Minimally invasive surgical decompression for lumbar spinal metastases
This 23-year-old female presented with 1-month of radiculopathic pain and paresthesia in the L5 distribution and foot-drop. She had a 6-year history of Ewing's sarcoma, status post multiple sessions of chemotherapy and radiation with remission and numerous relapses []. The patient had known metastatic disease to the L2-L4 epidural tissue and the L4-L5 vertebral bodies, posterior elements, and transverse processes. She was presently on chemotherapy, and in the past had received an L3 corpectomy, cage placement, L3-L4 laminectomy, and L3-L5 posterior spinal instrumentation and fusion 3 years prior. Her last stereotactic radiotherapy session was 4 years ago. Oncology predicted 3 months expected survival.\nPreoperatively the patient had 9/10 pain in her right leg with 2/5 strength on dorsiflexion and decreased sensation to light touch in L5 and S1 distributions. Magnetic resonance imaging (MRI) confirmed an enlarging epidural tumor extending from the L2-L4 levels, involving the L4-L5 level, and extending into the L3-L4 and L5-S1 right neural foramina [].\nThe patient underwent right-sided MIS L4-L5 laminotomy, resection of the dorsal and ventral tumor encroaching on the spinal canal, and L5 nerve root decompression by foraminotomy [].\nPostoperatively, she had immediate resolution of the right L5 radiculopathy and increased strength in right ankle dorsiflexion to 4/5. She was able to walk without foot drag, orthosis, or limp and was discharged the same day without opioid medication []. Postoperative MRI demonstrated adequate decompression of L5 nerve root []. The patient was immediately restarted on continuous chemotherapy and received 15 days of radiotherapy to L4.\nAt 9 months follow-up, she demonstrated 4+/5 strength, with a well-healed incision, and without the need for pain medication.