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

J Korean Neurotraumatol Soc. 2011 Oct;7(2):57-62. Korean.
Published online October 31, 2011.
Copyright © 2011 Korean Neurotraumatology Society
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 and 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, Email:
Received March 29, 2011; Revised August 13, 2011; Accepted August 15, 2011.



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.


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.


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.


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

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


A: Radiographic photography of anterior-posterior group. B: Radiographic photography of posterior group.
Click for larger image

Preoperative ambulatory function in each group.
Click for larger image

Postoperative ambulatory function in each group.
Click for larger image

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

Postoperative pain relief in each group after a month.
Click for larger image


Age and Sex, Tokuhashi score, frequency of primary cancer in each group
Click for larger image

Mean surgical level and Surgical complications
Click for larger image


The authors have no financial conflicts of interest.

1. Akeyson EW, McCutcheon IE. Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg 1996;85:211–220.
2. Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, et al. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien) 1990;107:37–43.
3. Barcena A, Lobato RD, Rivas JJ, Cordobes F, de Castro S, Cabrera A, et al. Spinal metastatic disease: analysis of factors determining functional prognosis and the choice of treatment. Neurosurgery 1984;15:820–827.
4. Black P. Spinal metastasis: current status and recommended guidelines for management. Neurosurgery 1979;5:726–746.
5. Boland PJ, Lane JM, Sundaresan N. Metastatic disease of the spine. Clin Orthop Relat Res 1982:95–102.
6. Brice J, Mckissock W. Surgical treatment of malignant extradural spinal tumours. Br Med J 1965;1:1341–1344.
7. Bridwell KH, Jenny AB, Saul T, Rich KM, Grubb RL. Posterior segmental spinal instrumentation (PSSI) with posterolateral decompression and debulking for metastatic thoracic and lumbar spine disease. Limitations of the technique. Spine (Phila Pa 1976) 1988;13:1383–1394.
8. Bucy PC. The treatment of malignant tumors of the spine: a review. Neurology 1963;13:938–944.
9. Chadduck WM, Boop WC Jr. Acrylic stabilization of the cervical spine for neoplastic disease: evolution of a technique for vertebral body replacement. Neurosurgery 1983;13:23–29.
10. Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 1983;59:111–118.
11. Cooper PR, Errico TJ, Martin R, Crawford B, DiBartolo T. A systematic approach to spinal reconstruction after anterior decompression for neoplastic disease of the thoracic and lumbar spine. Neurosurgery 1993;32:1–8.
12. Cybulski GR, Stone JL, Opesanmi O. Spinal cord decompression via a modified costotransversectomy approach combined with posterior instrumentation for management of metastatic neoplasms of the thoracic spine. Surg Neurol 1991;35:280–285.
13. Cahill DW, Kumar R. Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach. J Neurosurg 1999;90 1 Suppl:42–47.
14. DeWald RL, Bridwell KH, Prodromas C, Rodts MF. Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine (Phila Pa 1976) 1985;10:21–26.
15. Dunn EJ. The role of methylmethacrylate in the stabilization and replacement of the tumors of the cervical spine. Spine 1977:15–24.
16. Faccioli F, Lima J, Bricolo A. One-stage decompression and stabilization in the treatment of spinal tumors. J Neurosurg Sci 1985;29:199–205.
17. Fessler RG, Dietze DD Jr, Millan MM, Peace D. Lateral parascapular extrapleural approach to the upper thoracic spine. J Neurosurg 1991;75:349–355.
18. Fidler MW. Posterior instrumentation of the spine. An experimental comparison of various possible techniques. Spine (Phila Pa 1976) 1986;11:367–372.
19. Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 1978;3:40–51.
20. Greenberg HS, Kim JH, Posner JB. results with a new treatment protocol. Ann Neurol 1980;8:361–366.
21. Hall AJ, Mackay NN. The results of laminectomy for compression of the cord or cauda equina by extradural malignant tumour. J Bone Joint Surg Br 1973;55:497–505.
22. Harrington KD. Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg 1984;61:107–117.
23. Harrington KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop Relat Res 1988:177–197.
24. Harrington KD. The use of methlymethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease. J Bone Joint Surg Am 1981;63:36–46.
25. Heller JG, Zdeblick TA, Kunz DA, McCabe R, Cooke ME. Spinal instrumentation for metastatic disease: in vitro biomechanical analysis. J Spinal Disord 1993;6:17–22.
26. Heller M, Perrin R, Macnab I. Treatment of metastatic disease of the spine with posterolateral decompression and luque instrumentation. Neuroorthopedics 1986;2:70–74.
27. King GJ, Kostuik JP, McBroom RJ, Richardson W. Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976) 1991;16:265–271.
28. Kostuik JP, Errico TJ, Gleason TF, Errico CC. Spinal stabilization of vertebral column tumors. Spine (Phila Pa 1976) 1988;13:250–256.
29. McAfee PC, Bohlman HH. One-stage anterior cervical decompression and posterior stabilization with circumferential arthrodesis. A study of twenty-four patients who had a traumatic or a neoplastic lesion. J Bone Joint Surg Am 1989;71:78–88.
30. McAfee PC, Bohlman HH, Ducker T, Eismont FJ. Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases. J Bone Joint Surg Am 1986;68:1145–1157.
31. Overby MC, Rothman AS. Anterolateral decompression for metastatic epidural spinal cord tumors. Results of a modified costotransversectomy approach. J Neurosurg 1985;62:344–348.
32. Shaw B, Mansfield FL, Borges L. One-stage posterolateral decompression and stabilization for primary and metastatic vertebral tumors in the thoracic and lumbar spine. J Neurosurg 1989;70:405–410.
33. Siegal T, Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery 1985;17:424–432.
34. Siegal T, Tiqva P, Siegal T. Vertebral body resection for epidural compression by malignant tumors. Results of forty-seven consecutive operative procedures. J Bone Joint Surg Am 1985;67:375–382.
35. Sundaresan N, Choi IS, Hughes JE, Sachdev VP, Berenstein A. Treatment of spinal metastases from kidney cancer by presurgical embolization and resection. J Neurosurg 1990;73:548–554.
36. Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A. Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery 1991;29:645–650.
37. Sundaresan N, DiGiacinto GV, Krol G, Hughes JE. Spondylectomy for malignant tumors of the spine. J Clin Oncol 1989;7:1485–1491.
38. Sundaresan N, Galicich JH, Lane JM. Harrington rod stabilization for pathological fractures of the spine. J Neurosurg 1984;60:282–286.
39. Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P. Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 1985;63:676–684.
40. Sundaresan N, Steinberger AA, Moore F, Sachdev VP, Krol G, Hough L, et al. Indications and results of combined anterior-posterior approaches for spine tumor surgery. J Neurosurg 1996;85:438–446.
41. Tokuhashi Y, Ajiro Y, Umezawa N. Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine (Phila Pa 1976) 2009;34:69–73.