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Minimally Invasive Surgery for Spinal Tumors

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Abstract

The decision-making challenges of surgically treating spinal neoplasms are many and include the individual patient’s symptom profile, the nature and morphology of the tumor(s), presence of multiple or peripheral metastases, neurologic or pending neurologic status (spinal cord compression), resultant spinal deformities or instabilities, adjuvant radiation or chemotherapies, and expected life span. The minimally invasive surgical treatment of spinal tumors has historically been considered oxymoronic, as exposures that allow for adequate tumor exposure and resectioning were, by nature, open exposure approaches. Less-invasive exposures were long considered inadequate in managing a variety of tumors, especially when en bloc resection is required. With the advent of stereotactic radiotherapy, the development and proliferation of endoscopic and mini-open approaches, and the paradigm shifts in spinal oncology thinking, a new era of individualized multidisciplinary approaches has emerged, minimizing morbidity and maximizing effectiveness. Several less-invasive approaches for spine tumor removal are currently being used and can be broadly categorized as thoracoscopic, mini-open anterior, and mini-open posterior approaches. Each approach has benefits and drawbacks and should be tailored to the individual needs of the patient. Because these patients usually undergo these procedures for quality of life (prevention of paralysis, maintenance of continence, and pain control), minimizing the morbidity from the surgery is paramount. Moreover, faster wound healing is desirable to allow for early postoperative radiation or chemotherapy. The goal of a less-invasive approach is to try to achieve these two goals, yet at the same time still accomplish the same surgical result.

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References

  1. Bell GR. Surgical treatment of spinal tumors. Clin Orthop Relat Res. 1997;335:54–63.

    Google Scholar 

  2. Klimo Jr P, Kestle JR, Schmidt MH. Treatment of metastatic spinal epidural disease: a review of the literature. Neurosurg Focus. 2003;15:E1.

    PubMed  Google Scholar 

  3. Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, et al. Diagnosis and management of metastatic spine disease. J Neurosurg Spine. 2010;13:94–108.

    Article  PubMed  Google Scholar 

  4. Gokaslan ZL. Spine surgery for cancer. Curr Opin Oncol. 1996;8:178–81.

    Article  CAS  PubMed  Google Scholar 

  5. Csaszar N, Ganju A, Mirnics ZS, Varga PP. Psychosocial issues in the cancer patient. Spine. 2009;34:S26–30.

    Article  CAS  PubMed  Google Scholar 

  6. Fisher CG, Andersson GB, Weinstein JN. Spine focus issue. Summary of management recommendations in spine oncology. Spine. 2009;34:S2–6.

    Article  PubMed  Google Scholar 

  7. Hart RA, Boriani S, Biagini R, Currier B, Weinstein JN. A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine. Spine. 1997;22:1773–82.

    Article  CAS  PubMed  Google Scholar 

  8. Delank KS, Wendtner C, Eich HT, Eysel P. The treatment of spinal metastases. Dtsch Arztebl Int. 2011;108:71–9.

    PubMed Central  PubMed  Google Scholar 

  9. Fisher CG, Keynan O, Boyd MC, Dvorak MF. The surgical management of primary tumors of the spine: initial results of an ongoing prospective cohort study. Spine. 2005;30:1899–908.

    Article  PubMed  Google Scholar 

  10. Fisher CG, Keynan O, Ondra S, Gokaslan Z. Introduction to focus issue in spine oncology: the synthesis of evidence and expert opinion for best practice recommendation. Spine. 2009;34:S21–5.

    Article  PubMed  Google Scholar 

  11. Andersson GB, Chapman JR, Dekutoski MB, Dettori J, Fehlings MG, Fourney DR, et al. Do no harm: the balance of “beneficence” and “non-maleficence”. Spine. 2010;35:S2–8.

    Article  PubMed  Google Scholar 

  12. Dekutoski MB, Norvell DC, Dettori JR, Fehlings MG, Chapman JR. Surgeon perceptions and reported complications in spine surgery. Spine. 2010;35:S9–21.

