Endoscopically assisted single-stage posterior transpedicular 2-level vertebral column resection and cage reconstruction for contiguous thoracic vertebral body metastases
Spinal metastases account for approximately 50% of skeletal lesions and demonstrate an increased incidence in the elderly. Poor long-term survival, and a high incidence of operative complications, see the majority of patients managed by radiation, with surgical intervention reserved as a last resort. Even in patients with a Tokuhashi score dictating surgical excision, significant controversy exists regarding the ideal surgical intervention that should be performed. In terms of clarifying this controversy the most essential consideration is proposed to be survival prognosis. In the thoracic spine the commonly employed surgical interventions are a posterolateral thoracotomy and transpleural vertebral body curettage or resection with a cage and lateral plate reconstruction, a posterior transpedicular tumour resection and vertebral body reconstruction, or a combined approach. While more extensive, and not without complications, a posterior Vertebral Column Resection (VCR) is a viable surgical option in these patients. During en-bloc or piecemeal VCR surgery, a surgeon invariably encounters a blind spot during which he/she must rely on palpation to relieve the ventral dural compression.
We report a case of an elderly female patient who presented to our unit acutely paraplegic secondary to 2-level pathological thoracic burst fractures from metastatic ovarian carcinoma. She was taken to the operating room for a 2-level VCR, and during the procedure we used a 30-degree endoscope to visualize the anterior dural surface, utilizing the benefit of magnification to ensure the dura had been thoroughly decompressed. According to our PubMed review this is the first report of this novel adjunctive technique.