Posterior Thoracic Corpectomies with Cage Reconstruction for Metastatic Spinal Tumors: Comparing the MiniOpen Approach to the Open Approach
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1 Posterior Thoracic Corpectomies with Cage Reconstruction for Metastatic Spinal Tumors: Comparing the MiniOpen Approach to the Open Approach Darryl Lau, MD and Dean Chou, MD Department of Neurological Surgery University of California, San Francisco
2 Background Spinal metastasis most commonly affects the vertebral bodies of the spinal column Commonly, an open posterior approach is taken to perform a transpedicular, costotransversectomy, or lateral- extracavitary corpectomy Less invasive approaches such as the mini-open approach may decrease morbidity and shorten recovery time
3 Methods AIM: compare outcomes of patients who undergo miniopen vs. traditional open transpedicular corpectomy for spinal metastases in the thoracic spine Retrospective comparative study Consecutive cohort from 2006 to 2013 Chi-square test and two-tailed t-test were used to compare perioperative and follow-up outcomes between the two groups: Operative time Estimated blood loss Complications Neurological status (ASIA) Revision/reoperation
4 Mini-open Technique Open transpedicular corpectomy: traditional exposure over level of corpectomy and instrumentation levels Mini-open transpedicular corpectomy: midline facial dissection only over the corpectomy level of interest and percutaneous instrumentation above and below that level
5 Mini-open Technique
6 Mini-open Technique
7 Same skin incision, but different facial opening
8 Results Total of 49 patients Well matched cohort. No significant differences in: 21 mini-open 28 open demographics comorbidities preoperative neurological status (ASIA score) tumor type number of corpectomies performed number of levels instrumented No difference in operative time: open (413.6 minutes) vs. mini-open (452.4 minutes) (p=0.329).
9 Results Mini-open group had significantly: shorter hospital stay (11.4 days vs. 7.4 days, p=0.001) less blood loss ( cc vs cc, p=0.019) Mini-open group trended towards: lower perioperative complication rate (9.5% vs. 21.4%) (p=0.265) lower infection rate (17.9% vs. 9.5%) (p=0.409). At follow-up, no differences in: ASIA score (p=0.342), complication rate after the 30-day postoperative period (p=0.999), and need for surgical revision (p=0.803)
10 Conclusion The mini-open transpedicular corpectomy: is a viable option maybe associated with lower morbidity and hasten recovery offers similar follow-up outcomes as the traditional open approach
11 References Bhatt AD, Schuler JC, Boakye M, Woo SY: Current and emerging concepts in non-invasive and minimally invasive management of spine metastasis. Cancer Treat Rev 39: , 2013 Chou D, Eltgroth M, Yang I, Lu D, Manley G: Rib head disarticulation for multilevel transpedicular thoracic corpectomies and expandable cage reconstruction. Neurol India 57: , 2009 Chou D, Lau D, Roy E: Feasibility of the mini-open vertebral column resection for severe thoracic kyphosis. J Clin Neurosci, 2013 Chou D, Lu DC: Mini-open transpedicular corpectomies with expandable cage reconstruction. Technical note. J Neurosurg Spine 14:71-77, 2011 Chou D, Wang VY: Trap-door rib-head osteotomies for posterior placement of expandable cages after transpedicular corpectomy: an alternative to lateral extracavitary and costotransversectomy approaches. J Neurosurg Spine 10:40-45, 2009 Chou D, Wang VY, Gupta N: Transpedicular corpectomy with posterior expandable cage placement for L1 burst fracture. J Clin Neurosci 16: , 2009 Fang T, Dong J, Zhou X, McGuire RA, Jr., Li X: Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine. J Neurosurg Spine 17: , 2012 Lau D, Leach MR, La Marca F, Park P: Independent predictors of survival and the impact of repeat surgery in patients undergoing surgical treatment of spinal metastasis. J Neurosurg Spine 17: , 2012 Lu DC, Chou D, Mummaneni PV: A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors. J Neurosurg Spine 14: , 2011 Lu DC, Lau D, Lee JG, Chou D: The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies. J Neurosurg Spine 12: , 2010
12 Disclosure Dr. Chou and Dr. Lau report report no conflict of interest or funding concerning the materials or methods used in this study.
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