Читать книгу Neurosurgery Outlines - Paul E. Kaloostian - Страница 96

• Acute pain control with medications and pain management

• Physical therapy and rehabilitation

• If asymptomatic or mildly symptomatic with pain/radiculopathy with small focus of tumor:

– Radiation treatment (radiation oncology consultation)

– Some metastatic tumors are radioresistant

– Chemotherapy (medical oncology consultation)

– Some metastatic tumors are radioresistant

– Kyphoplasty (to treat pain)

– Surgical instrumentation and fusion (if there is concern for deformity, instability, or cord compression)

• If asymptomatic or mildly symptomatic with thoracic cord compression:

– Surgical decompression and fusion over implicated segments if deemed suitable candidate for surgery:

– If poor surgical candidate with poor life expectancy, medical management recommended

– Surgery may be done anteriorly, posteriorly, or combined two-stage approach for added stabilization

– May include a combination of the following techniques: Laminectomy (entire lamina, thickened ligaments, and part of enlarged facet joints removed to relieve pressure), Laminotomy (section of lamina and ligament removed), Foraminotomy (expanding space of neural foramen by removing soft tissues, small disk fragments, and bony spurs in the locus), Laminoplasty (expanding space within spinal canal by repositioning lamina), Diskectomy (removal of section of herniated disk), Corpectomy (removal of vertebral body and disks), Bony Spur Removal

– Approaches: Posterior, anterior transthoracic, anterior transsternal