Minimally Invasive Pedicle Screws Fixation and Percutaneous Vertebroplasty for the Surgical Treatment of Thoracic Metastatic Tumors With Neurologic Compression

Abstract

Study design: A retrospective study.

Objective: To describe minimally invasive pedicle screw fixation (MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression and partial tumor resection for the treatment of thoracic metastasis with symptoms of neurologic compression and evaluate the feasibility, efficacy, and safety.

Summary of background data: Neurologic decompression, spinal tumor resection, and stabilization with instrumentation should be performed from an anterior, a posterior, or a combined approach for spinal metastatic tumors with symptoms of neurologic compression. These operations, however, have significant morbidity related to the surgical approach, potential blood loss, extensive dissection, or biomechanical instability.

Methods: Eighteen patients who sustained single-level thoracic vertebral metastasis and neurologic compression underwent MIPS (The minimal-access in a paraspinal sacrospinalis muscle-splitting approach was performed to insert the pedicle screws into the vertebrae under direct vision and two rods of appropriate size were placed over the pedicle screws through subcutaneous soft tissues and muscles) combined with PVP, minimally invasive neurologic decompression, and partial tumor resection. The patients were evaluated preoperatively according to the Tomita, revised Tokuhashi, Bilsky grading system, and Spinal Instability Neoplastic Score. Pre- and postoperative VAS score, American Spinal Injury Association grade, ambulatory status, and urinary continence were also recorded. The Cobb angles, central, and anterior vertebral body height were measured on the lateral radiographs before surgery and during the follow-up.

Results: Clinical follow-up was available for 17 patients in this study ranging from 12 to 16 months (mean time, 14.2 months), and 1 patient died 8 months after surgery. The Visual Analog Scale was significantly decreased after surgery. Improvement of paraplegia was observed after surgery in all of these patients. Spine stability was observed in all of the surviving patients during the follow-up.

Conclusion: MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a good choice of surgical treatment of thoracic metastatic tumors with neurologic compression.

Level of evidence: 2.