Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2010-12, Vol.35 (26 Suppl), p.S347-S354
• Main Authors: Uribe, Juan S, Dakwar, Elias, Le, Tien V, Christian, Ginger, Serrano, Sherrie, Smith, William D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; Humans; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Orthopedic Procedures - methods; Prospective Studies; Spinal Cord Neoplasms - surgery; Spinal Neoplasms - surgery; Thoracic Vertebrae - surgery; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3182022d0f

Prospective registry. The objective of this study is to examine procedural and long-term outcomes of a mini-open, lateral approach for tumor removal in the thoracic spine. The majority of spinal tumors present as metastatic tumors in the thoracic spine. Conventional surgical treatments have been associated with high rates of approach-related morbidities as well as difficult working windows for complete tumor excision. Recent advances in minimally invasive techniques, particularly mini-open (minimally invasive, not endoscopic) approaches, help to reduce the morbidities of conventional procedures with comparable outcomes. Twenty-one consecutively treated patients at 2 institutions were treated between 2007 and 2009. Treatment variables, including operating time, estimated blood loss, length of hospital stay, and complications were collected, as were outcome measures, including the visual analog scale for pain and the Oswestry disability index. Twenty-one patients with thoracic spinal tumors were successfully treated with a minimally invasive lateral approach. Operating time, estimated blood loss, and length of hospital stay were 117 minutes, 291 mL, and 2.9 days, respectively. One (4.8%) perioperative complication occurred (pneumonia). Mean follow-up was 21 months. Two patients had residual tumor at last follow-up. Two patients died during the study as the result of other metastases (spine tumor was secondary). Visual analog scale improved from 7.7 to 2.9 and Oswestry disability index improved from 52.7% to 24.9% from preoperative to the last follow-up. The mini-open lateral approach described here can be performed safely and without many of the morbidities and difficulties associated with conventional and endoscopic procedures. Proper training in minimally invasive techniques and the use of direct-visualization minimally invasive retractors are required to safely and reproducibly treat these complex indications.