Below the spinal cord, mechanical radiculopathy serves as the primary indication for decompression, as has been shown to consistently respond to stabilization and decompression 27.

Patients with ESCC scores of 2 and 3 due to radioresistant tumors generally require decompression. The utilization of metastatic epidural spinal cord compression (ESCC) score 10 facilitates description of the degree of epidural tumor extension, with scores of 2 (spinal cord displacement) and 3 (absence of CSF around the spinal cord due to tumor extension) representing patients with high-grade epidural disease. The principal surgical indications among patients with spinal metastases include mechanical instability and spinal cord compression due to radioresistant tumors. Patient reported outcome (PRO) data were collected in order to define the effect of MAS surgery on spine tumor-related symptoms and to validate this treatment algorithmДЇigure 1 outlines the algorithm used for selection of MAS procedure in the treatment of patients with thoracolumbar fractures due to metastatic tumors. Our experience with MAS spine tumor surgery led to the development of an algorithm to facilitate the selection of appropriate MAS techniques ( Figure 1). Our encouraging results with percutaneous spinal instrumentation lead us to explore the additional role of MAS techniques in decompression of the spinal cord and nerve roots. We previously published our initial experience with percutaneous instrumented stabilization with cement augmentation for the treatment of neoplastic spinal instability 29. Combination of surgery with post-operative high-dose conformal radiation has improved local tumor control and has diminished the role of aggressive tumor excision 8. These goals may be achieved using a variety of techniques including combination of posterior and anterior instrumentation, corpectomy, laminectomy and separation surgery, with MAS techniques having been described for all of these surgical options. Surgical indications for the treatment of spinal metastases include restoration of mechanical stability and decompression the spinal cord or nerve roots 9. Since patients with spinal tumors generally require a combination of surgical, radiation and systemic therapies, expeditious post-operative healing and return to treatment is of paramount importance.

The growing implementation of minimal access surgery (MAS) in the treatment of degenerative and traumatic spinal disorders has led to the exploration of MAS role in the treatment of spinal deformity and tumors.

Pro tools 12.7 unstable