Comparison of Peri-Operative Effectiveness between Anterior-Posterior Approach and Posterior Only Approach in Metastatic Thoracic Spinal Tumor

Ji Hoon Kim; Jin Hoon Park; Sang Ryong Jeon

doi:10.13004/jknts.2011.7.2.57

Journal List > J Korean Neurotraumatol Soc > v.7(2) > 1084099

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Kim, Park, and Jeon: Comparison of Peri-Operative Effectiveness between Anterior-Posterior Approach and Posterior Only Approach in Metastatic Thoracic Spinal Tumor

Clinical Article

Journal of Korean Neurotraumatology Society 2011; 7(2): 57-62.

Published online: 31 October 2011

DOI: https://doi.org/10.13004/jknts.2011.7.2.57

Comparison of Peri-Operative Effectiveness between Anterior-Posterior Approach and Posterior Only Approach in Metastatic Thoracic Spinal Tumor

Ji Hoon Kim, MD, Jin Hoon Park, MD, Sang Ryong Jeon, MD, PhD

Department Neurological Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

Address for correspondence: Sang Ryong Jeon, MD, PhD. Department Neurological Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3550, Fax: +82-2-3010-3550, srjeon@amc.seoul.kr

Received 29 March 2011 Revised 13 August 2011 Accepted 15 August 2011

Abstract

Objective

This paper shows the appropriate method of metastatic thoracic spine cord surgery by comparing survival, pain scale (Numeric Rating Scale) and Barthel index which are considered as the prognosis of surgery in anterior-posterior approach and posterior approach.

Methods

The author has researched 61 cases of metastatic thoracic spine tumor operations; 10 cases of anterior-posterior approach and 51 cases of posterior approach, performed in this institution for 8 years from January 2001 to December 2008. The author has compared improvement of neurologic symptoms after surgery (improvement in ambulation), survival, pain scale (Numeric Rating Scale) and functional outcome according to Barthel index. Statistical analysis was done using Kaplan Meyer Survival analysis, Log-Rank test and Mann-Whitney test.

Results

The average age of patients who received surgery were 56.8 years (35-72 years) and 53.9 years (26-75 years), in the anterior-posterior approach group and the posterior approach group respectively. The Barthel index increased from average 68.7 to 72.9 in the anterior-posterior approach group and 61.6 to 69.3 in the posterior approach group (p=0.027, p<0.001). Improvement in pain were 40% in the anterior-posterior approach group and 51% in the posterior approach on 1 month post-operation. Both posterior decompression and screw fixation were performed in both operations, and it has shown that there were no significant difference in survival, improvement of ambulation, improvement in pain and functional outcome compared with the anterior-posterior approach.

Conclusion

Considering similar survival and clinical outcomes, posterior approach can minimize morbidity related with operation.

Keywords: Metastatic spinal tumor, Anterior-posterior approach, Posterior approach, Prognosis

Figures and Tables

FIGURE 1

A: Radiographic photography of anterior-posterior group. B: Radiographic photography of posterior group.

FIGURE 2

Preoperative ambulatory function in each group.

FIGURE 3

Postoperative ambulatory function in each group.

FIGURE 4

Comparison of Barthel Index in each group. A: Combined anterior-posterior group. B: Posterior group.

FIGURE 5

Postoperative pain relief in each group after a month.

TABLE 1

Age and Sex, Tokuhashi score, frequency of primary cancer in each group

TABLE 2

Mean surgical level and Surgical complications

OP: operative

Notes

The authors have no financial conflicts of interest.

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