Minimally Invasive Separation Surgery with Intraoperative Stereotactic Guidance: A Feasibility Study

Rani Nasser, Jonathan Nakhla, Murray Echt, Rafael De la Garza Ramos, Merritt D. Kinon, Alok Sharan, Reza Yassari

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background The treatment of spinal metastasis consists of algorithms combining surgical and radiation modalities. Recently the concept of separation surgery followed by stereotactic radiosurgery was shown to be a safe and effective treatment to achieve local tumor control. Objective We examined a minimally invasive approach to separation surgery in a cadaveric study followed by a patient cohort with spinal metastasis using navigation to discuss our results and provide a technical note. Methods A cadaveric study using minimally invasive access systems examined the feasibility of spinal cord decompression. Subsequently, 17 patients with spinal metastasis underwent minimally invasive separation surgery and instrumentation using navigation. All patients were at least 3/5 and pre- and post-operative CT scans were used to evaluate the decompression. Endpoints included neurologic function, operative time, estimated blood loss, duration of hospital stay, and complications. Results The cadaveric study demonstrated adequate decompression of the spinal cord. For the operative cases, the post-operative imaging demonstrated excellent separation for safe stereotactic radiosurgery. The mean incision length was 4.9 cm. The average operative time was 6 hours and 48 minutes, the mean length of stay was 12.8 days and the mean surgical blood loss was 458 mL. The median Spine Instability Neoplastic Score score was 10 with a range of 6–16. All patients remained or improved their neurologic baseline with excellent pain control. One patient incurred a perioperative complication. Conclusions Minimally invasive separation surgery for spinal metastasis allows for circumferential decompression of the spinal cord and safe post-operative stereotactic radiosurgery. In addition, we demonstrated the efficacy of intra-operative navigation in guiding the resection.

Original languageEnglish (US)
Pages (from-to)68-76
Number of pages9
JournalWorld Neurosurgery
Volume109
DOIs
StatePublished - Jan 1 2018

Fingerprint

Minimally Invasive Surgical Procedures
Feasibility Studies
Decompression
Radiosurgery
Neoplasm Metastasis
Spinal Cord
Operative Time
Nervous System
Length of Stay
Surgical Blood Loss
Spine
Radiation
Pain
Therapeutics
Neoplasms

Keywords

  • Minimally invasive
  • Separation surgery
  • Spinal oncology
  • Stereotactic navigation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Minimally Invasive Separation Surgery with Intraoperative Stereotactic Guidance : A Feasibility Study. / Nasser, Rani; Nakhla, Jonathan; Echt, Murray; De la Garza Ramos, Rafael; Kinon, Merritt D.; Sharan, Alok; Yassari, Reza.

In: World Neurosurgery, Vol. 109, 01.01.2018, p. 68-76.

Research output: Contribution to journalArticle

Nasser, Rani ; Nakhla, Jonathan ; Echt, Murray ; De la Garza Ramos, Rafael ; Kinon, Merritt D. ; Sharan, Alok ; Yassari, Reza. / Minimally Invasive Separation Surgery with Intraoperative Stereotactic Guidance : A Feasibility Study. In: World Neurosurgery. 2018 ; Vol. 109. pp. 68-76.
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abstract = "Background The treatment of spinal metastasis consists of algorithms combining surgical and radiation modalities. Recently the concept of separation surgery followed by stereotactic radiosurgery was shown to be a safe and effective treatment to achieve local tumor control. Objective We examined a minimally invasive approach to separation surgery in a cadaveric study followed by a patient cohort with spinal metastasis using navigation to discuss our results and provide a technical note. Methods A cadaveric study using minimally invasive access systems examined the feasibility of spinal cord decompression. Subsequently, 17 patients with spinal metastasis underwent minimally invasive separation surgery and instrumentation using navigation. All patients were at least 3/5 and pre- and post-operative CT scans were used to evaluate the decompression. Endpoints included neurologic function, operative time, estimated blood loss, duration of hospital stay, and complications. Results The cadaveric study demonstrated adequate decompression of the spinal cord. For the operative cases, the post-operative imaging demonstrated excellent separation for safe stereotactic radiosurgery. The mean incision length was 4.9 cm. The average operative time was 6 hours and 48 minutes, the mean length of stay was 12.8 days and the mean surgical blood loss was 458 mL. The median Spine Instability Neoplastic Score score was 10 with a range of 6–16. All patients remained or improved their neurologic baseline with excellent pain control. One patient incurred a perioperative complication. Conclusions Minimally invasive separation surgery for spinal metastasis allows for circumferential decompression of the spinal cord and safe post-operative stereotactic radiosurgery. In addition, we demonstrated the efficacy of intra-operative navigation in guiding the resection.",
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