TY - JOUR
T1 - Minimally Invasive Tubular Separation Surgery for Metastatic Spinal Cord Compression
T2 - 2-Dimensional Operative Video
AU - De la Garza Ramos, Rafael
AU - Echt, Murray
AU - Gelfand, Yaroslav
AU - Yanamadala, Vijay
AU - Yassari, Reza
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2020.
PY - 2021/4/15
Y1 - 2021/4/15
N2 - Symptomatic cord compression affects approximately 20% of patients with spinal metastatic disease. Direct decompressive surgery followed by conventional radiation was shown to be superior to radiation alone in a landmark trial published in 2005.1 For radioresistant tumors causing high-grade compression, however, "separation surgery" followed by stereotactic body radiation therapy was developed. The main goal of this newer technique is to decompress and create a distance between the spinal cord and tumor to allow for safe delivery of radiation.2 This technique has shown to provide durable local tumor control, pain relief, and preservation of neurological function.3,4 In this study, we describe a minimally invasive tubular separation surgery technique used to treat symptomatic cord compression in a 59-yr-old man with metastatic prostate adenocarcinoma to T9. The patient presented with acute motor weakness and sensory level. A tubular retraction system was used to dock over the pedicle at T9 bilaterally and a posterior decompression with ligamentectomy was first performed. This was followed by transpedicular decompression and ventral removal of the posterior longitudinal ligament. Space was created between the ventral tumor and spinal cord to allow for postoperative stereotactic body radiation. The patient had a significant improvement in his strength and gait postoperatively. Patient consent was obtained for videotaping prior to surgical intervention.
AB - Symptomatic cord compression affects approximately 20% of patients with spinal metastatic disease. Direct decompressive surgery followed by conventional radiation was shown to be superior to radiation alone in a landmark trial published in 2005.1 For radioresistant tumors causing high-grade compression, however, "separation surgery" followed by stereotactic body radiation therapy was developed. The main goal of this newer technique is to decompress and create a distance between the spinal cord and tumor to allow for safe delivery of radiation.2 This technique has shown to provide durable local tumor control, pain relief, and preservation of neurological function.3,4 In this study, we describe a minimally invasive tubular separation surgery technique used to treat symptomatic cord compression in a 59-yr-old man with metastatic prostate adenocarcinoma to T9. The patient presented with acute motor weakness and sensory level. A tubular retraction system was used to dock over the pedicle at T9 bilaterally and a posterior decompression with ligamentectomy was first performed. This was followed by transpedicular decompression and ventral removal of the posterior longitudinal ligament. Space was created between the ventral tumor and spinal cord to allow for postoperative stereotactic body radiation. The patient had a significant improvement in his strength and gait postoperatively. Patient consent was obtained for videotaping prior to surgical intervention.
KW - Metastatic cord compression
KW - Minimally invasive surgery
KW - Separation surgery
KW - Spinal tumor
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UR - http://www.scopus.com/inward/citedby.url?scp=85104369466&partnerID=8YFLogxK
U2 - 10.1093/ons/opaa421
DO - 10.1093/ons/opaa421
M3 - Article
C2 - 33377155
AN - SCOPUS:85104369466
SN - 2332-4252
VL - 20
SP - E356
JO - Operative neurosurgery (Hagerstown, Md.)
JF - Operative neurosurgery (Hagerstown, Md.)
IS - 5
ER -