Abstract

Background data: The vertebral column represents the most common bony site for metastasis with an incidence ranged from 30% to 70% in patients with metastatic neoplasms. The dorsal spine carries the highest frequent site for metastasis all over the vertebral column followed by the lumber spine. These metastatic lesions are clinical entities that often necessitate a complex spinal decompression and anterior reconstruction. Posterolateral approaches alone allow for excellent decompression with transpedicular fixation and safe visualization of the neural elements for corpectomy and reconstruction so we can avoid the complications that can be happened with the staged surgery.

Purpose: our aim in the study is to report cases and evaluate our approach for fixation and assess the postoperative period regarding pain improvement and neurological deficit.

Study design: A retrospective study included 26 patients presented to neurosurgery department at Sohag university hospital within three years, between August 2014 and August 2017. Evaluation made through using the Quebec Back Pain Disability Scale and muscle power grading scale.

Material and methods: Twenty-six patients with metastatic dorsolumber spine lesions underwent a single-stage surgery by midline posterior approach. Posterior decompression with transpedicular fixation above and below the affected segment was done for all patients. Unilateral facetectomies and pediculectomy followed by corpectomy was done. Insertion of pyramesh titanium cage filled with iliac bone graft with tightness of the screws bilateral. Follow up period was 6-12 months postoperatively.

Results: The average age was 58.36±5.96 (range 33-67) years. More than two thirds of them were males (69.2%). Majority of the lesions were dorsal (77%). Postoperative infection observed in four patients (15.4%) who improved by IV antibiotics and frequent dressing while CSF leak occurred in three patients (11.5%) who stopped after daily dressing and we made CSF lumbar tap in one patient. Twenty-two patients showed neurological improvement post-operatively (84.6%).  The remaining four were paraplegic with no improvement. Back pain improved for all cases.

Conclusion: Posterolateral approach alone is an efficient safe for dorsolumber decompression and reconstruction in metastatic spine.

Keywords: Corpectomy – Pyramesh - posterolateral - pediculectomy- facetectomies.