Posterior surgical approaches and outcomes in metastatic spine-disease

Paul Klimo, Andrew T. Dailey, Richard G. Fessler

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Spinal cord compression represents a major cause of morbidity and suffering in cancer patients. Surgery should be considered a form of primary therapy in many of these patients. The goals of surgery and the approach used are functions of a number of variables, including the surgeon's preference, the location of disease within the spine (cervical, thoracic, or lumbar), the extent of disease within each vertebra, the number of levels affected, and the patient's medical health and overall prognosis. Currently, the goals of any major debulking surgery are to decompress the spinal cord, prevent local recurrence, reconstruct the spine, and provide immediate stabilization with the use of fixation devices. Posterior approaches, starting with the decompressive laminectomy, have traditionally been the most common surgical procedures for metastatic spine disease. The laminectomy should only be used for disease isolated to the dorsal spine without evidence of concomitant instability. A laminectomy combined with instrumentation has been shown to provide superior results but should be reserved for those patients who cannot tolerate or would not benefit from more aggressive surgery. Various posterolateral approaches have been devised to access more ventrally placed lesions. These include the transpedicular approach, the costotransversectomy, and the lateral extracavitary/parascapular approach. Each of these allows adequate spinal cord decompression anteriorly and posteriorly and the ability to reconstruct and stabilize with acceptable perioperative risk. It must be remembered that surgery for this disease is almost always palliative. Thus, surgery should be a means to maximize the patient's quality of life while minimizing the risk of suffering surgical complications.

Original languageEnglish (US)
Pages (from-to)425-435
Number of pages11
JournalNeurosurgery clinics of North America
Volume15
Issue number4
DOIs
StatePublished - Oct 1 2004

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Spine
Laminectomy
Spinal Cord
Spinal Cord Compression
Decompression
Thorax
Quality of Life
Morbidity
Recurrence
Equipment and Supplies
Health
Neoplasms
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Posterior surgical approaches and outcomes in metastatic spine-disease. / Klimo, Paul; Dailey, Andrew T.; Fessler, Richard G.

In: Neurosurgery clinics of North America, Vol. 15, No. 4, 01.10.2004, p. 425-435.

Research output: Contribution to journalReview article

Klimo, Paul ; Dailey, Andrew T. ; Fessler, Richard G. / Posterior surgical approaches and outcomes in metastatic spine-disease. In: Neurosurgery clinics of North America. 2004 ; Vol. 15, No. 4. pp. 425-435.
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