Single-Stage Posterolateral Transpedicle Approach with Circumferential Decompression and Instrumentation for Spinal Metastases

Abstract

Metastatic tumors to the spine account for significant morbidity in cancer patients. With treatment, one seeks to restore quality of life, reduce pain, and preserve or maintain neurological function. The roles for chemotherapy, radiation therapy (RT), and surgery continue to evolve, but clearly all play significant roles in treating metastatic spinal tumors. Initial attempts to treat tumors using a laminectomy approach proved no better than radiation alone. Inherently, laminectomy is ineffective for treating metastatic spine tumors because it does not effectively address anterior vertebral body or epidural tumor, and creates iatrogenic instability. The evolution of operative approaches for metastatic spine tumors, including anterior transcavitary and posterolateral, and the development of segmental fixation has markedly improved surgical outcomes (1–5, 7–14, 16–30). This chapter describes the authors’ indications, operative techniques, and outcomes using a singlestage posterolateral transpedicle approach (PTA) (2), which provides exposure for epidural tumor and vertebral body resection, and anterior and posterior reconstruction.