Lightning Podiums: Spinal Gumbo - 803A

Presented by: I. Lieberman

Author(s):

I. Lieberman(1), X. Hu(1)

(1) Texas Back Institute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, United States

Abstract

Introduction: Surgery plays an important role in the treatment of patients with metastatic or primary spine tumors. In recent years, various new techniques, such as robotic assisted spine surgery have been developed which has shown some promising results by improving the accuracy of spinal instrumentation and reducing potential complications. The purpose of this study was to evaluate our experience using robotic guidance in the treatment of spinal tumors.

Methods: Data were collected from medical records for each surgery in which the robotic system was used to pre-plan and assist biopsy, pedicle screw placement and/or vertebral augmentation in the treatment of spinal tumors. Patient's age, gender, diagnosis and surgical procedure were documented. The surgical time, estimated blood loss, and intraoperative complications were obtained. The visual analog scale (VAS) for back pain and leg pain preoperatively and at the latest follow up were recorded.

Results: A total of 21 consecutive patients were included in this study, beginning with our first case experience. There were 15 female (71%). The mean age of the patients was 58 years (range 21-78). The primary tumors were renal cancer (6), lung cancer (3), breast cancer (2), multiple myeloma (2), sarcoma (2), Giant cell tumor (1), hemangioma (1), lymphoma (1), malignant spindle cell neoplasm (1), plasma cell neoplasm (1) and schwannoma (1). All patients presented with back pain and/or myelopathy. Robotic assisted posterior instrumentation was planned and successfully performed in 19 patients. Robotic assisted vertebral or sacral augmentation was planned and performed in 11 patients. The average number of levels instrumented was 4 (range 2-7). The average surgery time (skin to skin) was 4 hours and 44 minutes and the mean blood loss was 331 ml. There were no intraoperative complications. At mean 11 months follow-up, on average, the patients' back pain improved 4.3 points (2.5 vs 6.8, p < 0.001) and the patients' leg pain improved 3.3 points (1.4 vs 4.7, p < 0.05).

Conclusion: The published complication rates of spinal tumor surgeries range between 5.3% and 19%. With robotic assistance, the surgical complication rate appears improved over the historical figures. Our study shows that the robotic system was safe and performed as desired in the treatment of metastatic and primary spine tumors. These results support further evaluation in a larger series of patients.