Nelson Moussazadeh1, David G Rubin2, Lily McLaughlin3, Eric Lis4, Mark H Bilsky1, Ilya Laufer5. 1. Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA. 2. Legacy Spine & Neurological Associates, 5800 W. 10th St, Little Rock, AR, USA. 3. Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA. 4. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA. 5. Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA. Electronic address: lauferi@mskcc.org.
Abstract
BACKGROUND CONTEXT: Pathologic vertebral compression fractures (VCFs) represent a major source of morbidity and diminished quality of life in the spinal oncology population. Procedures with low morbidity that effectively treat patients with pathologic fractures are especially important in the cancer population where life expectancy is limited. Vertebroplasty and kyphoplasty are often not effective for mechanically unstable pathologic fractures extending into the pedicle and facet joints. Combination of cement augmentation and percutaneous instrumented stabilization represents a minimally invasive treatment option that does not delay radiation and systemic therapy. PURPOSE: The objective of the study was to evaluate the safety and efficacy of cement-augmented short-segment percutaneous posterolateral instrumentation for tumor-associated VCF with pedicle and joint involvement. METHODS: Forty-four consecutive patients underwent cement-augmented percutaneous spinal fixation for unstable tumors between 2011 and 2014. Retrospective analysis of prospectively collected data, including visual analog pain scale (VAS) response score and procedural complications, was performed. RESULTS: Patients with a median composite Spinal Instability Neoplastic Scale score of 10 (range=8-15) were treated with constructs spanning one to four disk spaces (median of two spaces, constituting 84% of all cases). The proportion of patients with severe pain decreased from 86% preoperatively to 0%; 65% of patients reported no referable instability pain postoperatively. There was one adjacent-level fracture responsive to kyphoplasty, and one case of asymptomatic screw pullout. Two patients subsequently required decompression in the setting of disease progression despite radiation; there was no perioperative morbidity. CONCLUSIONS: Percutaneous cement-augmented posterolateral spinal fixation is a safe and effective option for palliation of appropriately selected mechanically unstable VCF that extends into pedicle and/or joint.
BACKGROUND CONTEXT: Pathologic vertebral compression fractures (VCFs) represent a major source of morbidity and diminished quality of life in the spinal oncology population. Procedures with low morbidity that effectively treat patients with pathologic fractures are especially important in the cancer population where life expectancy is limited. Vertebroplasty and kyphoplasty are often not effective for mechanically unstable pathologic fractures extending into the pedicle and facet joints. Combination of cement augmentation and percutaneous instrumented stabilization represents a minimally invasive treatment option that does not delay radiation and systemic therapy. PURPOSE: The objective of the study was to evaluate the safety and efficacy of cement-augmented short-segment percutaneous posterolateral instrumentation for tumor-associated VCF with pedicle and joint involvement. METHODS: Forty-four consecutive patients underwent cement-augmented percutaneous spinal fixation for unstable tumors between 2011 and 2014. Retrospective analysis of prospectively collected data, including visual analog pain scale (VAS) response score and procedural complications, was performed. RESULTS:Patients with a median composite Spinal Instability Neoplastic Scale score of 10 (range=8-15) were treated with constructs spanning one to four disk spaces (median of two spaces, constituting 84% of all cases). The proportion of patients with severe pain decreased from 86% preoperatively to 0%; 65% of patients reported no referable instability pain postoperatively. There was one adjacent-level fracture responsive to kyphoplasty, and one case of asymptomatic screw pullout. Two patients subsequently required decompression in the setting of disease progression despite radiation; there was no perioperative morbidity. CONCLUSIONS: Percutaneous cement-augmented posterolateral spinal fixation is a safe and effective option for palliation of appropriately selected mechanically unstable VCF that extends into pedicle and/or joint.
Authors: Ori Barzilai; Lily McLaughlin; Eric Lis; Anne S Reiner; Mark H Bilsky; Ilya Laufer Journal: Oper Neurosurg (Hagerstown) Date: 2019-05-01 Impact factor: 2.703
Authors: Ori Barzilai; Ilya Laufer; Adam Robin; Ran Xu; Yoshiya Yamada; Mark H Bilsky Journal: Oper Neurosurg (Hagerstown) Date: 2019-03-01 Impact factor: 2.703
Authors: Patrick D Kelly; Scott L Zuckerman; Yoshiya Yamada; Eric Lis; Mark H Bilsky; Ilya Laufer; Ori Barzilai Journal: Neurosurg Rev Date: 2019-06-01 Impact factor: 3.042