The management of malignant spinal cord compression: a modified technique of spinal reconstruction

Abstract

Objectives:This study aims to assess the results of a single-stage posterolateral transpedicular corpectomy and fusion in malignant spinal cord compression of the thoracolumbar spine.Methods:Sixteen cases of thoracolumbar metastases were treated with single-stage posterolateral transpedicular corpectomy and fusion. A modified technique of nerve preserving bilateral cage placement was described. Pain, American Spinal Injury Association (ASIA) scores, spinal deformity, primary pathologies, and survival were recorded.Results:The most common primary pathology was lung, followed by renal and colorectal cancer. Significant pain reduction was achieved in all patients, regardless of previous nonsurgical treatment. No patient suffered neurological deterioration after surgery. For the 10 patients who presented with neurological deficits, 90% improved after surgery. Significant improvement in Cobb angle and vertebral height were observed postoperatively. A mean survival of 5·6 months was recorded at the completion of this manuscript.Discussion:Single-stage posterolateral transpedicular corpectomy and fusion appeared to be a safe and an effective approach in malignant spinal cord compression. The current modified technique extends its application to lumbar spine by preserving all nerve roots. The significant improvement of pain and neurological deficits leads to better quality of life. The benefits of surgery in the overall survival remain to be investigated.