| Popis: |
The decision-making challenges of surgically treating spinal neoplasms are many and include the individual patient’s symptom profile, the nature and morphology of the tumor(s), presence of multiple or peripheral metastases, neurologic or pending neurologic status (spinal cord compression), resultant spinal deformities or instabilities, adjuvant radiation or chemotherapies, and expected life span. The minimally invasive surgical treatment of spinal tumors has historically been considered oxymoronic, as exposures that allow for adequate tumor exposure and resectioning were, by nature, open exposure approaches. Less-invasive exposures were long considered inadequate in managing a variety of tumors, especially when en bloc resection is required. With the advent of stereotactic radiotherapy, the development and proliferation of endoscopic and mini-open approaches, and the paradigm shifts in spinal oncology thinking, a new era of individualized multidisciplinary approaches has emerged, minimizing morbidity and maximizing effectiveness. Several less-invasive approaches for spine tumor removal are currently being used and can be broadly categorized as thoracoscopic, mini-open anterior, and mini-open posterior approaches. Each approach has benefits and drawbacks and should be tailored to the individual needs of the patient. Because these patients usually undergo these procedures for quality of life (prevention of paralysis, maintenance of continence, and pain control), minimizing the morbidity from the surgery is paramount. Moreover, faster wound healing is desirable to allow for early postoperative radiation or chemotherapy. The goal of a less-invasive approach is to try to achieve these two goals, yet at the same time still accomplish the same surgical result. |
