Minimally invasive surgical decompression for lumbar spinal metastases
This 73-year-old male presented with a 1 month history of progressively worsening left leg weakness, numbness, and dysethesia. He had a 2-year history of metastatic hepatocellular carcinoma secondary to transfusion-acquired hepatitis C and a known metastatic lesion at L3-L4 for which he had already received radiation therapy. Oncology service predicted 6 months longevity.\nPreoperative examination revealed 2/5 strength in the left hip and knee with radiculopathy. MRI showed numerous spinal metastases, confirming the presence of a large 5.5 × 4.8 cm enhancing paraspinal mass at L3-L4 level with mass effect. Although he was high cardiac risk (three-vessel coronary artery disease) and thrombocytopenic (platelet <50), he elected to undergo palliative debulking of the lumbar epidural tumor via left-sided L3-L4 MIS spinal decompression with L3-L4 laminectomy. Prior to incision, patient was given platelets to correct this thrombocytopenia. Intraoperatively, the tumor was found to encase the underlying nerve root.\nAfter decompression, he experienced immediate improvement of his radiculopathy and improved lower extremity weakness, increasing to 3/5 left hip and knee strength. Postoperative troponins were within normal range.\nFurther clinical and radiographic assessments were not possible as the patient suffered a STEMI 2 weeks after surgical decompression (with do not resuscitate [DNR] order) and succumbed to cardiogenic shock [].