Introduction: Minimally invasive approaches to tumor resection can reduce morbidity, correct deformity, and provide lasting benefit for the patient without extensive spinal instrumentation, or morbid high-blood-loss procedures.
Methods: Patients with MRI evidence of metastatic epidural spinal cord compression (MESCC)underwent minimally invasive spinal decompression.
Results: 30 patients underwent 32 immediate procedures and 46 total surgical procedures. Average surgical time was 170 minutes, with an average EBL of 560 cc. Cobb's angle greater than 10 degrees before surgery (n=16, mean = 18 degrees), decreased significantly (p<0.00023, mean = 14. 4/8 profoundly weak patients improved at least two motor levels, (including two from paralplegic to ambulating) at one month, an average improvement of 3.5 Hauser score levels. The mean survival time was 1.62 years for patients with good ambulation post-op, 0.57 years in patients with poor ambulation (p<0.01). 5 deaths in the first 30 days, but no DVT, PE, or wound infections. Hospital stay average = 6.7 days. 7 patients underwent 14 additional minimally invasive procedures. Average period between recurrences was 6 months; those who had a surgical recurrence within 4 months of the initial procedure did not undergo any further procedures; they survived for an average of 4.7 months total. Those with a recurrence more than 4 months after the index procedure survived more than 28 months on average, underwent an average of 3.75 procedures each, with an average period between re-operations of 6.9 months.
Conclusions: Minimally invasive spinal cord decompressions for metastatic lesions have short hospital stays, low rates of wound and other post-operative complications, with short procedures, rapid mobilization, potential improvement in ambulation status even for those with the worst exams, and can improve the quality of life for patients with MESCC. Long-term survival can be maintained in this population with repeat procedures.
Patient Care: reducing the impact of surgical procedures to decompress and stabilize the spines of patients with spinal metastases and spinal cord compression.
Learning Objectives: By the condlusion of this session, participants should be able to determine what the criteria are for performing a minimally invasive spine tumor surgical procedure