Expert’s comment concerning Grand Rounds case entitled “Posterolateral cervical transpedicular corpectomy for the surgical management of metastatic tumor” by M.H. Pham et al. (Eur Spine J; 2018: DOI 10.1007/s00586-018-5466-7)

[摘要] Open image in new window This is a very interesting case report that also reviews much of the literature relevant to the choice of approach for metastatic disease to the upper cervical spine [1]. The authors have done a great job explaining their rationale for performing cervical corpectomy from a posterior approach. Although there are certainly drawbacks to it, it is definitely worth being aware of this option when faced with situations where an anterior approach would be problematic (e.g., previous radiation exposure, tracheo-espohageal comorbidities). Anterior approaches are particularly challenging at C3 from a standard Smith–Robinson exposure when the patient has a short neck, heavy build or a large mandible. The detailed preoperative planning and thorough description of the operative steps provided by the authors is much appreciated.In recently published articles, we described our “LMNOP” strategy [2, 3] for approach planning in metastatic spine tumors: (L) location of disease with respect to the anterior and/or posterior columns of the spine and number of spinal levels involved (contiguous or non-contiguous); (M) mechanical instability as graded by the Spine Instability Neoplastic Score (SINS), [4, 5] (N) neurology (i.e., symptomatic epidural spinal cord compression); (O) oncology (i.e., histopathologic diagnosis); and (P) patient fitness, patient wishes, prognosis and response to prior therapy.

[学科分类] 骨科学