450 Anterior Separation Surgery to Allow for Stereotactic Ablative Radiotherapy: A Novel Approach Permiting Radical Oncological Treatment of Spinal Oligometastastc Disease

Abstract

Abstract Background A paradigm shift in the treatment of spinal metastases has allowed surgeons to deliver curative results utilising radical oncological treatment. In oligometastatic disease (OMD), Stereotactic Ablative Radiotherapy (SABR) as a primary modality or adjuvant treatment to surgery has shown excellent survival outcomes, lower morbidities, and better pain management. The novel use of carbon fibre (CF) vertebral body replacement (VBR) allows optimal SABR planning, less reflection and better future surveillance imaging. CF reinforced PEEK has mechanical properties that allow high resistance to ionising radiation and low wear particles, which is better suited for planned SABR as opposed to titanium VBR and screws. Case presentation A 48-year-old female presented with a recurrent solitary metachronous oligometastatic breast T2 lesion. Her systemic suitability indicated for separation surgery (SS) with post-operative SABR to avoid morbid excision surgery. This case report illustrates novel treatment for spinal oligometastatic disease utilising anterior separation surgery with custom CF VBR with postoperative SABR. Due to several contraindications of posterior separation surgery, anterior surgery was opted for utilising the philosophy of Enneking radical surgery despite Enneking inappropriate resection. Results There were no intra-operative and post-operative complications. 30-months postoperative follow-up and imaging demonstrated that the patient was tumour-free, mobile, pain-free and living independently. Conclusions Utilising this novel approach, Anterior Spinal SS and SABR has shown maximum local control and can deliver curative, radical oncological control. The use of CF has properties allowing high resistance to ionizing radiation and low wear particles, which is better for planned SABR as opposed to titanium VBR and screws.