Traditional Open versus Mini-open Transpedicular Corpectomy in Thoracic Spinal Metastases
Meeting Highlight from the 31st Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves—Spine Summit 2015
Darryl Lau, MD, a resident in the Department of Neurosurgery at the University of California at San Francisco presented, Posterior Thoracic Corpectomies with Cage Reconstruction for Metastatic Spinal Tumors: Comparing the Mini-Open Approach to the Open Approach. Dr. Lau’s presentation was made during the 31st Annual Meeting of the Section on Disorders of the Spine and Peripheral Nerves—Spine Summit 2015 in Phoenix, AZ.
Spinal metastases are known to affect the spine’s vertebral bodies. Generally, open transpedicular corpectomy is the treatment for thoracic metastasis. However, ample evidence shows that less invasive approaches, such as mini-open or MIS approaches can decrease morbidity and shorten recovery time. In this study, the authors compare a mini-open approach to the traditional open approach to determine if the mini-open approach is superior.
- In a traditional open transpedicular corpectomy, there is exposure of the fascia and paraspinal muscles over all levels—the level of the corpectomy and instrumented levels.
- The mini-open transpedicular corpectomy opens up the fascia and paraspinal muscles only at the level of the corpectomy. Percutaneous instrumentation is utilized above and below.
About the Study
Doctors Lau and Chou performed a retrospective study; a consecutive cohort from 2006 to 2013 of a single surgeon’s experience. The outcomes of interest were operative time, estimated blood loss, complications, neurological status utilizing the American Spinal Injury Association score (ASIA score), and long-term revision reoperation rates.
The study included 49 patients; 21 in the mini-open group and 28 in the open group. “We had a really well-matched cohort; there’s no significant difference between the two groups in terms of demographics, comorbidities, their neurological status, tumor types, the number of corpectomies performed, and the number of levels instrumented. There was also no difference in operative time between the open group and the mini-open group,” remarked Dr. Lau. The open group had a mean of 414 minutes versus 450 minutes in the mini-open.
“The mini-open group trended towards lower perioperative complication rates and lower infection rates; however, this wasn’t significant. I think if we had a larger cohort with a larger power, this probably would be significant as well. In terms of long-term follow up, there is no difference in ASIA score and there is no difference in complication rates following the 30-day postoperative period. In regard to the need for surgical revision, the rates were actually the same and there is no difference there,” stated Dr. Lau.
The mini-open transpedicular corpectomy is a viable option. The procedure offers patients with spinal metastases a faster recovery, which is very important considering their short life expectancy.