Elsevier

World Neurosurgery

Volume 112, April 2018, Pages 57-63
World Neurosurgery

Case Report
Full Endoscopic Interlaminar Approach for Nerve Root Decompression of Sacral Metastatic Tumor

https://doi.org/10.1016/j.wneu.2018.01.075Get rights and content

Highlights

  • The case of a patient with sacral metastatic tumor and right iliac bone with S1 exiting nerve root compression is reported.

  • A full endoscopic interlaminar approach for nerve root decompression of sacral metastasis may be safe and effective.

  • Few studies have assessed the use of endoscopic surgery in treating sacral metastasis.

Background

Endoscopic surgery has been successfully applied in treatment of degenerative spinal disease, but few studies have assessed its use in treating sacral metastasis. We report a successful full endoscopic interlaminar approach for sacral nerve root decompression of a sacral metastatic tumor.

Case Description

An 80-year-old man with a history of hepatocellular carcinoma presented with buttock pain with radiation to the right lower leg for 1 week. There was also decreased muscle power of the right lower extremity. Lumbosacral magnetic resonance imaging revealed metastasis of the sacral spine and right iliac bone with S1 exiting nerve root compression. S1 nerve root decompression via a full endoscopic interlaminar approach under local anesthesia was performed. Under fluorescence guidance, a working sleeve with a beveled opening was placed in the interlaminar space of L5-S1. We entered the sacral canal and identified the S1 exiting nerve root. A laminotomy was performed from the internal edge of the right sacral laminae toward the lateral recess. During decompression of the nerve root, buttock and leg pain improved gradually. There was almost complete resolution of leg pain after surgery, and the patient recovered the ability to walk. Visual analog scale score for pain decreased from 8 to 2 after 3 months of follow-up.

Conclusions

For patients with sacral metastasis without spinal instability or difficulty lying in prone position under local anesthesia, the full endoscopic interlaminar approach for nerve root decompression of sacral metastasis may be a suitable method.

Introduction

Percutaneous endoscopic surgery has been widely and successfully applied in the treatment of degenerative spinal disease. It confers a number of advantages, including less intraoperative blood loss, early wound healing, and shortened hospital stay. With proper indication, pain relief and neurologic preservation are comparable to open surgery. Nevertheless, the application of this endoscopic technique for sacral metastasis has not been comprehensively evaluated in the literature owing to the relatively rare prevalence.1 In patients with nerve compression, especially in cases caused by cancer growth, it would be advantageous to achieve nerve decompression with minimal tissue damage. Thus, we performed sacral nerve root decompression via the full endoscopic interlaminar approach in an elderly patient with sacral nerve compression caused by bony metastasis. We present the clinical scenario and surgical process and discuss our findings.

Section snippets

Case Description

An 80-year-old man experiencing buttock pain with radiation to the right lower leg for 1 week presented to our outpatient department on April 21, 2017. A review of his medical history revealed diagnosis of hepatocellular carcinoma in 2008. He received transcatheter arterial chemoembolization 4 times and radiofrequency ablation 4 times during the period 2008–2017. He also had a herniated intervertebral disc at L3-4 and L4-5, which was treated by discectomy and spinal fusion.

Follow-up laboratory

Discussion

The skeleton is the third most common site of metastases after the lungs and liver. The spine is the most common location of bony metastasis.2, 3, 4, 5 Furthermore, a review of the literature revealed that 30%–90% of patients with terminal cancer have metastatic spinal disease.6, 7 The most common sites of symptomatic spinal metastasis are the thoracic (60%–80%), lumbar (15%–30%), and cervical (10%–15%) spine.8, 9 Metastasis to the sacrum is rare.1 In hepatocellular carcinoma, the incidence of

Conclusions

For a patient with sacral metastasis, surgical treatment with radiotherapy is indicated when there is spinal instability, intractable pain, and acute and severe motor or sphincter dysfunction with nerve compression. With careful selection of patients without spinal instability or difficulty lying in the prone position under local anesthesia, the full endoscopic interlaminar approach for nerve root decompression of sacral metastasis may be a suitable method. This modality successfully relieved

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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