    Article  PubMed  Google Scholar 

  13. Oner FC, Ramos LM, Simmermacher RK, Kingma PT, Diekerhof CH, Dhert WJ, et al. Classification of thoracic and lumbar spine fractures: problems of reproducibility. A study of 53 patients using CT and MRI. Eur Spine J. 2002;11:235–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Vaccaro AR, Kim DH, Brodke DS, Harris M, Chapman JR, Schildhauer T, et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect. 2004;53:359–73.

    PubMed  Google Scholar 

  15. Vaccaro AR, Lim MR, Hurlbert RJ, Lehman Jr RA, Harrop J, Fisher DC, et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech. 2006;19:1–10.

    Article  PubMed  Google Scholar 

  16. Cherqui A, Kim DH, Kim SH, Park HK, Kline DG. Surgical approaches to paraspinal nerve sheath tumors. Neurosurg Focus. 2007;22:E9.

    PubMed  Google Scholar 

  17. Black P. Spinal metastasis: current status and recommended guidelines for management. Neurosurgery. 1979;5:726–46.

    Article  CAS  PubMed  Google Scholar 

  18. Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg. 1983;59:111–8.

    Article  CAS  PubMed  Google Scholar 

  19. Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53:741–8.

    Article  CAS  PubMed  Google Scholar 

  20. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.

    Article  PubMed  Google Scholar 

  21. Siegal T, Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery. 1985;17:424–32.

    Article  CAS  PubMed  Google Scholar 

  22. Siegal T, Tiqva P, Siegal T. Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive operative procedures. J Bone Joint Surg Am. 1985;67:375–82.

    CAS  PubMed  Google Scholar 

  23. Siegal T, Siegal T. Treatment of malignant epidural cord and cauda equina compression. Prog Exp Tumor Res. 1985;29:225–34.

    CAS  PubMed  Google Scholar 

  24. Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF. Impact of surgical intervention on quality of life in patients with spinal metastases. Spine. 2006;31:2849–56.

    Article  PubMed  Google Scholar 

  25. Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam Jr JB, et al. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg. 1998;89:599–609.

    Article  CAS  PubMed  Google Scholar 

  26. Klimo Jr P, Thompson CJ, Kestle JR, Schmidt MH. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol. 2005;7:64–76.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Polly Jr DW, Chou D, Sembrano JN, Ledonio CG, Tomita K. An analysis of decision making and treatment in thoracolumbar metastases. Spine. 2009;34:S118–27.

    Article  PubMed  Google Scholar 

  28. Holman PJ, Suki D, McCutcheon I, Wolinsky JP, Rhines LD, Gokaslan ZL. Surgical management of metastatic disease of the lumbar spine: experience with 139 patients. J Neurosurg Spine. 2005;2:550–63.

    Article  PubMed  Google Scholar 

  29. Bohinski RJ, Rhines LD. Principles and techniques of en bloc vertebrectomy for bone tumors of the thoracolumbar spine: an overview. Neurosurg Focus. 2003;15:E7.

    PubMed  Google Scholar 

  30. Riaz S, Fox R, Lavoie MV, Mahood JK. Vertebral body reconstruction for thoracolumbar spinal metastasis—a review of techniques. J Ayub Med Coll Abbottabad. 2006;18:70–7.

    PubMed  Google Scholar 

  31. Wai EK, Finkelstein JA, Tangente RP, Holden L, Chow E, Ford M, et al. Quality of life in surgical treatment of metastatic spine disease. Spine. 2003;28:508–12.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  33. Hsieh PC, Koski TR, Sciubba DM, Moller DJ, O’Shaughnessy BA, Li KW, et al. Maximizing the potential of minimally invasive spine surgery in complex spinal disorders. Neurosurg Focus. 2008;25:E19.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  35. Krisht KM, Mumert ML, Schmidt MH. Management considerations and strategies to avoid complications associated with the thoracoscopic approach for corpectomy. Neurosurg Focus. 2011;31:E14.

    Article  PubMed  Google Scholar 

  36. Lu DC, Chou D, Mummaneni PV. A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. J Neurosurg Spine. 2011;14:758–64.

    Article  PubMed  Google Scholar 

  37. O’Toole JE, Eichholz KM, Fessler RG. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11:471–6.

    Article  PubMed  Google Scholar 

  38. Parker SL, Adogwa O, Witham TF, Aaronson OS, Cheng J, McGirt MJ. Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg. 2011;54:33–7.

