title: Single posterior approach for circumferential decompression and anterior reconstruction using cervical trabecular metal mesh cage in patients with metastatic spinal tumour.
abstract: BACKGROUND
  The goal of surgical management of metastatic spinal tumours is to remove the tumour mass, restore spinal stability and alignment, and provide a better quality of life. A single posterior transpedicular approach, with circumferential decompression, for anterior reconstruction has been advocated to reduce the risk of complication and morbidity associated with a combined anterior-posterior approach. The purpose of our study was to evaluate the clinical outcomes of patients who underwent a single posterior approach for anterior reconstruction at our institution to determine the feasibility and effectiveness of the approach, including the use of a cervical trabecular metal (TM) mesh cage as a vertebral body replacer. As a secondary aim, we evaluated the effect of accumulated experience with the surgical approach on clinical outcomes.
  
  
  METHODS
  Twenty consecutive cases of single posterior approach were identified from a retrospective review of spinal surgeries performed at our institution between January 2009 and December 2012. Information on the following clinical outcomes was retrieved from the medical charts for analysis: visual analogue pain score (VAS); neurological status, classified on the Frankel scale; vertebral body reconstruction; spinal alignment, using Cobb's angle; operative time; volume of blood loss; complications; and the modified Brodsky criteria score, which was used to classify functional recovery as excellent, good, fair, or poor.
  
  
  RESULTS
  Pre- to post-surgical evaluation of outcomes demonstrated a significant decrease in pain (p < 0.001), improved spinal alignment, with a mean correction angle of 12° (range, 3°-29°), and higher Frankel score (p < 0.001). No severe complications were identified, including deep surgical infection or neurologic deterioration. Eighteen patients achieved good to excellent outcomes, based on the modified Brodsky criteria (p < 0.001), with two patients dying within 9 and 11 months of their surgery. Accumulated surgical experience reduced operative time and intraoperative blood loss (p ≤ 0.007).
  
  
  CONCLUSIONS
  A single posterior approach provided good to excellent clinical and functional outcomes. Based on this evidence, we propose that a posterior approach provides a feasible alternative to the combined posterior-anterior approach for managing patients with metastatic spinal tumours.
authors: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, Republic of China. edatrauma@gmail.com.
authors: Yen-Chun
authors: YC
authors: Chiu
authors: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, Republic of China. edaspine@gmail.com.
authors: Shih-Chieh
authors: SC
authors: Yang
authors: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, Republic of China. liok@xuite.net.
authors: Yu-Hsien
authors: YH
authors: Kao
authors: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, Republic of China. ed100130@edah.org.tw.
authors: Yuan-Kun
authors: YK
authors: Tu
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D013117:Spinal Cord Compression; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D014129:Trabecular Meshwork