Abstract
BACKGROUND CONTEXT Patients with metastatic epidural compression often present with neurological deficits and need prompt decompression and stabilization. A transpedicular decompression (TPD) can provide sufficient debulking of the epidural disease that is often situated ventral to the dura. Following such procedures anterior column support (cement or steinman pin combination, cages, allograft) have been used. PURPOSE To assess complications or revisions associated with not using anterior column support following transpedicular decompression (TPD) in metastatic spine disease. STUDY DESIGN/SETTING Retrospective, Level I trauma center, Tertiary referall Cancer Center. PATIENT SAMPLE A total of 36 patients undergoing TPD without anterior column support. OUTCOME MEASURES Revision surgery, surgical complication rates. METHODS Patients with metastatic spine disease undergoing TPD with posterior segmental instrumentation at a level I trauma center were identified. All patients had symptomatic metastatic epidural disease. The study period was 3/2011 to 8/2017. Patients were operated on by two orthopaedic spine surgeons. Demographic information, surgical data (EBL, length of surgery, level of TPD, levels instrumented, tumor histology, postoperative complications) were recorded. RESULTS A total of 36 patients undergoing TPD without anterior column support were identified. There were 12 F, 24 M, average age of 67.2 (46–87). TPD was performed in 26 thoracic lesions, nine lumbar lesions and one cervical or thoracic lesion. Average of 5.24 levels (2–10) were instrumented. In five cases (13.9%) MIS screws with open TPD was performed. Average EBL was 725.6ml, surgical length was 198 minutes and average hospital stay was 11.7 days. Common histology included lung (n=9), prostate (n=6), breast (n=5), multiple myeloma (n=3), renal cell (n=3), melanoma (n=2). Surgical complications included three surgical site infections (8.3%), there were no (0%) revisions needed for implant failure. At latest follow-up 12 (33%) patients were alive, average length of survival was 12.5 months (0.5–70 months). CONCLUSIONS Patients with symptomatic metastatic epidural disease may need debulking of the lesion, often ventral to the thecal sac, in order to preserve neurological function. Although in selected cases there may be a role for anterior column, we have demonstrated that posterior segmental instrumentation alone along with transpedicular decompression can be performed without a risk of instrumentation failure or need for revision surgery.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
