Laratta Joseph L, Weegens Ryan, Malone Kyle T, Chou Dean, Smith William D
Norton Leatherman Spine Center, Louisville, KY, USA.
University of Louisville Medical Center, Louisville, KY, USA.
J Spine Surg. 2020 Mar;6(1):62-71. doi: 10.21037/jss.2019.12.12.
Although primary tumors of the spine and neural elements are rare, metastatic disease to the spine is quite common. Traditionally, surgical treatment for spinal tumor patients involves open decompression with or without stabilization. The single-position minimally invasive (MIS) lateral approach, which has been recently described over the recent decade, allows simultaneous access to the anterior and posterior columns with the patient positioned in the lateral decubitus position. Herein, we review the application of single-position MIS lateral surgery for the treatment of spinal neoplasm. The aim was to review the evolution, operative technique, outcomes, and complications associated with MIS lateral approaches for spinal tumors. The history of spinal tumor diagnosis and management are reviewed and discussed as well as the author's experience and literature regarding spinal tumor treatment outcome and surgical complications, with particular attention to single-position, MIS lateral approaches. In addition, the author's surgical technique is outlined in detail for thoracic, thoracolumbar and lumbar tumors. Furthermore, there are specific indications and complications associated with the surgical treatment of spinal tumors, and the MIS, single-position lateral approach, when applied appropriately, allows for concurrent access to the anterior and posterior column while mitigating the complications associated with traditional, open posterior-based approaches. In the treatment of spinal neoplasms, the goals of surgery are dictated by a number of tumor-specific and patient-specific factors. Therefore, operative treatment of tumors in the future may be a consolidation of historical surgical techniques and MIS, single-position lateral approaches. Regardless, multidisciplinary management is imperative for the individualized treatment of the patient and optimization of outcome.
尽管脊柱和神经组织的原发性肿瘤很少见，但脊柱转移性疾病却相当常见。传统上，脊柱肿瘤患者的手术治疗包括有或没有内固定的开放减压术。近十年来新描述的单体位微创（MIS）外侧入路，可在患者侧卧位时同时显露脊柱的前柱和后柱。在此，我们回顾单体位MIS外侧手术在脊柱肿瘤治疗中的应用。目的是回顾与脊柱肿瘤MIS外侧入路相关的发展历程、手术技术、疗效及并发症。回顾并讨论了脊柱肿瘤诊断和治疗的历史，以及作者关于脊柱肿瘤治疗效果和手术并发症的经验及文献，尤其关注单体位MIS外侧入路。此外，详细概述了作者针对胸椎、胸腰段和腰椎肿瘤的手术技术。再者，脊柱肿瘤手术治疗存在特定的适应症和并发症，而MIS单体位外侧入路在恰当应用时，可同时显露前柱和后柱，同时减轻与传统开放后入路相关的并发症。在脊柱肿瘤的治疗中，手术目标由多种肿瘤特异性和患者特异性因素决定。因此，未来肿瘤的手术治疗可能是传统手术技术与MIS单体位外侧入路的结合。无论如何，多学科管理对于患者的个体化治疗和优化治疗效果至关重要。
