title: Versatility of percutaneous pedicular screw fixation in metastatic spine tumor surgery: a prospective analysis.
abstract: BACKGROUND
  Posterior percutaneous spinal fixation (PPSF) has evolved to address the problems associated with metastatic spinal disease (MSD). This study was designed to evaluate the feasibility and spectrum of application of PPSF in the management of MSD, highlighting its clinical advantages.
  
  
  METHODS
  Twenty-seven consecutive patients with MSD treated with PPSF in our institution from January 2011 to June 2014 were studied. After a multidisciplinary assessment, all patients were considered for surgical intervention due to clinical presentation of either neural deficit, skeletal instability, or both. Some of these patients belonged to the poor prognostic category based on survival prognostic scoring systems. The patients were categorized into seven groups depending on the modality of PPSF used. Demographic data, operative details, and clinical outcomes were investigated for each category and compared pre- and postoperatively.
  
  
  RESULTS
  The median age was 60 years (range 49-78 years). Generally, all patients either maintained or improved their neurological status and achieved pain alleviation. Ambulatory status and Eastern Cooperative Oncology Group (ECOG) scores were improved using any modality of PPSF. The pure-stabilization group had the lowest amount of mean blood loss, shortest operative time, and intensive care unit (ICU) and hospital stays, while the long-construct group was observed to have the greatest amount of blood loss, and longest operative time and ICU stay.
  
  
  CONCLUSIONS
  For patients with MSD, even with predicted poor prognosis on survival prognostic scoring systems, it is possible to improve functional outcomes and quality of life with PPSF, keeping surgical morbidity to a minimum. PPSF allows patients with pure spinal instability to be addressed successfully with least morbidity.
authors.affiliation: Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore, dosksn@nus.edu.sg.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.forename: Aye Sandar
authors.initials: AS
authors.lastname: Zaw
authors.forename: Ma Ramona
authors.initials: MR
authors.lastname: Reyes
authors.forename: Rishi
authors.initials: R
authors.lastname: Malhotra
authors.forename: Pang Hung
authors.initials: PH
authors.lastname: Wu
authors.forename: Milindu Chanaka
authors.initials: MC
authors.lastname: Makandura
authors.forename: Joseph
authors.initials: J
authors.lastname: Thambiah
authors.forename: Gabriel Ka Po
authors.initials: GK
authors.lastname: Liu
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong
mesh_terms: D000368:Aged; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011379:Prognosis; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery*