Transforaminal Endoscopic Partial Vertebrectomy for Decompression of Spinal Metastases: A Novel, Minimally Invasive Approach to Treating Symptomatic Lumbar Vertebral Body Metastases

Abstract

Vertebral body metastases cause a significant degree of disability in patients with advanced oncological disease. Surgical treatment is an effective treatment however it comes with a long recovery period and significant post-operative pain. When spinal metastases are involved, wound healing is a limiting factor in recommencement of radiotherapy. An endoscopic vertebrectomy allows for safe rhizolysis and subsequent fixation to maintain stability. We present the first case of endoscopic partial vertebrectomy for symptomatic spinal metastases. A fifty-eight-year-old lady presented with spinal metastases secondary to metastatic lung cancer. She underwent a transforaminal endoscopic partial vertebrectomy with rhizolysis of the exiting nerve root and percutaneous pedicle screw fixation of the L3-L5 vertebral bodies. She recovered well post-operatively with complete resolution of the radicular pain and a return to baseline mobility. Endoscopic partial vertebrectomy presents a new approach to treatment of spinal metastases. This allows for a reduction in post-operative length of hospital stay, post-operative pain and an improved rate of wound healing. The reduction in wound healing allows for a faster return to treatment when compared with an open approach. An endoscopic approach is beneficial for treatment of foraminal pathology, allowing for good visualisation of the nerve root to perform optimal rhizolysis.

Keywords

• endoscopy
• minimally invasive surgical procedures
• spine