Abstract
Patients with metastatic epidural spinal cord compression (MESCC) often need surgical intervention due to pain, neurological deficits, and spinal instability. Spinal disease is commonly treated via the minimally invasive mini-open approach. However, few studies have evaluated MESCC treatment via mini-open approach. The present study compared the traditional open approach versus the mini-open approach for thoracolumbar MESCC. A cohort of 209 consecutive patients who were diagnosed with thoracolumbar metastases and underwent corpectomy and polymethylmethacrylate reconstruction from 2010 to 2016 was retrospectively identified. Traditional open surgery was performed in 113 patients (open group; mean age 57.7 years), while 96 patients underwent mini-open surgery (mini-open group; mean age 54.3 years). Patients were followed up for 24 months or until death. The baseline characteristics of both groups were similar. The most common origin of the primary lesion was the lung (37.3%), hematological system (22.0%), and kidney (15.8%). Surgery effectively achieved pain relief, restored neurological function, and improved quality of life in both groups. The mini-open group was superior to the open group regarding estimated blood loss, blood transfusion, hospital stay, complications, and pain score. While the mini-open group had a longer operation time than the open group, the two groups had similar improvements in the Frankel grade and Karnofsky functional score. The 30-day mortality rate tended to be higher in the open group (5.3%) than the mini-open group (2.1%) without significance. The 24-month survival rate was similar in both groups (26.5% versus 26.0%). In conclusion, surgery improved pain, function, and quality of life in patients with MESCC. The mini-open approach resulted in less estimated blood loos, less blood transfusion, and shorter hospitalization than the traditional open approach, while both methods had similar mortality and morbidity rates. Thus, the mini-open approach may be more beneficial than the traditional approach for MESCC.
Highlights
Spinal metastasis accounts for approximately 60% of all osseous metastatic disease, and occult spinal disease is present in at least 25% of patients who die as a result of malignant tumors [1,2,3]
The traditional open approach was used in 49 females and 64 males with a mean age of 57.7 years, while the mini-open approach was used in 37 females and 59 males with a mean age of 54.3 years
One previous study that evaluated a consecutive cohort who underwent thoracic transpedicular corpectomies for spinal metastases via the mini-open approach (n=21) or the open approach (n=28) reported that the mini-open approach was associated with less blood loss and shorter hospital stay compared with open surgery [11]
Summary
Spinal metastasis accounts for approximately 60% of all osseous metastatic disease, and occult spinal disease is present in at least 25% of patients who die as a result of malignant tumors [1,2,3]. MESCC is a devastating consequence of spinal metastases, and is an oncologic emergency that requires rapid diagnosis and treatment. MESCC causes marked impairments in quality of life due to pain and neurological dysfunction [1, 4, 6]. The goals of MESCC treatment are to improve quality of life, maintain or improve neurological function, and relieve pain through spinal cord decompression, spinal stability, and local tumor control [1, 4, 6]. The most common therapies used to treat MESCC are surgery, radiotherapy, or a combination of these two methods [1, 4, 5, 8]. Many patients require surgery due to neurological deficits, pain, and vertebral collapse. Palliative debulking methods are preferred for patients with a short life expectancy, as these methods are simpler and have lower morbidity rates [1, 4, 9, 10]
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