PMID- 32080011 OWN - NLM STAT- MEDLINE DCOM- 20200904 LR - 20221207 IS - 1528-1159 (Electronic) IS - 0362-2436 (Linking) VI - 45 IP - 14 DP - 2020 Jul 15 TI - Transpedicular Vertebrectomy With Circumferential Spinal Cord Decompression and Reconstruction for Thoracic Spine Metastasis: A Consecutive Case Series. PG - E820-E828 LID - 10.1097/BRS.0000000000003450 [doi] AB - STUDY DESIGN: Retrospective case series. OBJECTIVE: To study the feasibility, outcomes, and complications of transpedicular vertebrectomy (TPV), and reconstruction for metastatic lesions to the thoracic spine. SUMMARY OF BACKGROUND DATA: Metastatic lesions to the thoracic spine may need surgical treatment requiring anterior-posterior decompression/stabilization. Anterior reconstruction may be performed using poly methyl meth acrylate (PMMA) cement or cages. Use of cement has been reported to be associated with complications. METHODS: From 2008 to 2016, consecutive cases (single surgeon) undergoing TPV for thoracic spine metastasis (T2-12) were included. Demographic, surgical, and clinical data were collected through chart review. MRI, CT, positron emission tomography images were used to identify extent of disease, epidural spinal cord compression (ESCC), and degree of vertebral body collapse. Hall-Wellner confidence band was used for the survival curve. RESULTS: Ninety six patients were studies with a median age 60 years. Most patients 56 (58%) presented with mechanical pain. 29% cases had lung metastasis. Single level TPV was performed in 73 patients (76%). Anterior reconstruction included PMMA in 78 patients (81.25%), and titanium cage in 18 patients (18.25%). Frankel grade improvement was seen in 16 cases (P = 0.013). ESCC improved by a median of 5.9 mm (P < 0.001). Kyphosis reduced by median of 7.5 degrees (P < 0.001). VAS improved by median of seven (P < 0.001). Total 59 deaths were observed. The median survival time was estimated to be 6 months (95% CI: 5, 10). Surgical outcome and complication rates are similar between the two construct types. Correction of kyphosis was seen to be slightly better with the use of PMMA. Overall 29.16% cases developed complications (11.4% major). Two cases developed neurological deficit following epidural hematoma requiring surgery. One case had instrumentation failure from cement migration, needing revision. CONCLUSION: The result of our study shows significantly improved clinical and radiological outcomes for TPV for thoracic metastatic lesions. We also discuss some important steps for use of PMMA to avoid complications. LEVEL OF EVIDENCE: 4. FAU - Rustagi, Tarush AU - Rustagi T AD - Ohio State University Wexner Medical, Columbus, OH. AD - Indian Spinal Injuries Centre, New Delhi, India. FAU - Mashaly, Hazem AU - Mashaly H AD - Ohio State University Wexner Medical, Columbus, OH. AD - Department of Neurological Surgery, Ain Shams University, Egypt. FAU - Ganguly, Ranjit AU - Ganguly R AD - Ohio State University Wexner Medical, Columbus, OH. FAU - Akhter, Asad AU - Akhter A AD - Ohio State University Wexner Medical, Columbus, OH. FAU - Mendel, Ehud AU - Mendel E AD - Ohio State University Wexner Medical, Columbus, OH. LA - eng PT - Journal Article PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 RN - 0 (Bone Cements) SB - IM MH - Bone Cements MH - *Decompression, Surgical/methods/mortality MH - Humans MH - Middle Aged MH - Posture MH - *Plastic Surgery Procedures/methods/mortality MH - Retrospective Studies MH - *Spinal Neoplasms/mortality/secondary/surgery MH - Thoracic Vertebrae/*surgery MH - Treatment Outcome EDAT- 2020/02/23 06:00 MHDA- 2020/09/05 06:00 CRDT- 2020/02/22 06:00 PHST- 2020/02/23 06:00 [pubmed] PHST- 2020/09/05 06:00 [medline] PHST- 2020/02/22 06:00 [entrez] AID - 00007632-202007150-00009 [pii] AID - 10.1097/BRS.0000000000003450 [doi] PST - ppublish SO - Spine (Phila Pa 1976). 2020 Jul 15;45(14):E820-E828. doi: 10.1097/BRS.0000000000003450.