Percutaneous Stabilization

  • Ori Barzilai
  • Mark H. Bilsky
  • Ilya LauferEmail author


Neoplastic spinal instability serves as an independent surgical indication as radiation and systemic cancer treatment do not restore spinal stability. In the setting of spinal instability with low-grade epidural disease and without spinal cord or nerve root compromise, percutaneous stabilization offers short operative times with minimal blood loss, quick recovery, and rapid return to systemic therapy. Utilization of minimally invasive surgery to restore spinal stability offers palliative benefit in reducing instability-associated pain and improvement of quality of life. Widespread use of navigation systems has allowed better understanding of their advantages and pitfalls. These systems improve the accuracy and safety of pedicle screw placement, especially in more complex spinal deformities, while eliminating operating room staff radiation exposure. Technological and engineering advances have brought forth a variety of percutaneous stabilization systems, each with unique strengths and limitations. With the growing complexity of decision-making in cancer care, it is important that surgeons familiarize with cancer treatment paradigms to facilitate decision-making and provide safe, adequate, and timely therapies. One option is the Neurologic, Oncologic, Mechanical stability and Systemic (NOMS) framework. Modern cancer therapies have improved overall survival times, and spinal metastatic disease is commonly diagnosed. The utilization of minimally invasive surgical techniques, such as percutaneous stabilization, is likely to grow. Surgeons must study the procedural aspects of minimally invasive surgery including complication avoidance, staff radiation safety, and technical troubleshooting.


Spine Tumor Percutaneous Minimally invasive surgery (MIS) Minimal access surgery (MAS) Spinal stabilization Spinal metastases 


  1. 1.
    Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324–8.CrossRefGoogle Scholar
  2. 2.
    Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744–51.CrossRefGoogle Scholar
  3. 3.
    Barzilai O, Laufer I, Yamada Y, Higginson DS, Schmitt AM, Lis E, et al. Integrating evidence-based medicine for treatment of spinal metastases into a decision framework: neurologic, oncologic, mechanicals stability, and systemic disease. J Clin Oncol. 2017;35(21):2419–27. Scholar
  4. 4.
    Bilsky MH, Laufer I, Burch S. Shifting paradigms in the treatment of metastatic spine disease. Spine (Phila Pa 1976). 2009;34(22 Suppl):S101–7.CrossRefGoogle Scholar
  5. 5.
    Yamada Y, Katsoulakis E, Laufer I, Lovelock M, Barzilai O, McLaughlin LA, et al. The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery. Neurosurg Focus. 2017;42(1):E6.CrossRefGoogle Scholar
  6. 6.
    Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the spine oncology study group. Spine (Phila Pa 1976). 2010;35(22):E1221–9.CrossRefGoogle Scholar
  7. 7.
    Rades D, Fehlauer F, Schulte R, Veninga T, Stalpers LJ, Basic H, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol. 2006;24(21):3388–93.CrossRefGoogle Scholar
  8. 8.
    Holly LT, Foley KT. Intraoperative spinal navigation. Spine (Phila Pa 1976). 2003;28(15 Suppl):S54–61.Google Scholar
  9. 9.
    Rahmathulla G, Nottmeier EW, Pirris SM, Deen HG, Pichelmann MA. Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance. Neurosurg Focus. 2014;36(3):E3.CrossRefGoogle Scholar
  10. 10.
    Hansen-Algenstaedt N, Kwan MK, Algenstaedt P, Chiu CK, Viezens L, Chan TS, et al. Comparison between minimally invasive surgery and conventional open surgery for patients with spinal metastasis: a prospective propensity score-matched study. Spine (Phila Pa 1976). 2017;42(10):789–97.CrossRefGoogle Scholar
  11. 11.
    Hikata T, Isogai N, Shiono Y, Funao H, Okada E, Fujita N, et al. A retrospective cohort study comparing the safety and efficacy of minimally invasive versus open surgical techniques in the treatment of spinal metastases. Clin Spine Surg. 2017;30(8):E1082–E1087.CrossRefGoogle Scholar
  12. 12.
    Rao PJ, Thayaparan GK, Fairhall JM, Mobbs RJ. Minimally invasive percutaneous fixation techniques for metastatic spinal disease. Orthop Surg. 2014;6(3):187–95.CrossRefGoogle Scholar
  13. 13.
    Kumar N, Malhotra R, Maharajan K, Zaw AS, Wu PH, Makandura MC, et al. Metastatic spine tumor surgery: a comparative study of minimally invasive approach using percutaneous pedicle screws fixation versus open approach. Clin Spine Surg. 2017;30(8):E1015–E1021.CrossRefGoogle Scholar
  14. 14.
    Disa JJ, Smith AW, Bilsky MH. Management of radiated reoperative wounds of the cervicothoracic spine: the role of the trapezius turnover flap. Ann Plast Surg. 2001;47(4):394–7.CrossRefGoogle Scholar
  15. 15.
    Yang Z, Yang Y, Zhang Y, Zhang Z, Chen Y, Shen Y, et al. Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review. World J Surg Oncol. 2015;13:68.CrossRefGoogle Scholar
  16. 16.
    Burval DJ, McLain RF, Milks R, Inceoglu S. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976). 2007;32(10):1077–83.CrossRefGoogle Scholar
  17. 17.
    Jackson JB 3rd, Crimaldi AJ, Peindl R, Norton HJ, Anderson WE, Patt JC. Effect of polyether ether ketone on therapeutic radiation to the spine: a pilot study. Spine (Phila Pa 1976). 2017;42(1):E1–7.CrossRefGoogle Scholar
  18. 18.
    Barzilai O, DiStefano N, Lis E, Yamada Y, Lovelock DM, Fontanella AN, et al. Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: a clinical and dosimetric analysis. J Neurosurg Spine. 2017:1–7.Google Scholar
  19. 19.
    Mendel E, Bourekas E, Gerszten P, Golan JD. Percutaneous techniques in the treatment of spine tumors: what are the diagnostic and therapeutic indications and outcomes? Spine (Phila Pa 1976). 2009;34(22 Suppl):S93–100.CrossRefGoogle Scholar
  20. 20.
    Papanastassiou ID, Filis AK, Gerochristou MA, Vrionis FD. Controversial issues in kyphoplasty and vertebroplasty in malignant vertebral fractures. Cancer Control. 2014;21(2):151–7.CrossRefGoogle Scholar
  21. 21.
    Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225–35.CrossRefGoogle Scholar
  22. 22.
    Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, et al. Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am. 1995;77(8):1200–6.CrossRefGoogle Scholar
  23. 23.
    Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000;9(3):235–40.CrossRefGoogle Scholar
  24. 24.
    Tian NF, Huang QS, Zhou P, Zhou Y, Wu RK, Lou Y, et al. Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J. 2011;20(6):846–59.CrossRefGoogle Scholar
  25. 25.
    Laudato PA, Pierzchala K, Schizas C. Pedicle screw insertion accuracy using O-Arm, robotic guidance or freehand technique: a comparative study. World J Surg Oncol. 2015;13:68.Google Scholar
  26. 26.
    Zairi F, Arikat A, Allaoui M, et al. Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis. J Neurosurg Spine. 2012;17(1):19–23.CrossRefGoogle Scholar

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 Surgery, Weill Cornell Medical CollegeNew YorkUSA

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