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Modified lateral extracavitary approach for vertebral column resection and expandable cage reconstruction of thoracic spinal metastases.
MedLine Citation:
PMID:  23230517     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Spinal metastasis is common and can be associated with considerable morbidity. Vertebral resection and reconstruction have been shown to preserve neurological function and decrease pain. Most commonly, two-stage, combined anterior/posterior approaches are performed to surgically address significant vertebral metastasis. Recently, single-stage posterior approaches for vertebrectomies have been performed more often as a result of advances in instrumentation and anesthesia. The objective is to describe a series of patients with metastatic thoracic spine tumors who were treated using a modified, lateral extracavitary approach for a posterior-only vertebral column resection and expandable cage reconstruction.
METHODS: A retrospective analysis of 21 cases and 20 patients was performed.
RESULTS: The average estimated blood loss and length of surgery were 1700 ml (range, 200-7600 ml) and 6.8 h (range, 4-9 h), respectively. The mean follow-up was 14 months (range, 4-30 months). One patient had a permanent neurological deficit as a result of a postoperative hematoma. Of the five patients who were unable to walk prior to surgery, two regained the ability to ambulate. The total complication rate was 43% with majority being minor. A total of 94% of patients had durable preservation of the neurological function.
CONCLUSION: The posterior approach for vertebral column resection and reconstruction is a viable alternative to the standard combined approach. We demonstrate the feasibility of performing the lateral extracavitary approach through a midline incision from T1 to T12. This less invasive approach continues to evolve as instrumentation becomes more advanced and possesses significant advantages in the oncologic setting.
Authors:
Rahul Jandial; Mike Y Chen
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Publication Detail:
Type:  Journal Article     Date:  2012-11-20
Journal Detail:
Title:  Surgical neurology international     Volume:  3     ISSN:  2152-7806     ISO Abbreviation:  Surg Neurol Int     Publication Date:  2012  
Date Detail:
Created Date:  2012-12-11     Completed Date:  2012-12-12     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101535836     Medline TA:  Surg Neurol Int     Country:  India    
Other Details:
Languages:  eng     Pagination:  136     Citation Subset:  -    
Affiliation:
Department of Surgery, Division of Neurosurgery, City of Hope National Medical Center, MOB 2001, 1500 East Duarte Road, Duarte, CA, USA.
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