title: Early surgical experience with minimally invasive percutaneous approach for patients with metastatic epidural spinal cord compression (MESCC) to poor prognoses.
abstract: OBJECTIVE
  This study was designed to assess the impact of minimally invasive surgery (MIS) for the treatment of patients with metastatic epidural spinal cord compression (MESCC) and vertebral body fracture, in terms of feasibility, clinical improvement, and morbidity.
  
  
  METHODS
  Twenty-five consecutive patients with diagnosis of MESCC from solid primary tumors were treated between January 2008 and June 2010 at our institution. All patients, after multidisciplinary assessment, were considered with poor prognosis because of their disease's extension and/or other clinical conditions. Mini-invasive percutaneous surgery was performed in all patients followed by radiotherapy within 2 weeks postoperatively. Clinical outcome was evaluated by modified visual analog scale for pain, Frankel Scale for neurologic deficit, and magnetic resonance imaging or computed tomography scan.
  
  
  RESULTS
  Clinical remission of pain was obtained in the vast majority of patients (96%). Improvement of neurological deficit was observed in 22 patients (88%). No major morbidity or perioperative mortality occurred. The average hospital stay was 6 days. Local recurrence occurred in two patients (8%). Median survival was 10 (range, 6-24) months. Overall survival at 1 year was 43%.
  
  
  CONCLUSIONS
  For patients with MESCC and body fracture, with limited life expectancy, minimally invasive spinal surgery followed by radiotherapy, is feasible and provides clinical benefit in most of patients, with low morbidity. We believe that a minimally invasive approach can be an alternative surgical method compared with more aggressive or demanding procedures, which in selected patients with metastatic spinal cord compression with poor prognosis could represent overtreatment.
authors: Department of Neurosurgery, Istituto Clinico Humanitas Cancer Center, Milan, Italy.
authors: Flavio
authors: F
authors: Tancioni
authors: Pierina
authors: P
authors: Navarria
authors: Federico
authors: F
authors: Pessina
authors: Simona
authors: S
authors: Marcheselli
authors: Elisa
authors: E
authors: Rognone
authors: Pietro
authors: P
authors: Mancosu
authors: Armando
authors: A
authors: Santoro
authors: Riccardo Rodriguez Y
authors: RR
authors: Baena
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D013117:Spinal Cord Compression / Q000517:prevention & control*; D016103:Spinal Fractures / Q000517:prevention & control*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome