Eric Massicotte, Matthew Foote, Rajesh Reddy and Arjun Sahgal, Technology in Cancer Research and Treatment (2012) 11
We report a novel approach in the treatment of spinal metastases with epidural disease and mechanical instability using a combined minimal access spine surgery (MASS) technique followed by spine stereotactic body radiotherapy (SBRT).
This study was performed as a retrospective review of the first ten consecutive patients treated with this combined approach. The MASS technique was based on a tubular retraction system to gain access for decompression and mechanical stabilization achieved using methylmethacrylate (MMA) applied under direct visualization.
SBRT consisted of one to five image-guided high dose per fraction treatments. Eight patients were symptomatic at baseline. Pain, disability, and quality of life (QOL) were prospectively determined using the visual analogue score (VAS), Oswestry Disability Index (ODI), and ShortForm36 version 2, respectively.
The median followup was 13 months (range, 318). MASS successfully decompressed each patient. The median blood loss was 335ml. Following MASS, the median time to SBRT treatment planning was 6.5 days and subsequent median time to treatment was 7 days. Local control was observed in 7 of the 10 patients. Improvements in VAS, ODI and QOL were observed postSBRT. We report preliminary efficacy for our MASS-SBRT combined approach for patients with spinal metastases, mechanical pain and epidural disease.