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A posterior fusion alone will result in continued spinal cord compression
65%
613/942
A posterior laminectomy alone will lead to progressive lordosis
6%
54/942
An anterior corpectomy and reconstruction will inadequately decompress the neural elements
10%
93/942
A kyphoplasty and posterior fusion is the recommended treatment of choice
15%
138/942
A kyphoplasty alone should be performed to minimize bleeding with renal cell carcinoma
4%
36/942
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This patient has a metastatic lesion to the thoracic vertebrae with spinal cord compression. A posterior fusion alone will inadequately decompress the spinal cord. This patient's imaging shows a metastatic lesion in the lower thoracic vertebral bodies with spinal cord compression. Metastatic cancer is the most common reason for a destructive bone lesion in adults with carcinomas more commonly spreading to bone. These include breast (16-37% of breast cancer patients develop spine mets),lung (12-15%), thyroid (4%), renal (3-6%), and prostate (9-15%). Renal cell carcinoma is not radiosensitive and therefore, is unresponsive to radiation therapy. In these cases, surgery depends on life expectancy and overall patient health; however, an anterior corpectomy and reconstruction would allow for complete decompression as well as reconstruction of the anterior column. White et al. reviewed metastatic spine disease. They report that computed tomography-guided biopsy is considered to be safe and accurate for evaluating spinal lesions. They concluded that treatment is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors, but new data has demonstrated the benefit of surgical decompression using improved techniques such as anterior approaches. Patchell et al. prospectively reviewed patients with metastatic cancer-related spinal cord compression who received either surgery followed by radiation or radiation alone. They report favorable results following the combination of surgery and radiation; the study was actually terminated early due to the results. They concluded that patients treated with surgery had an increased ability to ambulate, longer duration of ambulatory ability, and decrease in opioid consumption. Figures A&B are the CT images demonstrating a lower thoracic lesions with spinal cord compression. Incorrect Answers: Answer 2: Posterior laminectomy would not adequately decompress the neural elements and will lead to progressive kyphosis. However, a posterior approach with laminectomy, transpedicular decomperssion and posterior fusion without anterior column reconstruction could be considered in a patient with short life expectancy and/or poor overall health Answer 3: An anterior corpectomy and reconstruction would allow for complete decompression as well as reconstruction of the anterior column Answers 4&5: Kyphoplasty is not indicated in a lesion with disruption of the posterior cortex and neurologic impairment
3.5
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