    Article  CAS  PubMed  Google Scholar 

  39. Fehlings MG, David KS, Vialle L, Vialle E, Setzer M, Vrionis FD. Decision making in the surgical treatment of cervical spine metastases. Spine. 2009;34:S108–17.

    Article  PubMed  Google Scholar 

  40. Yin QS, Ai FZ, Zhang K, Mai XH, Xia H, Wu ZH. Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up. Orthop Surg. 2010;2:149–55.

    Article  PubMed  Google Scholar 

  41. Yin QS, Ai FZ, Zhang K, Chang YB, Xia H, Wu ZH, et al. Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation. Chin J Traumatol. 2006;9:14–20.

    PubMed  Google Scholar 

  42. Yin Q, Ai F, Zhang K, Chang Y, Xia H, Wu Z, et al. Irreducible anterior atlantoaxial dislocation: one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature. Spine. 2005;30:E375–81.

    Article  PubMed  Google Scholar 

  43. Amini A, Beisse R, Schmidt MH. Thoracoscopic spine surgery for decompression and stabilization of the anterolateral thoracolumbar spine. Neurosurg Focus. 2005;19:E4.

    PubMed  Google Scholar 

  44. Boriani S, Biagini R, De IF, Bertoni F, Malaguti MC, Di FM, et al. En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients. Spine. 1996;21:1927–31.

    Article  CAS  PubMed  Google Scholar 

  45. Hall DJ, Webb JK. Anterior plate fixation in spine tumor surgery. Indications, technique, and results. Spine. 1991;16:S80–3.

    Article  CAS  PubMed  Google Scholar 

  46. Kan P, Schmidt MH. Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease. Neurosurg Focus. 2008;25:E8.

    Article  PubMed  Google Scholar 

  47. King GJ, Kostuik JP, McBroom RJ, Richardson W. Surgical management of metastatic renal carcinoma of the spine. Spine. 1991;16:265–71.

    Article  CAS  PubMed  Google Scholar 

  48. Kostuik JP. Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation results. Spine. 1983;8:512–31.

    Article  CAS  PubMed  Google Scholar 

  49. Lewandrowski KU, Hecht AC, DeLaney TF, Chapman PA, Hornicek FJ, Pedlow FX. Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery. Spine. 2004;29:1150–8.

    Article  PubMed  Google Scholar 

  50. Sakaura H, Hosono N, Mukai Y, Ishii T, Yonenobu K, Yoshikawa H. Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine. J Spinal Disord Tech. 2004;17:297–300.

    Article  PubMed  Google Scholar 

  51. Uribe JS, Dakwar E, Le TV, Christian G, Serrano S, Smith WD. Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach. Spine. 2010;35:S347–54.

    Article  PubMed  Google Scholar 

  52. Yao KC, Boriani S, Gokaslan ZL, Sundaresan N. En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus. 2003;15:E6.

    PubMed  Google Scholar 

  53. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–20.

    PubMed  Google Scholar 

  54. Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res. 1986;204:9–24.

    PubMed  Google Scholar 

  55. Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine. 1997;22:1036–44.

    Article  CAS  PubMed  Google Scholar 

  56. Heary RF, Bono CM. Metastatic spinal tumors. Neurosurg Focus. 2001;11:e1.

    Article  CAS  PubMed  Google Scholar 

  57. Lu DC, Lau D, Lee JG, Chou D. The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies. J Neurosurg Spine. 2010;12:583–91.

    Article  PubMed  Google Scholar 

  58. Fourney DR, Abi-Said D, Rhines LD, Walsh GL, Lang FF, McCutcheon IE, et al. Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. J Neurosurg. 2001;94:232–44.

    CAS  PubMed  Google Scholar 

  59. Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine. 2000;25:2240–9; discussion.

    Article  CAS  PubMed  Google Scholar 

  60. Bauer HC. Posterior decompression and stabilization for spinal metastases. Analysis of sixty-seven consecutive patients. J Bone Joint Surg Am. 1997;79:514–22.

