Yu-Tong Gu, Zhang L, Wang YC and Dong J
Objectives: To evaluate the feasibility, efficacy and safety of percutaneous vertebroplasty (PVP), minimally invasive decompression and partial tumor resection combined with percutaneous pedicle screws fixation (PPS) for surgical treatment of thoracic metastasis with neurologic compression.
Methods: Twenty patients with 1-level thoracic vertebral metastasis and neurologic compression were treated with the procedure of PVP and PPS combined with minimally invasive neurologic decompression and partial tumor resection through mini posterior midline approach. The prognostic score was evaluated according to Tomita scoring system before operation. VAS score and ASIA grade were also recorded before and after operation. Cobb angles, central and anterior vertebral body height were measured on the lateral X-rays.
Results: The mean prognostic score of Tomita was 7 (range, 6-7 points). The mean follow-up of 13.8 (12-15) months was available for 17 patients and other 3 patients died more than half one year after operation. There were no complications and no death due to complications of the procedure itself. The VAS significantly dropped from 9 (range, 7-10) preoperatively to 3 (range, 2-4) (p<0.001) immediately after surgery and to 1 (range, 0-1) (p<0.001) at the 1-year follow-up. All patients got improvement of paraplegia after operation. At the 3-month follow-up, 3 of 5 patients with complete motor paralysis improved from ASIA scale B to D, 11 of 15 patients with incomplete motor paralysis from C or D to E. Eleven of 17 surviving patients got ASIA scale E at the 1-year follow-up. Spine stability was observed in all of the surviving patients during the follow-up.
Conclusion: PVP, minimally invasive decompression and partial tumor resection combined with PPS is a good choice of surgical treatment for thoracic metastatic tumors with neurologic compression.
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