PMID- 27476840
OWN - NLM
STAT- MEDLINE
DCOM- 20170228
LR  - 20190408
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 41
IP  - 2
DP  - 2016 Aug
TI  - The role of the mini-open thoracoscopic-assisted approach in the management of 
      metastatic spine disease at the thoracolumbar junction.
PG  - E16
LID - 10.3171/2016.5.FOCUS16162 [doi]
AB  - OBJECTIVE: Treatment advances have resulted in improved survival for many cancer 
      types, and this, in turn, has led to an increased incidence of metastatic 
      disease, specifically to the vertebral column. Surgical decompression and 
      stabilization prior to radiation therapy have been shown to improve functional 
      outcomes, but anterior access to the thoracolumbar junction may involve open 
      thoracotomy, which can cause significant morbidity. The authors describe the 
      treatment of 12 patients in whom a mini-open thoracoscopic-assisted approach 
      (mini-open TAA) to the thoracolumbar junction was used to treat metastatic 
      disease, with an analysis of outcomes. METHODS: The authors reviewed a 
      retrospective cohort of patients treated for thoracolumbar junction metastatic 
      disease with mini-open TAA between 2004 and 2016. Data collection included 
      operative time, estimated blood loss, length of stay, follow-up duration, and 
      pre- and postoperative visual analog scale scores and Frankel grades. RESULTS: 
      Twelve patients underwent a mini-open TAA procedure for metastatic disease at the 
      thoracolumbar junction. The mean age of patients was 59 years (range 53-77 
      years), mean estimated blood loss was 613 ml, and the mean duration of the 
      mini-open TAA procedure was 234 minutes (3.8 hours). The median length of stay in 
      the hospital was 7.5 days (range 5-21 days). All 12 patients had significant 
      improvement in their postoperative pain scores in comparison with their 
      preoperative pain scores (p < 0.001). No patients suffered from worsening 
      neurological function after surgery, and of 7 patients who presented with 
      neurological dysfunction, 6 (86%) had an improvement in their Frankel grade after 
      surgery. No patients experienced delayed hardware failure requiring reoperation 
      over a mean follow-up of 10 months (range 1-45 months). CONCLUSIONS: The 
      mini-open TAA to the thoracolumbar junction for metastatic disease is a durable 
      procedure that has a reduced morbidity rate compared with traditional open 
      thoracotomy for ventral decompression and fusion. It compares well with 
      traditional and novel posterior approaches to the thoracolumbar junction. The 
      authors found a significant improvement in preoperative pain and neurological 
      symptoms that supports greater use of the mini-open TAA for the treatment of 
      complex metastatic disease at the thoracolumbar junction.
FAU - Ravindra, Vijay M
AU  - Ravindra VM
AD  - Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer 
      Institute, University of Utah, Salt Lake City, Utah.
FAU - Brock, Andrea
AU  - Brock A
AD  - Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer 
      Institute, University of Utah, Salt Lake City, Utah.
FAU - Awad, Al-Wala
AU  - Awad AW
AD  - Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer 
      Institute, University of Utah, Salt Lake City, Utah.
FAU - Kalra, Ricky
AU  - Kalra R
AD  - Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer 
      Institute, University of Utah, Salt Lake City, Utah.
FAU - Schmidt, Meic H
AU  - Schmidt MH
AD  - Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer 
      Institute, University of Utah, Salt Lake City, Utah.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Aged
MH  - Cohort Studies
MH  - *Disease Management
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Lumbar Vertebrae/diagnostic imaging/*surgery
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Spinal Neoplasms/diagnostic imaging/*secondary/*surgery
MH  - Thoracic Vertebrae/diagnostic imaging/*surgery
MH  - Thoracoscopy/*methods
OTO - NOTNLM
OT  - EBL = estimated blood loss
OT  - SSI = surgical site infection
OT  - TAA = thoracoscopic-assisted approach
OT  - VAS = visual analog scale
OT  - metastatic
OT  - mini-open TAA
OT  - thoracoscopic-assisted approach
OT  - thoracotomy
EDAT- 2016/08/02 06:00
MHDA- 2017/03/01 06:00
CRDT- 2016/08/02 06:00
PHST- 2016/08/02 06:00 [entrez]
PHST- 2016/08/02 06:00 [pubmed]
PHST- 2017/03/01 06:00 [medline]
AID - 10.3171/2016.5.FOCUS16162 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2016 Aug;41(2):E16. doi: 10.3171/2016.5.FOCUS16162.