Extensive Posterolateral Approach for Giant Spinal Epidural Tumors

Abstract

Objective. Our objective was to determine the safety, efficacy, and surgical outcome of an extensive posterolateral approach for giant spinal epidural tumors.

Materials and Methods. Our clinical study included 12 patients with various giant primary tumors and metastases of the spine, who underwent surgery between 2008 and 2019. The surgical procedure consisted of costotransversectomy, laminectomy, corpectomy, tumor resection, spinal column stabilization, and reconstruction. Neurological status examination and pain assessment were recorded at the time of admission, upon discharge and at outpatient check-up.

Results. In our clinical sample, there were no major perioperative complications. All patients were discharged from the intensive care unit back to the hospital department within a week after the surgery. Postoperative follow-up showed no deterioration of neurological status. Furthermore, there was a moderate to significant improvement of paraparesis in all patients for weeks after surgery. The most notable improvement was significant pain relief in all the patients. None of the patients had issues with failure of the implanted hardware. Two patients died less than six months after the surgery due to the progression of the primary malignant process.

Conclusion. An extensive posterolateral approach to giant spinal epidural tumors is an effective one-step approach. It presents a good compromise between invasiveness and sufficient exposure for both tumor resection and spinal column reconstruction. Good short-term clinical improvement can be achieved, but the long term results depend on the advancement of the initial disease. Careful evaluation and selection of patients are necessary to achieve clinical improvement and prolonged life expectancy, and the best results are achieved with a multidisciplinary approach.