What factors determine the choice of surgical approach for metastatic spinal lesions

The approach to the spine depends on the location of the tumor, the presence/absence of spinal instability, and the presence/absence of neural compression/neural deficit. Because most metastases involve the vertebral body, reconstruction of the anterior and middle spinal columns is usually indicated. The anterior approach provides direct access to remove the affected vertebral body, decompress the dural sac, and reconstruct the anterior and middle spinal columns with an intracolumnar spacer and anterior spinal instrumentation. However, if two or more vertebral bodies require removal or if bone quality is poor, posterior spinal instrumentation is required. A single-stage posterolateral approach for decompression and stabilization is an alternative surgical option for patients with circumferential epidural spinal cord compression, patients who cannot tolerate an anterior approach due to medical comorbidities, and tumors located in the upper thoracic region that are difficult to approach through a thoracotomy.

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