Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Oper Neurosurg (Hagerstown). 2021 Apr 15;20(5):E356. doi: 10.1093/ons/opaa421.
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.
症状性脊髓压迫影响大约 20%的脊柱转移瘤患者。2005 年发表的一项里程碑式试验表明，直接减压手术联合常规放疗优于单纯放疗。1 然而，对于引起高级别压迫的放疗抵抗性肿瘤，开发了“分离手术”加立体定向体部放射治疗。这种新技术的主要目的是减压并在脊髓和肿瘤之间产生距离，以允许安全地进行放疗。2 该技术已被证明可提供持久的局部肿瘤控制、缓解疼痛和保留神经功能。3,4 在本研究中，我们描述了一种微创管状分离手术技术，用于治疗一名 59 岁男性的 T9 转移性前列腺腺癌引起的症状性脊髓压迫。患者表现为急性运动无力和感觉水平。使用管状牵开系统在 T9 双侧的椎弓根上对接，并首先进行后路减压和韧带切除术。随后进行经皮减压和后纵韧带的腹侧切除。在腹侧肿瘤和脊髓之间创造空间，以便术后进行立体定向体部放射治疗。患者术后的力量和步态有明显改善。在手术干预前获得了患者的录像同意。
