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Posterolateral Approach to Thoraco-Lumbar Metastases - Separation Surgery

  • Ori Barzilai
  • Ilya Laufer
  • Mark H. BilskyEmail author
Chapter

Abstract

Treatment of metastatic spinal disease is a multidisciplinary team effort. With scientific and technological advancements, decision-making has become increasingly complex. Neurologic, oncologic, mechanical and systemic (NOMS) is an adaptive treatment algorithm that integrates advances in cancer care and can aid in strategic treatment planning as it covers the four major considerations in spine tumor care: neurology, oncology, mechanical stability, and systemic status and co-morbidities. Spine stereotactic radiosurgery (SSRS) has revolutionized the treatment of spinal metastatic disease and has been demonstrated to deliver an ablative tumoral dose resulting in high rates of local control. SSRS is defined as high-dose conformal photon therapy and overcomes radioresistance seen with conventional external beam radiation therapy by fundamentally changing the radiobiologic effect. The response to SSRS is dose-dependent, and in order to deliver a tumoricidal dose, a safe distance between the spinal cord and tumor must be present or created. Hence, patients with high-grade cord compression from “radioresistant” tumors undergo hybrid separation surgery-SSRS treatment. This entails a single-stage posterolateral surgical approach enabling circumferential spinal cord decompression and stabilization. This hybrid separation surgery-radiosurgery therapy has been proven to be safe and efficient but also improves patients’ health-related quality of life (HRQoL) (Barzilai et al., Neuro Oncol Pract, 2017).

Keywords

Spine Tumor Metastases Surgery Separation surgery Radiosurgery 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Memorial Sloan Kettering Cancer Center, Department of NeurosurgeryNew YorkUSA
  2. 2.Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkUSA

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