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Posterior-only 2-level vertebrectomy and fusion in a medically complex patient with lumbar metastasis: illustrative case – Lumbar Fusion

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The article discusses the case of a 68-year-old male patient with intractable lower back pain and diminished ambulation due to a lumbar metastasis from a cholangiocarcinoma primary. The patient underwent a high-risk surgery involving a 2-level vertebrectomy with expandable cage placement and fusion from T10 to S2 using a posterior-only approach. Despite the risks involved, the patient regained mobility and quality of life post-surgery. The case highlights the feasibility of using a posterior-only approach for lumbar vertebrectomies and fusion in certain cases, emphasizing the importance of multidisciplinary deliberations and thorough discussion of the risks and expected outcomes with the patient, especially in palliative surgeries with a limited prognosis

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

BACKGROUND: Spinal metastases are commonly seen in patients with cancer and often indicate a poor prognosis. Treatment can include curative or palliative surgery, chemotherapy, and radiation therapy. The surgical approach varies widely on the basis of the affected region of the spine, the location of the tumor (anterior versus posterior), the goal of surgery, the health of the patient, and surgeon preference.

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J Neurosurg Case Lessons. 2024 Apr 1;7(14):CASE23646. doi: 10.3171/CASE23646. Print 2024 Apr 1. ABSTRACT BACKGROUND: Spinal metastases are commonly seen in patients with cancer and often indicate a poor prognosis. Treatment can include curative or palliative surgery, chemotherapy, and radiation therapy. The surgical approach varies widely on the basis of the affected region of the,

J Neurosurg Case Lessons. 2024 Apr 1;7(14):CASE23646. doi: 10.3171/CASE23646. Print 2024 Apr 1.

ABSTRACT

BACKGROUND: Spinal metastases are commonly seen in patients with cancer and often indicate a poor prognosis. Treatment can include curative or palliative surgery, chemotherapy, and radiation therapy. The surgical approach varies widely on the basis of the affected region of the spine, the location of the tumor (anterior versus posterior), the goal of surgery, the health of the patient, and surgeon preference.

OBSERVATIONS: The authors present a case of a 68-year-old male with intractable lower-back pain and substantially diminished ambulation. Diagnostic imaging revealed a lumbar metastasis from a cholangiocarcinoma primary at L2-3 (4.5 cm anteroposterior × 5.7 cm transverse × 7.0 cm craniocaudal). The patient underwent a 2-level vertebrectomy with expandable cage placement and T10 to S2 fusion via a posterior-only approach. The patient regained much of his mobility and quality of life after the surgery.

LESSONS: Although this was a high-risk surgery, the authors show that a posterior-only approach can be used for lumbar vertebrectomies and fusion when necessary. Palliative surgeries carrying a high risk, especially in the setting of a limited prognosis, should include multidisciplinary deliberations and a thorough discussion of the risks and outcome expectations with the patient.

PMID:38560936 | DOI:10.3171/CASE23646

The London Spine Unit : the highest rated spinal hospital on Harley Street UK

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Posterior-only 2-level vertebrectomy and fusion in a medically complex patient with lumbar metastasis: illustrative case

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J Neurosurg Case Lessons. 2024 Apr 1;7(14):CASE23646. doi: 10.3171/CASE23646. Print 2024 Apr 1. ABSTRACT BACKGROUND: Spinal metastases are commonly seen in patients with cancer and often indicate a poor prognosis. Treatment can include curative or palliative surgery, chemotherapy, and radiation therapy. The surgical approach varies widely on the basis of the affected region of the

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