Less Invasive Palliative Surgery for Spinal Metastases

BackgroundThere may be patients with spinal metastasis for whom neither vertebroplasty/kyphoplasty nor open surgery is appropriate. Percutaneous pedicle screw fixation (PPSF) may fill the gap between techniques. ObjectivesTo assess the outcome of the PPSF and radiotherapy/chemotherapy. MethodsPPSF was performed for 16 patients (mean age, 5712 years) with pathologic fractures, Tomita score 5, 3-6 months of life expectancy, minimal epidural tumor extension and a Nurick grade better than 3. PPSF was performed under general anesthesia. Collapsed vertebra(e) was restored during assembly of contoured rod. Vertebroplasty was then performed for 14 patients at the restored vertebra(e). The Eastern Cooperative Oncology Group (ECOG) performance status grade was 2 in seven patients and 3 in nine. The numerical rating pain score (NRS) was 8.21.8. The follow-up was 261 +/- 193 days. ResultsAll patients walked home at postoperative day 4-7. Radiotherapy and chemotherapy was performed for 8 and 10 patients, respectively. ECOG was improved or stationary in 13/16 (81%) at 1-month and improved in 6/6 of alive patients at the last follow-up. NRS was 3.8 +/- 2.0. The median ambulation and survival times were 207 and 222 days. ConclusionUsing a multidisciplinary approach, quality of life can be improved for fragile patients with spinal metastasis. J. Surg. Oncol. 2013; 108:499-503. (c) 2013 Wiley Periodicals, Inc.