1Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center; and.
2Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.
Neurosurg Focus. 2021 May;50(5):E11. doi: 10.3171/2021.2.FOCUS217.
High-grade metastatic epidural spinal cord compression from radioresistant tumor histologies is often treated with separation surgery and adjuvant stereotactic body radiation therapy. Historically, long-segment fixation is performed during separation surgery with posterior transpedicular fixation of a minimum of 2 spinal levels superior and inferior to the decompression. Previous experience with minimal access surgery techniques and percutaneous stabilization have highlighted reduced morbidity as an advantage to the use of shorter fixation constructs. Cement augmentation of pedicle screws is an attractive option for enhanced stabilization while performing shorter fixation. Herein, the authors describe their initial experience of open separation surgery using short-segment cement-augmented pedicle screw fixation for spinal reconstruction.
The authors performed a retrospective chart review of patients undergoing open (i.e., nonpercutaneous, minimal access surgery) separation surgery for high-grade epidural spinal cord compression using cement-augmented pedicle screws at single levels adjacent to the decompression level(s). Patient demographics, treatment data, operative complications, and short-term radiographic outcomes were evaluated.
Overall, 44 patients met inclusion criteria with radiographic follow-up at a mean of 8.5 months. Involved levels included 19 thoracic, 5 thoracolumbar, and 20 lumbar. Cement augmentation through fenestrated pedicle screws was performed in 30 patients, and a vertebroplasty-type approach was used in the remaining 14 patients to augment screw purchase. One (2%) patient required an operative revision for a hardware complication. Three (7%) nonoperative radiographic hardware complications occurred, including 1 pathologic fracture at the index level causing progressive kyphosis and 2 incidences of haloing around a single screw. There were 2 wound complications that were managed conservatively without operative intervention. No cement-related complications occurred.
Open posterolateral decompression utilizing short-segment cement-augmented pedicle screws is a viable alternative to long-segment instrumentation for reconstruction following separation surgery for metastatic spine tumors. Studies with longer follow-up are needed to determine the rates of delayed complications and the durability of these outcomes.
对于来自耐辐射肿瘤组织学的高级转移性硬膜外脊髓压迫，通常采用分离手术和辅助立体定向体部放射治疗进行治疗。历史上，在分离手术中进行长节段固定，在后路经椎弓根固定，在减压上下至少 2 个脊柱节段。微创外科技术和经皮稳定的前期经验突出了缩短固定结构的优势，即降低发病率。在进行较短固定时，使用骨水泥增强椎弓根螺钉是增强稳定性的一种有吸引力的选择。在此，作者描述了他们使用短节段骨水泥增强椎弓根螺钉固定进行脊柱重建的开放性分离手术的初步经验。
作者对接受开放性（即非经皮微创外科手术）分离手术治疗高位硬膜外脊髓压迫症的患者进行了回顾性图表审查，这些患者使用临近减压水平的单节段骨水泥增强椎弓根螺钉进行固定。评估了患者的人口统计学、治疗数据、手术并发症和短期影像学结果。
总体而言，44 例患者符合纳入标准，在平均 8.5 个月时进行了影像学随访。受累节段包括 19 个胸椎、5 个胸腰椎和 20 个腰椎。30 例患者行经皮椎弓根螺钉骨水泥增强，其余 14 例患者采用经皮椎体成形术方法增强螺钉固定。1 例（2%）患者因器械并发症需要手术翻修。3 例（7%）非手术影像学器械并发症发生，包括 1 例在指数水平发生的病理性骨折导致进行性后凸畸形和 2 例单个螺钉周围 halo 征。有 2 例伤口并发症，无需手术干预即可保守治疗。无骨水泥相关并发症。
对于转移性脊柱肿瘤分离手术后的重建，开放性后外侧减压术联合短节段骨水泥增强椎弓根螺钉是长节段器械的可行替代方案。需要进行更长时间的随访研究，以确定迟发性并发症的发生率和这些结果的耐久性。
