Open AccessMinimally Invasive Percutaneous Fixation Techniques for Metastatic Spinal Disease
Author(s) -
Rao Prashanth J.,
Thayaparan Ganesha K.,
Fairhall Jacob M.,
Mobbs Ralph J.
Publication year - 2014
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12114
Subject(s) - medicine , surgery , percutaneous , decompression , fixation (population genetics) , population , environmental health
Objective Surgical treatment of spinal metastasis is generally a palliative procedure. Although minimally invasive surgical ( MIS ) techniques are supposedly less morbid than open techniques, there is a lack of stratification of MIS techniques based on anticipated longevity. A simple stratification into three percutaneous surgical techniques based on modified Tokuhashi score is here proposed. Methods Patients recommended for spinal surgery for metastatic spinal disease between 2009 and 2012 and operated on by the senior author ( RJM ) were retrospectively reviewed. One of three MIS techniques was offered based on estimated survival using a modified Tokuhashi score. Technique #1 is suitable for patients with predicted short longevity (<6 months). Using a mini‐open midline or paramedian decompression and percutaneous screw fixation, the goal here is for rapid mobilization and minimization of hospitalization. Technique #2 is suitable for patients with predicted medium longevity (6–12 months). They are suitable for decompression and/or cement vertebral body replacement and a two levels stabilization. Technique #3 is suitable for patients with predicted long term survival survival (>12 months). In these patients, the primary goal of surgery is a wide local or marginal resection of tumor, decompression of the neurological elements and a robust stabilization construct. They are suitable for an open 360°decompression, vertebral body reconstruction and a multilevel stabilization. Results The study included eight patients with a mean age of 59 years (range, 36–72 years). Mean modified Tokuhashi score was 10 (range, 7–13) with three patients in the short term, two in the medium term and three in the long term survival category. Mean blood loss was 700 mL (range, 100–1200 mL), mean operating time 280 min (range, 120–360 min) and length of stay in the hospital was on average 13 days (range, 3–30 days). Conclusion The authors present three minimally invasive technique options for the management of spinal metastatic disease corresponding to three clinical prognostic categories. In this small series, MIS techniques resulted in speedy recovery, minimal morbidity and no mortality.