Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases

Study Design. Retrospective review of prospectively maintained institutiona l spine database. Objectives. To assess the pain, neurologic, and functional outcome of patie nts with metastatic spinal cord compression using a posterolateral transped icular approach with circumferential fusion. Summary of Background Data. Patients with spinal metastases often have patt erns of disease requiring both an anterior and posterior surgical decompres sion and spinal fusion. For patients whose concurrent illness or previous s urgery makes an anterior approach difficult, a posterior transpedicular app roach was used to resect the involved vertebral bodies, posterior elements, and epidural tumor. This approach provides exposure sufficient to decompre ss and instrument the anterior and posterior columns. Methods. During the past 15 months, 25 patients were operated on using a po sterolateral transpedicular approach. The primary indications for surgery w ere back pain (15 patients) and neurologic progression (10 patients). All p atients had vertebral body disease, and 21 patients had high-grade spinal c ord compression from epidural disease as assessed by magnetic resonance ima ging. Seven patients underwent preoperative embolization for vascular tumor s, in each patient, the anterior column was reconstructed with polymethyl m ethacrylate and Steinmann pins and the posterior column with long segmental fixation. Results. All patients achieved immediate stability. Pain relief was signifi cant in all 23 patients who had had moderate or severe pain, Neurologic sym ptoms were stable or improved in 23 patients. One patient with an acutely e volving myelopathy was immediately worse after surgery, and one patient had a delayed neurologic worsening, progressing to paraplegia. Conclusions. The posterolateral transpedicular approach provides a wide sur gical exposure to decompress and instrument the anterior and posterior spin e. This technique avoids the morbidity associated with anterior approaches and provides immediate stability. Vascular rumors may be removed safely aft er embolization. Patients can be mobilized early after surgery.