{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:29:50Z","timestamp":1783081790394,"version":"3.54.6"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Surgery for spinal metastases has undergone multiple transformations in operative technique, with the goal of enhancing local disease control and facilitating adjuvant therapies. The transpedicular approach offers a minimally invasive strategy for achieving circumferential spinal cord decompression, optimizing conditions for high-dose radiation therapies such as stereotactic body radiation therapy and safe cytoreduction. This study aimed to assess the safety and effectiveness of the transpedicular approach in achieving 360\u00b0 spinal cord decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In this multicentric retrospective observational study, the medical records of symptomatic patients who underwent circumferential decompression of the dural sac for spinal metastases between January 2018 and June 2023 were analyzed. Assessed data included perioperative complications and clinical outcomes in terms of neurological function and axial pain. Neurological status was evaluated using the American Spinal Injury Association Impairment Scale and modified Medical Research Council scale. Radiological assessments included epidural spinal cord compression grading and the Spine Instability Neoplastic Score. Statistical analyses were conducted to identify predictors of outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Circumferential decompression was successfully achieved in all cases. Neurological improvement was observed in 76.3% of patients at discharge, with sustained functional benefits at a mean follow-up of 19.2 months. Postoperative pain improved in 84.2% of patients. A significant association was found between immediate postoperative neurological improvement and long-term outcomes (p = 0.004). Univariate logistic regression analysis indicated that immediate postoperative improvement significantly reduced the likelihood of deterioration at the last follow-up [Nagelkerke R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.135, Exp(B) = 0.208; p = 0.004]. The total complication rate was 9.8%. Complications included CSF leaks (2.8%), wound infections (1.9%), and low rates of neurological deterioration (0.9%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The transpedicular approach provides a safe and effective route for circumferential spinal cord decompression in metastatic spinal disease. It minimizes perioperative risks, facilitates high-dose radiation therapy, and achieves favorable neurological and pain outcomes in thoracic and lumbar locations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.focus24971","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:39:26Z","timestamp":1746081566000},"page":"E7","source":"Crossref","is-referenced-by-count":2,"title":["Transpedicular approach for circumferential decompression and separation surgery as a safe and effective way to maximize surgical treatment for spinal metastases: a multicentric study"],"prefix":"10.3171","volume":"58","author":[{"given":"Giuseppe","family":"Di Perna","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Universit\u00e0 degli Studi di Foggia, Apulia, Italy;"},{"name":"Department of Neurosurgery, AOU Citt\u00e0 della Salute e della Scienza, Turin, Piedmont, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ajello","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AOU Citt\u00e0 della Salute e della Scienza, Turin, Piedmont, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Colamaria","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Universit\u00e0 degli Studi di Foggia, Apulia, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Carbone","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Universit\u00e0 degli Studi di Foggia, Apulia, Italy;"},{"name":"Department of Neurosurgery\u2013Karlsruher Neurozentrum, St\u00e4dtisches Klinikum Karlsruhe, Baden-W\u00fcrttemberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery\u2013Karlsruher Neurozentrum, St\u00e4dtisches Klinikum Karlsruhe, Baden-W\u00fcrttemberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvio","family":"Tartara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AO Maggiore Parma, Emilia-Romagna, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Marengo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AOU Citt\u00e0 della Salute e della Scienza, Turin, Piedmont, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Spetzger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery\u2013Karlsruher Neurozentrum, St\u00e4dtisches Klinikum Karlsruhe, Baden-W\u00fcrttemberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Garbossa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AOU Citt\u00e0 della Salute e della Scienza, Turin, Piedmont, Italy;"},{"name":"Department of Neurosurgery, Universit\u00e0 degli Studi di Torino, Turin, Piedmont, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Cofano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AOU Citt\u00e0 della Salute e della Scienza, Turin, Piedmont, Italy;"},{"name":"Department of Neurosurgery, Universit\u00e0 degli Studi di Torino, Turin, Piedmont, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg Spine","first-page":"299","article-title":"Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey","volume":"26","author":"Redmond KJ","year":"2017","unstructured":"Redmond KJ, Lo SS, Soltys SG,  Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey. 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J Neurosurg Spine. 2019;30(3):299\u2013307."},{"issue":"suppl 20","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"S218","article-title":"Molecular markers and targeted therapeutics in metastatic tumors of the spine: changing the treatment paradigms","volume":"41","author":"Goodwin CR","year":"2016","unstructured":"Goodwin CR, Abu-Bonsrah N, Rhines LD,  Molecular markers and targeted therapeutics in metastatic tumors of the spine: changing the treatment paradigms. Spine (Phila Pa 1976). 2016;41(suppl 20):S218-S223."},{"issue":"2","key":"b5","series-title":"Global Spine J","first-page":"179","article-title":"Spine stereotactic body radiotherapy: indications, outcomes, and points of caution","volume":"7","author":"Tseng CL","year":"2017","unstructured":"Tseng CL, Eppinga W, Charest-Morin R,  Spine stereotactic body radiotherapy: indications, outcomes, and points of caution. 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Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience. Neurosurg Focus. 2021;50(5):E11."},{"issue":"3","key":"b26","series-title":"J Clin Oncol","first-page":"268","article-title":"Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study","volume":"34","author":"Fehlings MG","year":"2016","unstructured":"Fehlings MG, Nater A, Tetreault L,  Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study. 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Lancet Oncol. 2005;6(1):15\u201324."},{"key":"b29","series-title":"Surg Neurol Int","first-page":"437","article-title":"Diffuse vertebral metastases from glioblastoma with vertebroepidural diffusion: a case report and review of the literature","volume":"12","author":"Colamaria A","year":"2021","unstructured":"Colamaria A, Blagia M, Sacco M, Carbone F. Diffuse vertebral metastases from glioblastoma with vertebroepidural diffusion: a case report and review of the literature. 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