    CAS  PubMed  Google Scholar 

  61. Harrington KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop Relat Res. 1988;233:177–97.

    PubMed  Google Scholar 

  62. Lucio JC, VanConia RB, Deluzio KJ, Lehmen JA, Rodgers JA, Rodgers WB. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy. 2012;5:65.

    PubMed Central  PubMed  Google Scholar 

  63. Smith WD, Christian G, Serrano S, Malone KT. A comparison of perioperative charges and outcome between open and mini-open approaches for anterior lumbar discectomy and fusion. J Clin Neurosci. 2012;19:673–80.

    Article  PubMed  Google Scholar 

  64. Rodgers WB, Gerber EJ, Rodgers JA. Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine. 2010;35:S355.

    Article  PubMed  Google Scholar 

  65. Chou D, Lu DC. Mini-open transpedicular corpectomies with expandable cage reconstruction. Technical note. J Neurosurg Spine. 2011;14:71–7.

    Article  PubMed  Google Scholar 

  66. Dakwar E, Smith WD, Malone KT, Uribe JS. Minimally invasive lateral extracavitary resection of foraminal neurofibromas. J Clin Neurosci. 2011;18:1510–2.

    Article  PubMed  Google Scholar 

  67. Lu DC, Dhall SS, Mummaneni PV. Mini-open removal of extradural foraminal tumors of the lumbar spine. J Neurosurg Spine. 2009;10:46–50.

    Article  PubMed  Google Scholar 

  68. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6:435–43.

    Article  PubMed  Google Scholar 

  69. Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. Spine. 2010;35:S338–46.

    Article  PubMed  Google Scholar 

  70. Tohmeh AG, Rodgers WB, Peterson MD. Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine. 2011;14:31–7.

    Article  PubMed  Google Scholar 

  71. Baaj AA, Dakwar E, Le TV, Smith DA, Ramos E, Smith WD, et al. Complications of the mini-open anterolateral approach to the thoracolumbar spine. J Clin Neurosci. 2012;19:1265–7.

    Article  PubMed  Google Scholar 

  72. Khan SN, Cha T, Hoskins JA, Pelton M, Singh K. Minimally invasive thoracolumbar corpectomy and reconstruction. Orthopedics. 2012;35:e74–9.

    Article  PubMed  Google Scholar 

  73. Uribe JS, Dakwar E, Cardona RF, Vale FL. Minimally invasive lateral retropleural thoracolumbar approach: cadaveric feasibility study and report of 4 clinical cases. Neurosurgery. 2011;68:32–9.

    Article  PubMed  Google Scholar 

  74. Deviren V, Kuelling FA, Poulter G, Pekmezci M. Minimal invasive anterolateral transthoracic transpleural approach: a novel technique for thoracic disc herniation. A review of the literature, description of a new surgical technique and experience with first 12 consecutive patients. J Spinal Disord Tech. 2011;24:E40–8.

    Article  PubMed  Google Scholar 

  75. Karikari IO, Nimjee SM, Hardin CA, Hughes BD, Hodges TR, Mehta AI, et al. Extreme lateral interbody fusion approach for isolated thoracic and thoracolumbar spine diseases: initial clinical experience and early outcomes. J Spinal Disord Tech. 2011;24:368.

    Article  PubMed  Google Scholar 

  76. Uribe JS, Smith WD, Pimenta L, Hartl R, Dakwar E, Modhia UM, et al. Minimally invasive lateral approach for symptomatic thoracic disc herniation: initial multicenter clinical experience. J Neurosurg Spine. 2012;16:264–79.

    Article  PubMed  Google Scholar 

  77. Sahgal A, Larson DA, Chang EL. Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys. 2008;71:652–65.

    Article  PubMed  Google Scholar 

  78. Sahgal A, Bilsky M, Chang EL, Ma L, Yamada Y, Rhines LD, et al. Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. J Neurosurg Spine. 2011;14:151–66.

    Article  PubMed  Google Scholar 

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Correspondence to William D. Smith MD .

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Smith, W.D., Malone, K.T., Chou, D. (2014). Minimally Invasive Surgery for Spinal Tumors. In: Phillips, F., Lieberman, I., Polly, D. (eds) Minimally Invasive Spine Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5674-2_32

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