgery in the management of metastatic spine disease. Int J Surg Oncol. 2011;2011:598148.

    PubMed Central  PubMed  Google Scholar 

  14. Ofluoglu O. Minimally invasive management of spinal metastases. Orthop Clin North Am. 2009;40(1):155–68, viii.

  15. Smith ZA, Yang I, Gorgulho A, Raphael D, De Salles AA, Khoo LT. Emerging techniques in the minimally invasive treatment and management of thoracic spine tumors. J Neurooncol. 2012;107(3):443–55.

    Article  PubMed  Google Scholar 

  16. Tancioni F, Navarria P, Pessina F, et al. Early surgical experience with minimally invasive percutaneous approach for patients with metastatic epidural spinal cord compression (MESCC) to poor prognoses. Ann Surg Oncol. 2012;19(1):294–300.

    Article  PubMed  Google Scholar 

  17. Wang MY, Ludwig SC, Anderson DG, Mummaneni PV. Percutaneous iliac screw placement: description of a new minimally invasive technique. Neurosurg Focus. 2008;25(2):E17.

    Article  PubMed  Google Scholar 

  18. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine. 2010;35(22):E1221–1229.

    Article  PubMed  Google Scholar 

  19. Bauer HC, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66(2):143–6.

    Article  CAS  PubMed  Google Scholar 

  20. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine. 2010;35(26 Suppl):S281–286.

    Article  PubMed  Google Scholar 

  21. Kim CW, Siemionow K, Anderson DG, Phillips FM. The current state of minimally invasive spine surgery. Instr Course Lect. 2011;60:353–70.

    PubMed  Google Scholar 

  22. Deutsch H, Boco T, Lobel J. Minimally invasive transpedicular vertebrectomy for metastatic disease to the thoracic spine. J Spinal Disord Tech. 2008;21(2):101–5.

    Article  PubMed  Google Scholar 

  23. Scheufler KM. Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation. Neurosurgery. 2007;61(4):798–808; discussion 808–799.

  24. Kumar N WP, Zaw AS, Malhotra R. Metastatic spine tumour surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Eur Spine J. Springer, Lyon. 2014;S527–S557.

  25. Huang TJ, Hsu RW, Li YY, Cheng CC. Minimal access spinal surgery (MASS) in treating thoracic spine metastasis. Spine. 2006;31(16):1860–3.

    Article  PubMed  Google Scholar 

  26. Kossmann T, Jacobi D, Trentz O. The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. Eur Spine J. 2001;10(5):396–402.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Sundaresan N, Rothman A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine. 2002;27(16):1802–6.

    Article  PubMed  Google Scholar 

  28. Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine. 1999;24(18):1943–51.

    Article  CAS  PubMed  Google Scholar 

  29. Bergey DL, Villavicencio AT, Goldstein T, Regan JJ. Endoscopic lateral transpsoas approach to the lumbar spine. Spine. 2004;29(15):1681–8.

    Article  PubMed  Google Scholar 

  30. Elsaghir H. Endoscopic medial parascapular approach to the thoracic spine. Surg Endosc. 2005;19(3):389–92.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors would like to thank Dr. Khin Lay Wai for statistical support. We also thank Chan Ee, K. Perini, and Amreet Kaur for their contribution in collecting data of the spine tumor patients.

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore

    Naresh Kumar FRCS (Orth), DM (Orth), Aye Sandar Zaw MPH, Ma Ramona Reyes MD, Rishi Malhotra MRCS, Pang Hung Wu MRCS, Milindu Chanaka Makandura MBBS, Joseph Thambiah MChOrth, Gabriel Ka Po Liu FRCS Ed & Hee-Kit Wong MChOrth (Liv)

Authors
  1. Naresh Kumar FRCS (Orth), DM (Orth)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aye Sandar Zaw MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ma Ramona Reyes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rishi Malhotra MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pang Hung Wu MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Milindu Chanaka Makandura MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joseph Thambiah MChOrth
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gabriel Ka Po Liu FRCS Ed
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hee-Kit Wong MChOrth (Liv)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naresh Kumar FRCS (Orth), DM (Orth).

Electronic supplementary material

Below is the link to the electronic supplementary material.10434_2014_4178_MOESM1_ESM.mp4

Supplementary material 1 (DOCX 1023 kb)

Supplementary material 2 (DOCX 720 kb)

Supplementary material 3 (DOC 668 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, N., Zaw, A.S., Reyes, M.R. et al. Versatility of Percutaneous Pedicular Screw Fixation in Metastatic Spine Tumor Surgery: A Prospective Analysis. Ann Surg Oncol 22, 1604–1611 (2015). https://doi.org/10.1245/s10434-014-4178-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4178-4

Keywords

Search

Navigation