Percutaneous posterior stabilisation of L1 to L5 with microsurgical decompression of L3/4, and percutaneous L3 biopsy, in a spinal metastasis

Abstract

Although guidelines (Harrington [1], Tokuhashi [2], Tomita [3]) for the treatment of spinal metastasis exist, the indication for an operative therapy is still a complex decision. In general, therapeutic decisions should be made in a multidisciplinary setting, taking into account alternatives, the morbidity of the planned surgery as well as the general health condition and life expectancy of the patient. Beside all therapeutic alternatives there are widely accepted indications for operative treatment, which are spinal instability, radio resistant tumours, clinically relevant neural compression, deformity and intractable pain. Especially the percutaneous stabilisation techniques, which evolved over the last years became an important tool for the treatment of spinal metastasis in particular in the presence of spinal instability. Although fusion can seldom be achieved with percutaneous stabilisation, often this is of moderate importance because of the limited life expectancy of the patients. When a neural compression is accompanying the instability, stabilisation can easily be supplemented with a microsurgical decompression.