Versatility of Percutaneous Pedicular Screw Fixation in Metastatic Spine Tumor Surgery

Abstract

Background: Minimally invasive surgery has been evolved to address the problems associated with metastatic spine diseases (MSD). Posterior percutaneous spinal fixation (PPSF) is one of the main modalities of minimally invasive surgery. There have been a number of studies which evaluated the outcomes of PPSF but none of them assessed in detail regarding the versatility of PPSF in MSD. This study was designed to evaluate feasibility and spectrum of application of PPSF in management of MSD, highlighting its clinical advantages. Hypothesis: The spectrum of PPSF is quite versatile in management of MSD, even in patients with predicted poor survival prognosis Methods: Twenty-seven consecutive patients with MSD treated with PPSF in our institution from January 2011 to June 2014 were studied. All patients, after a multi-disciplinary assessment, were considered for surgical intervention due to clinical presentation of either neural deficit, skeletal instability, or both. Some of these patients belonged to poor prognostic category based on survival prognostic scoring systems i.e Tokuhashi and Tomita. The patients were categorized into seven groups depending on the modality of PPSF used. Demographic data, operative details, and clinical outcomes were investigated for each category and compared pre and postoperatively. Result(s): The median age was 60 years (range: 49-78 yrs). Generally, all patients either maintained or improved their neurological status and achieved pain alleviation. none of the patients in any group showed worsening in neurological status in postoperative period. Ambulatory status and ECOG scores were also improved using any modality of PPSF. Pure stabilization group had the lowest amount of mean blood loss (92 ml), shortest operative time (180 minutes), ICU (1 day) and hospital stays (10 days) while long construct group was observed to have greatest amount of blood loss (355 ml), longest operative time (305 minutes) and ICU stay (2.5 days). Conclusion(s): For patients with MSD, even with predicted poor prognosis on survival prognostic scoring systems, it is possible to improve functional outcomes and quality of life with PPSF keeping surgical morbidity to a minimum. PPSF allows addressing patients with pure spinal instability successfully with least morbidity.