Our Summary

This research paper is about a study comparing two types of surgical procedures used to treat a painful and disabling condition caused by cancer called Metastatic Epidural Spinal Cord Compression (MESCC). The two surgical techniques compared were traditional open surgery (OS) and a newer, less invasive method called Minimally Invasive Spinal (MIS) decompression and fusion.

The researchers looked at various factors including blood loss during surgery, how long patients stayed in the hospital, how long the surgery took, the level of disability before and after the surgery, and any complications that occurred.

The study found that the MIS technique had better overall results than the traditional open surgery. It took less time, resulted in less blood loss, and had fewer complications. Furthermore, when they looked at the results of these surgeries over a 28-year period, they found that the rate of complications in MIS surgeries had decreased.

Based on these findings, the researchers concluded that the Minimally Invasive Spinal decompression and fusion technique is a good alternative to traditional open surgery for treating MESCC, as it has less overall complications and negative effects.

FAQs

  1. What are the two types of surgical procedures compared in this study for the treatment of Metastatic Epidural Spinal Cord Compression (MESCC)?
  2. What factors were considered by the researchers when comparing the two surgical techniques?
  3. Based on the study, which surgical technique had better overall results and why?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal surgery is to consider the option of Minimally Invasive Spinal decompression and fusion as it has been found to have better overall results compared to traditional open surgery for treating conditions like Metastatic Epidural Spinal Cord Compression. This technique has less blood loss, shorter surgical time, and fewer complications, making it a potentially safer and more effective option for patients.

Suitable For

Patients who are typically recommended spinal surgery are those who are experiencing severe back pain, nerve compression, spinal instability, or other conditions that are not responding to conservative treatments such as physical therapy or medication. In the case of MESCC, patients with cancer that has spread to the spine and is causing compression of the spinal cord may be recommended for spinal surgery in order to relieve symptoms and improve quality of life.

In particular, patients with MESCC who have failed conservative treatments and are experiencing severe pain, neurological deficits, or loss of mobility may be candidates for spinal surgery. The decision to undergo surgery will depend on various factors such as the extent of the cancer, the location of the compression, the patient’s overall health and ability to tolerate surgery, and the potential risks and benefits of the procedure.

Overall, spinal surgery may be recommended for patients who have exhausted other treatment options and are experiencing significant pain and disability due to spinal conditions such as MESCC. The choice of surgical technique, whether traditional open surgery or minimally invasive spinal decompression and fusion, will depend on the specific characteristics of the patient and the condition being treated.

Timeline

Before spinal surgery, a patient typically experiences symptoms such as severe back pain, numbness or weakness in the legs, difficulty walking, and loss of bladder or bowel control. They may undergo imaging tests such as MRI or CT scans to diagnose the condition causing these symptoms.

After deciding to undergo surgery, the patient will meet with their surgeon to discuss the procedure, potential risks, and expected outcomes. They may need to undergo pre-operative testing such as blood work and EKG to ensure they are healthy enough for surgery.

During the surgery, whether it is traditional open surgery or Minimally Invasive Spinal decompression and fusion, the patient is placed under general anesthesia. The surgeon will make incisions in the back, remove any damaged tissue, and stabilize the spine with hardware if necessary.

After surgery, the patient will spend time in the recovery room before being moved to a hospital room for monitoring. They will be encouraged to start moving as soon as possible to prevent complications such as blood clots. Physical therapy may be recommended to help with mobility and strength.

In the weeks and months following surgery, the patient will attend follow-up appointments with their surgeon to monitor their progress. They may need to continue physical therapy and gradually increase their activity level. It can take several months to fully recover from spinal surgery, but many patients experience significant improvement in their symptoms and quality of life.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with the specific spinal surgery procedure being recommended for my condition?
  2. How long is the recovery period expected to be after the surgery, and what kind of physical limitations or restrictions should I expect during this time?
  3. How successful is this type of spinal surgery in relieving pain and improving mobility for patients with conditions similar to mine?
  4. Are there any alternative treatment options to consider before proceeding with surgery, such as physical therapy, medication, or other non-invasive procedures?
  5. How experienced is the surgical team in performing this specific type of spinal surgery, and what is their success rate with similar cases?
  6. Will I need to undergo any additional procedures or therapies after the surgery to fully recover and regain function in the affected area of my spine?
  7. What kind of follow-up care and monitoring will be necessary after the surgery, and how often will I need to see my doctor for check-ups and evaluations?
  8. What can I do to optimize my chances for a successful outcome after the surgery, such as following a specific rehabilitation plan or making lifestyle changes?
  9. Are there any long-term effects or complications that I should be aware of after undergoing this type of spinal surgery, and how can they be managed or prevented?
  10. How will my condition be monitored and evaluated in the months and years following the surgery to ensure that it is effective in the long term?

Reference

Authors: Alshareef M, Klapthor G, Alawieh A, Lowe S, Frankel B. Journal: Eur Spine J. 2021 Oct;30(10):2906-2914. doi: 10.1007/s00586-021-06880-7. Epub 2021 May 30. PMID: 34052895