Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note.
OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment. METHODS The authors retrospectively reviewed a consecutive series of patients with ESCC and spinal instability who were considered to be poor surgical candidates and instead were treated with sLITT and percutaneous spinal stabilization. Demographic data, Spine Instability Neoplastic Scale score, degree of epidural compression before and after the procedure, length of hospital stay, and time to return to oncological treatment were analyzed. RESULTS Eight patients were treated with thermal ablation and percutaneous spinal stabilization. The primary tumors included melanoma (n = 3), lung (n = 3), thyroid (n = 1), and renal cell carcinoma (n = 1). The median Karnofsky Performance Scale score before and after the procedure was 60, and the median hospital stay was 5 days (range 3-18 days). The median Spine Instability Neoplastic Scale score was 13 (range 12-16). The mean modified postoperative ESCC score (2.75 ± 0.37) was significantly lower than the preoperative score (4.5 ± 0.27) (Mann-Whitney test, p = 0.0044). The median time to return to oncological treatment was 5 days (range 3-10 days). CONCLUSIONS The authors present the first cohort of sLITT associated with a percutaneous spinal stabilization for the treatment of ESCC and spinal instability. This minimally invasive technique can allow a faster recovery without prejudice of adjuvant systemic treatment, with adequate local control and spinal stabilization.
Departments of 1 Neurosurgery.
Claudio E
CE
Tatsui
Department of Neurosurgery, Catholic University of Campinas, São Paulo, Brazil.
Telmo A B
TA
Belsuzarri
Departments of 1 Neurosurgery.
Marilou
M
Oro
Departments of 1 Neurosurgery.
Laurence D
LD
Rhines
Radiation Oncology, and.
Jing
J
Li
Radiation Oncology, and.
Amol J
AJ
Ghia
Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and.
Behrang
B
Amini
Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and.
Heron
H
Espinoza
Radiation Oncology, and.
Paul D
PD
Brown
Departments of 1 Neurosurgery.
Ganesh
G
Rao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
ESCC = epidural spinal cord compression; KPS = Karnofsky Performance Scale; SINS = Spine Instability Neoplastic Scale; SRS = stereotactic radiosurgery; cEBRT = conventional external-beam radiation therapy; iMRI = intraoperative MRI; percutaneous spinal stabilization; sLITT = spinal laser interstitial thermotherapy; spinal laser interstitial thermotherapy; spinal metastasis