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Annals of Surgical Oncology

, Volume 21, Issue 9, pp 2864–2872 | Cite as

Optimal Approach to Circumferential Decompression and Reconstruction for Thoracic Spine Metastatic Disease

  • Neil R. Malhotra
  • Jennifer Kosty
  • Matthew Sanborn
  • Jonathan M. Bekisz
  • Theodore W. Mooncai
  • Thomas M. Neustein
  • Jessica Ou
  • Anna Zhu
  • Ali Bernstein
  • Sherman C. Stein
Thoracic Oncology
  • 380 Downloads

Abstract

Background

Circumferential decompression has been demonstrated to be the first-line therapy for patients with metastatic tumors in the thoracic spine requiring surgical intervention. However, there is significant debate regarding whether these tumors are best accessed anteriorly utilizing a thoracotomy or posteriorly. We used decision analysis to determine which approach yields greater health-related quality of life (QOL).

Methods

We searched Medline, Embase, and the Cochrane Library for relevant articles published between 1990 and 2011 on anterior and posterior approaches to metastatic disease in the thoracic spine. QOL values for major treatment outcomes were determined using the existing literature. Separate models were created for ambulatory and nonambulatory patients. A Monte Carlo simulation and sensitivity analyses were used to determine which treatment strategy resulted in the highest QOL.

Results

For ambulatory patients, an anterior approach resulted in a slightly higher QOL, and for nonambulatory patients, a posterior approach was favored, but these differences were not statistically significant.

Conclusions

Using a decision-analytic model, we found no significant difference in QOL resulting from anterior versus posterior approaches to metastatic lesions in the thoracic spine. Decisions should instead be based on surgeon comfort, tumor characteristics, anatomy of the lesion, patient-related factors, and goals of the operation.

Keywords

Thoracic Spine Posterior Approach Anterior Approach Spinal Cord Compression Posterior Decompression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors declare no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Neil R. Malhotra
    • 1
  • Jennifer Kosty
    • 2
  • Matthew Sanborn
    • 1
  • Jonathan M. Bekisz
    • 3
  • Theodore W. Mooncai
    • 3
  • Thomas M. Neustein
    • 3
  • Jessica Ou
    • 3
  • Anna Zhu
    • 3
  • Ali Bernstein
    • 3
  • Sherman C. Stein
    • 1
  1. 1.Department of NeurosurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of NeurosurgeryUniversity of CincinnatiCincinnatiUSA
  3. 3.The University of PennsylvaniaPhiladelphiaUSA

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