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Journal of Neurosurgical Sciences 2016 Nov 23


lingua: Inglese

Elective laminectomy and excision of the thoracic spine neoplasm: an evaluation of early outcomes

Pavan S. UPADHYAYULA 1, John K. YUE 2, Erik I. CURTIS 1, Joseph D. CIACCI 1

1 Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA; 2 Department of Neurological Surgery, University of California, San Francisco, CA, USA


BACKGROUND: Laminectomy plus excision of spinal neoplasms is commonly performed. The current study examines risk profiles associated with elective laminectomies of benign, malignant primary, and secondary/metastatic neoplasms of the thoracic spine.
METHODS: Adult patients undergoing elective thoracic laminectomy and excision of spinal neoplasm were abstracted from ACS-NSQIP years 2011-2014. Patients were classified into three cohorts: benign primary, malignant primary, secondary/metastatic. Univariate and multivariable analyses compared operation time, early complications, hospital length of stay (HLOS), and discharge destination across cohorts.
RESULTS: One-hundred sixty patients were included, aged 58.0±14.8-years. Mean operation time was 209.23±101.52 minutes and cohorts did not differ significantly on multivariable analysis. Mean HLOS was 6.10±7.14 days and did not differ by cohort. Early complications were observed in 15.6% of patients; secondary/metastatic patients associated with increased odds of >1 unit of blood transfusion, but not overall complications. Failure to be discharged home occurred in 31.8% of patients (benign primary: 30.0%, malignant primary: 66.6%, secondary/metastatic: 10.5%; p<0.001). Malignant primary tumors associated with increased multivariable odds of failure to be discharged home (OR 3.63, 95% CI [1.09, 12.10], p=0.036). Tumor location (extradural, intradural/extramedullary, intramedullary) was not a significant predictor of outcomes. A higher number of concurrent fusions were observed for secondary/metastatic laminectomies (benign primary: 7.3%; malignant primary: 5.5%; secondary/metastatic: 36.8%; p<0.001).
CONCLUSIONS: Comparable performance on operation time and HLOS between neoplasm cohorts suggests broad indication of resectional laminectomies for elective treatment. Primary malignant thoracic spine tumors may require higher levels of early post-discharge care. Future studies are needed to confirm these findings.

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Upadhyayula PS, Yue JK, Curtis EI, Ciacci JD. Elective laminectomy and excision of the thoracic spine neoplasm: an evaluation of early outcomes. J Neurosurg Sci 2016 Nov 23. 

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