title: Minimally Invasive Direct Lateral Corpectomy of the Thoracolumbar Spine for Metastatic Spinal Cord Compression.
abstract: ObjectivesTo evaluate the feasibility, safety, clinical, and radiologic outcomes of a minimally invasive direct lateral-approach corpectomy (MIDLaC) for decompression and stabilization of symptomatic metastatic spinal cord compression (MSCC).MethodsA retrospective study on a prospective cohort was conducted. Nineteen patients were consecutively treated with MIDLaC and posterior pedicle screw fixation between May 2012 and July 2014. Demographic information and radiologic outcomes including sagittal deformity correction and vertebral body height were recorded. Operative variables (operative duration, blood loss) and clinical variables (Tokuhashi score, mortality, complication rate, pain visual analogue scale [VAS], opioid usage, and Frankel grade) were recorded and analyzed.ResultsAll nineteen patients (mean age: 67.6 ± 12.7 years) successfully underwent MIDLaC with excellent neural decompression. Operative duration was 188.4 ± 30.3 minutes for single-level MIDLaC and 327.2 ± 71.9 minutes for multilevel surgery (p< 0.0001). Mean blood loss per spinal level was 390.8 mL with a decrease to 102.3 mL excluding renal cell MSCC. A total of 47.4% of patients had a Tokuhashi score of 0 to 8. There was one approach-related complication and one perioperative mortality. The overall complication rate was 15.8% (n= 3) with no postoperative wound infections. Kaplan-Meier survival estimates at 6 months were 0.50. Overall, 31.6% of patients improved by one or more Frankel grades, and no patients demonstrated worsening neurology postoperatively. VAS was significantly improved postoperatively (p< 0.05). Vertebral body height was significantly increased (+7.6 ± 8.1 mm;p= 0.002), with improvements in lumbar lordosis (8.3 ± 7.3 degrees) and thoracic kyphosis (2.4 ± 7.1 degrees) postoperatively.ConclusionMIDLaC is a safe and feasible palliative approach in the management of MSCC with encouraging early clinical outcomes. Further prospective studies are required to define the role of MIDLaC in the management of MSCC vis-à-vis other mini-open or minimally invasive techniques.
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Terence
authors.initials: T
authors.lastname: Tan
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Chu
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Thien
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Yi Yuen
authors.initials: YY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures; D065289:Pedicle Screws; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome