J Korean Neurosurg Soc.  2015 Feb;57(2):100-107. 10.3340/jkns.2015.57.2.100.

Minimally Invasive Option Using Percutaneous Pedicle Screw for Instability of Metastasis Involving Thoracolumbar and Lumbar Spine : A Case Series in a Single Center

• Park HY
• Lee SH
• Park SJ
• Kim ES
• Lee CS
• Eoh W

• KMID: 2191190
• DOI: http://doi.org/10.3340/jkns.2015.57.2.100

Abstract

OBJECTIVE
To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors.
METHODS
This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG).
RESULTS
Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days).
CONCLUSION
Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.

Keyword

Spinal metastasis; Percutaneous; Pedicle screw; Minimally invasive; Surgery

MeSH Terms

Back Pain
Female
Follow-Up Studies
Fractures, Compression
Humans
Life Expectancy
Male
Mortality
Neoplasm Metastasis*
Pain Measurement
Pathology
Retrospective Studies
Spine*
Visual Analog Scale
Walking

Figure

• 

  Fig. 1 A 57-year-old man with intractable back pain and radiculopathy due to spinal metastasis from renal cell carcinoma. A and B : Preoperative plain X-ray and sagittal reconstruction lumbar spine computed tomography reveals an osteolytic lesion of L5 body and compression fracture. C and D : Preoperative axial and sagittal T2 weighted magnetic resonance (MR) imaging show metastatic tumor with mild epidural compression. E : Follow-up plain X-ray 6 month after percutaneous screw fixation and radiation theraphy shows no further vertebral collapse canal compromise. F and G : Follw-up axial and sagittal T2 weighted MR imaging show the improvement of epidural compression.

• 

  Fig. 2 Progression free survival (A) and overall survival (B) analysis. During follow-up, the mean ambulation time was 196.9±56.5 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days] and the mean overall survival time was 249.9±53.3 days (95% CI, 145.3-354.4 days; median, 176 days).

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