Abstract
Introduction
The goal of surgical management for metastatic spinal tumors is to remove the tumor mass, restore the spinal stability and alignment, and provided better quality of life. Posterior transpedicular approach for circumferential decompression and reconstruction was proposed in concern of the morbidity related to anterior approach. We used this unique technique with trabecular metal (TM) mesh cage for anterior reconstruction to treat the patients with metastatic spinal tumor. Our purpose is to evaluate the feasibility and efficacy of this method as an alternative procedure for managing metastatic spinal tumors.
Methods
From January 2009 to December 2012, we performed single stage circumferential debridement and reconstruction with TM mesh cage through single posterior approach to treat 20 patients with metastatic spinal tumors. The visual analog score (VAS), neurologic status, vertebral body reconstruction, operation time, blood loss, and complications were recorded. The patient's conditions were evaluated on the basis of modified Brodsky's criteria which categorized them as excellent, good, fair, or poor.
Results
The average VAS score was 8.2 (range, 7 to 9) before surgery, which was significant decreased to 3.2 (range, 2 to 4) after surgery (p < 0.001). The average cobb's angle correction was 12 degree (range, 3 to 29). The neurologic status which classified by Frankel's scale was significant improved after surgery (p < 0.001). No one experienced severe complication such as deep infection or neurologic deterioration. Three patients experienced long-term paresthesia around nerve roots territory. Eighteen patients could achieve good or excellent outcome based on modified Brodsky's criteria and the improvement showed significant difference after surgery (p < 0.001). The blood loss and operative time in the last 10 cases was significantly decreased while comparing to the initial 10 cases (p = 0.007 for blood loss and p = 0.005 for operative time). No significant difference in clinical outcome which classified by Macnab criteria between the initial and last 10 patients (p = 0.654).
Conclusions
In our case series, good functional outcome and low complication rate could be achieved by single-stage posterior transpedicular approach. It could be an alternative method to manage the patients with metastatic spinal tumors.