Unilateral fixation utilizing minimally invasive surgery (MIS) system for lumbosacral metastasis in a patient with stage 4 renal cell carcinoma

INTRODUCTION AND IMPORTANCE: To summarize the clinical manifestations and treatment of a patient with lumbar metastases from renal cell carcinoma who underwent unilateral fixation of lumbosacral spine utilizing minimally invasive surgery systems. CASE PRESENTATION: A 71-year-old woman presented to a local hospital with complaints of low back pain. Computed tomography (CT) at the hospital revealed metastases to the lung, occipital bone, right ribs and fifth lumbar vertebrae from a primary left renal cancer. A lumbar Magnetic resonance imaging (MRI) performed at local clinic revealed an enlarged metastatic tumor invading the right body, transverse process and pedicle of fifth lumbar vertebra. Transmyofascial insertion of pedicle screws and connection with rod utilizing minimally invasive surgery (MIS) systems were made on the left L4.5.S1 vertebrae under fluoroscopy. The operating time was 36 min, the intraoperative blood loss was 30 g and fluoroscopic time was 56 s. Postoperative course was uneventful. She could walk with a single cane on the twenty postoperative days but passed away of systemic metastasis approximately10 months after the spinal fixation. An x-ray taken just before death showed no spinal instrumentation failure. DISCUSSION: Surgery for spinal metastasis from hypervascular tumor may result in profuse intraoperative bleeding that is difficult to control. It might be preferable to operate with MIS if patients with spinal metastases are candidate for either MIS or conventional methods. It has been reported that unilateral fixation could be as effective as bilateral fixation in up to two-segment lumbar spinal fusion. CONCLUSION: Unilateral fixation utilizing MIS systems may be effective in cases whom placing an instrumentation on the side with tumor extending posteriorly may cause massive bleeding.