Postoperative outcomes of minimally invasive pedicle screw fixation for treatment of unstable pathologic neoplastic fractures

Matthew Chin; Jael E Camacho; Ivan B Ye; Jacob J Bruckner; Alexandra E Thomson; Julio J Jauregui; Kendall Buraimoh; Daniel L Cavanaugh; Eugene Y Koh; Daniel E Gelb; Steven C Ludwig

doi:10.1016/j.jor.2022.02.014

Postoperative outcomes of minimally invasive pedicle screw fixation for treatment of unstable pathologic neoplastic fractures

J Orthop. 2022 Feb 15:30:72-76. doi: 10.1016/j.jor.2022.02.014. eCollection 2022 Mar-Apr.

Affiliation

¹ Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA.

Abstract

Study design: Retrospective Case Series.

Objectives: Minimally invasive techniques have emerged as a useful tool in the treatment of neoplastic spine pathology due to decrease in surgical morbidity and earlier adjuvant treatment. The objective of this study was to analyze outcomes and complications in a cohort of unstable, symptomatic pathologic fractures treated with percutaneous pedicle screw fixation (PPSF).

Methods: A retrospective review was performed on consecutive patients with spinal stabilization for unstable pathologic neoplastic fractures between 2007 and 2017. Patients who underwent PPSF through a minimally invasive approach were included. Surgical indications included intractable pain, mechanical instability, and neurologic compromise with radiologic visualization of the lesion.

Results: 20 patients with mean Tomita Score of 6.3 ± 2.1 points [95% CI, 5.3-7.2] were treated with constructs that spanned a mean of 4.7 ± 1.4 [95% CI, 4.0-5.3] instrumented levels. 10 (50%) patients were augmented with vertebroplasty. Majority of patients (65%) had no complications during their hospital stay and were discharged home (60%). Four patients received reoperation: two extracavitary corpectomies, one pathologic fracture at a different level, and one adjacent segment disease.

Conclusion: Minimally invasive PPSF is a safe and effective option when treating unstable neoplastic fractures and may be a viable alternative to the traditional open approach in select cases.

Level of evidence: 4.

Keywords: MIS, Minimally Invasive Surgery; MISS, Minimally Invasive Spine Surgery; Minimally invasive spine surgery; PPSF, Percutaneous Pedicle Screw Fixation; Pathologic fracture; Percutaneous pedicle screw fixation; Spine metastasis; Thoracolumbar spine.