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Posterolateral Approach to Thoraco-Lumbar Metastases - Separation Surgery

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Spinal Tumor Surgery

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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).

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Authors and Affiliations

  1. Memorial Sloan Kettering Cancer Center, Department of Neurosurgery, New York, NY, USA

    Ori Barzilai, Ilya Laufer & Mark H. Bilsky

  2. Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA

    Ilya Laufer & Mark H. Bilsky

Authors
  1. Ori Barzilai
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  2. Ilya Laufer
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  3. Mark H. Bilsky
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Corresponding author

Correspondence to Mark H. Bilsky .

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Editors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA

    Daniel M. Sciubba

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Barzilai, O., Laufer, I., Bilsky, M.H. (2019). Posterolateral Approach to Thoraco-Lumbar Metastases - Separation Surgery. In: Sciubba, D. (eds) Spinal Tumor Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98422-3_17

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  • DOI: https://doi.org/10.1007/978-3-319-98422-3_17

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98421-6

  • Online ISBN: 978-3-319-98422-3

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