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  • Minimally Invasive Surgical Treatment of Metastatic Epidural Spinal Cord Compression (MESCC): An Algorithm-based Approach

    Final Number:
    174

    Authors:
    Mohammed A. Alshareef MD, Gibson Klapthor BS; Stephen Lowe MD; Ali M Alawieh PhD; Bruce M. Frankel MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Metastatic epidural spinal cord compression (MESCC), a devastating complication occurring in 10% of patients with systemic cancer, results in sensory-motor deficits with bowel or bladder incontinence. With advancements in surgical treatments, surgery was demonstrated to have an important role in conjunction with radiation. However, more aggressive surgical treatments have been associated with an increased morbidity. As a result, minimally invasive surgical (MIS) approaches have been proposed as a viable alternative to open surgery.

    Methods: 43 patients with MESCC operated on from 2010-2017 were retrospectively evaluated. All patients were deemed to have greater than 3 months of life expectancy and were operated on by a single neurosurgeon using multiple MIS techniques including: tubular laminectomy and facetectomy, tubular transpedicular corpectomies, and tubular costo-transverse corpectomy. This series was analyzed for number of spinal levels involved, blood loss, and post-operative complications, and length of stay.

    Results: Compared to an open surgical cohort, multiple variables were shown to be significantly improved in the MIS cohort. The length of stay, blood loss, and length of stay were significantly lower in MIS compared to open surgery. Post-operative complications were low, with one wound infection, two hardware failures, and two deaths from disease progression within 30 days.

    Conclusions: MESCC itself carries significant morbidity and mortality. Surgical approaches for the palliative treatment of this condition should account for this fact. MIS surgery provides an alternative for palliative surgery including decompression and stabilization. Variables such as operative time, blood loss, and hospital length of stay were significantly improved in this small MIS series as compared to open published series. We propose an algorithm for treatment that includes Karnofsky score, patient age, neurological deficit, and the spinal instability neoplastic score (SINS) to determine type of treatment and surgical approach.

    Patient Care: Our research further encourages the consideration of minimally invasive spine surgery in patients with metastatic spinal disease. It provides another possible algorithm when considering the best treatment option for patients to provide adequate palliation and manage expectations appropriately.

    Learning Objectives: Minimally invasive surgery (MIS) can be utilized as an alternative to open decompression in a subset of patients with Metastatic epidural spinal cord compression (MESCC) MIS has lower overall morbidity than open surgical techniques with similar pain improvement results It is important to consider patient return to adjuvant therapy as part of the decision-making process for surgery

    References:

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