title: Long-segment percutaneous screw fixation for thoraco-lumbar spine metastases: a single center's experience.
abstract: BACKGROUND
  The management of spine metastases is an increasing concern for spine surgeons. Their treatment is mainly palliative with the goal to preserve or restore the patients' quality of life. Many minimally invasive techniques have been introduced with the aim to reduce the morbidity associated with more traditional open approaches. We aimed to evaluate the efficiency of long segment percutaneous pedicle screw stabilization for the treatment of instability associated with symptomatic thoracolumbar spine metastases.
  
  
  METHODS
  In this prospective study, we included all patients who underwent the percutaneous placement of pedicle screws in our institution between January 2008 and June 2014, for the palliative treatment of a symptomatic thoracolumbar spine metastasis. All patients had a normal examination. Postoperative radiation therapy was planned within 2 weeks following the stabilization. A clinical and radiological follow-up were planned at 3 months, 6 months and 1 year. Pain was measured using VAS and functional status was assessed using the Frankel Grading system. CT scan was performed before discharge and at each office evaluation.
  
  
  RESULTS
  Forty-four patients have been included. There were 26 men and 18 women, with a mean age of 57.3 years (range 36-79 years). The mean operative time was 85 minutes (range 47-124 min), and the estimated blood loss was inferior to 100 mL in all cases. The mean length of hospital stay was 5.2 days (range 3-18 days). All patients underwent postoperative radiation therapy within 2 weeks. Pain was significantly improved from the early postoperative period (P<0.001). Visual Analogic Scale scores decreased from 6.3 (2-10) to 3.0 (0-6) at discharge. No patient worsened his neurological condition postoperatively. One patient required a revision surgery at 3 months due to an important tumor progression at the treated level. Radiological follow-up demonstrated no case of misplacement, hardware breakage or loosening.
  
  
  CONCLUSIONS
  As the treatment of spine metastases is largely palliative, minimally invasive techniques should be discussed first to limit the impact of surgery in critical patients. Long-segment percutaneous screw fixation followed by early radiation therapy, appears to be a safe and effective treatment option to ensure solid and durable stability, as well as a good local tumor control.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France - fahed.zairi@gmail.com.
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Department of Rheumatology, Lille University Hospital, Lille, France.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Vielliard
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Alkis
authors.initials: A
authors.lastname: Bouras
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Mélodie-Anne
authors.initials: MA
authors.lastname: Karnoub
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Paulo
authors.initials: P
authors.lastname: Marinho
authors.affiliation: Department of Neurosurgery, Lille University Hospital, Lille, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Assaker
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D065289:Pedicle Screws; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*