title: Reducing kyphotic deformity by posterior vertebral column resection with 360° osteosynthesis in metastatic epidural spinal cord compression (MESCC).
abstract: Metastatic epidural spinal cord compression (MESCC) often requires anterior-posterior decompression and stabilization. To reduce approach-related complications, single-stage posterolateral vertebrectomy and 360° fusion is often performed. However, a sufficient reduction of kyphotic deformity through this approach has not been reported. The purpose of this study is to investigate the efficacy of kyphotic deformity reduction by this approach in MESCC.
  
  
  
  A retrospective analysis and chart review was performed for 14 consecutive patients who underwent a vertebrectomy and decompression from a posterolateral approach. Anterior mesh stabilization of the ventral column is used as hypomochlion for the posterior compression manoeuvre, which leads to reduction of the kyphotic deformity.
  
  
  
  Pre-operative back pain was 7.2 on a visual analogue scale. Back pain was reduced to 4.4 at discharge and 2.0 at the latest follow-up with a mean follow-up of 12 months (p < 0.001). The Frankel score remains constant or improved from D to E. Radiological segmental kyphosis was corrected from a mean of 16° to 4° (p < 0.001) post-operatively with a loss of 3° at the final follow-up, but still with significant corrections compared with the pre-operative measurements (p < 0.003).
  
  
  
  Single-stage posterolateral vertebrectomy and reconstruction is a safe and less invasive approach that allows a sufficient reduction of hyperkyphosis and preservation of neurological function in patients with MESCC. This approach is an efficient alternative to anterior-posterior fusion with good pain reduction and improved sagittal profile.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. m.dreimann@uke.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Dreimann
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Schön Klinik, Neustadt in Holstein, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Lennart
authors.initials: L
authors.lastname: Viezens
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Weiser
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Czorlich
authors.affiliation: Department of Neurosurgery, University Hospital Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Sven Oliver
authors.initials: SO
authors.lastname: Eicker
mesh_terms: D000368:Aged; D001416:Back Pain / Q000601:surgery; D019299:Decompression, Surgical; D004824:Epidural Space / Q000473:pathology; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016348:Osseointegration; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary*; D013131:Spine / Q000601:surgery*; D064232:Visual Analog Scale
keywords: Costotransversectomy; Kyphotic deformity; Metastatic epidural spinal cord compression (MESCC); Thoracic stabilization