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  4. Posterior Endoscopic Cervical Decompression in Metastatic Cervical Spine Tumors: An Alternative to Palliative Surgery

Posterior Endoscopic Cervical Decompression in Metastatic Cervical Spine Tumors: An Alternative to Palliative Surgery

JAAOS Glob Res Rev, 2022 · DOI: 10.5435/JAAOSGlobal-D-22-00201 · Published: November 1, 2022

OncologySurgery

Simple Explanation

This study presents a minimally invasive surgical option for treating spinal cord compression in the neck caused by cancer that has spread from elsewhere in the body. The method involves using an endoscope to directly remove the tumor and relieve pressure on the spinal cord. A 54-year-old man with liver cancer experienced progressive pain and weakness due to a tumor compressing his spinal cord in the neck. The tumor was successfully removed using the endoscopic technique, leading to complete neurologic recovery within a month. The endoscopic technique is considered a feasible and optional minimally invasive approach for decompressing cervical metastasis that causes unilateral radiculopathy and can serve as an alternative to palliative surgery.

Study Duration
6 Months
Participants
A 54-year-old man with hepatocellular carcinoma (HCC)
Evidence Level
Case Report

Key Findings

  • 1
    Posterior full-endoscopic decompression of cervical metastasis causing unilateral radiculopathy is a feasible surgical technique.
  • 2
    The patient achieved complete neurologic recovery at 1 month and showed no recurrent symptoms at the 6-month follow-up.
  • 3
    Postoperative radiographic study revealed adequate tumor mass resection and spinal decompression.

Research Summary

The study introduces a minimally invasive posterior full-endoscopic approach for direct decompression and tumor debulking in the cervical spine for metastatic spinal cord compression resulting from hepatocellular carcinoma (HCC). A 54-year-old male with HCC and progressive cervical radiculopathy underwent the described procedure, resulting in adequate tumor mass resection, spinal decompression, and complete neurologic recovery at 1 month with no recurrent symptoms at 6-month follow-up. The authors conclude that the posterior full-endoscopic decompression technique for cervical metastasis causing unilateral radiculopathy is feasible, yields satisfactory results, and represents the smallest surgical footprint currently available.

Practical Implications

Alternative Surgical Option

The posterior full-endoscopic decompression presents a viable alternative to traditional palliative surgery for metastatic cervical spine tumors.

Minimally Invasive Advantage

This technique offers a minimally invasive approach that can reduce blood loss, shorten surgical time, and promote early postoperative ambulation, especially beneficial for frail patients.

Improved Neurological Outcomes

The reported case demonstrates the potential for complete neurological recovery and symptom relief through effective tumor mass resection and spinal decompression.

Study Limitations

  • 1
    Single case report limits generalizability.
  • 2
    Availability of the endoscopic system may be a limiting factor.
  • 3
    Extensive cervical metastasis involving multiple vertebrae may not be suitable for this technique.

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