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Open Kyphoplasty and its Role in “Separation Surgery”

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Vertebral Body Augmentation, Vertebroplasty and Kyphoplasty in Spine Surgery

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Abstract

Different surgical options are available for the heterogeneous clinical conditions related to neoplastic spinal disorders and must be individualized to the specific needs of the single patient. Whenever excisional procedures like somatectomy, vertebrectomy, and extensive posterior stabilization are contraindicated in MSD, less invasive techniques, like percutaneous stabilization, endoscopic or minimal access surgical approaches, vertebroplasty, balloon kyphoplasty with their technical variations, may represent effective alternatives for intractable pain and/or mechanical instability. An Open Kyphoplasty (OKP), which includes a decompressive unilateral or bilateral laminectomy usually associated to a contralateral kyphoplasty, with or without a percutaneous posterior stabilization, may represent an intermediate and flexible solution which may be taken in consideration in patients with (1) a significant violation of the involved posterior vertebral wall; (2) an epidural tumor invasion; (3) an aggressive stage of disease, multiple vertebral lesions or poor prognosis; and (4) a general medical conditions precluding complex surgery. Minimal invasive techniques in conjunction with SSRS, have been recently advocated and seem very effective, even in case of significant epidural spinal cord impingement. Following the principles of “Separation Surgery,” the main goal of treatment has become to stabilize the column, to decompress the nervous structures and to create a safe distance (at least 2–3 mm), between the tumor and the cord as well as an adequate ablative target for SSRS. Reported tumor control rates of this new therapeutic strategy reach 85–90%, regardless of cancer histology.

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Authors and Affiliations

  1. Department of Neurosurgery, IRCCS National Cancer Institute “Regina Elena”, Roma, Italy

    Stefano Telera & Laura Raus

  2. Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Valerio Pipola & Alessandro Gasbarrini

  3. Spine Surgery Department, “Maggiore” Hospital AUSL Bologna, Bologna, Italy

    Federico De Iure

Authors
  1. Stefano Telera
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  2. Laura Raus
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  3. Valerio Pipola
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  4. Federico De Iure
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  5. Alessandro Gasbarrini
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Correspondence to Stefano Telera .

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Telera, S., Raus, L., Pipola, V., De Iure, F., Gasbarrini, A. (2021). Open Kyphoplasty and its Role in “Separation Surgery”. In: Vertebral Body Augmentation, Vertebroplasty and Kyphoplasty in Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-76555-2_12

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