Metastatic Myxoid Liposarcoma on the Upper Thoracic Spine Treated with a Less Invasive Technique

Liposarcoma, a common soft-tissue sarcoma, includes myxoid liposarcoma (MLS) as its second-most frequent subtype. MLS primarily affects the thigh region during the fourth to fifth decades of life and often metastasizes to the spine. Managing spinal metastases is complex, with pedicle screw anchoring strength being a key concern. Various techniques address this issue, including the use of exoskeleton cement with polymethylmethacrylate (PMMA). We present a case of a 37-year-old male with MLS metastatic to the spine, experiencing lower-extremity weakness despite prior tumor excision and chemotherapy. Posterior decompression and fusion were performed, revealing inadequate screw anchoring. To address this, we applied exoskeleton cement with PMMA, resulting in improved pain but limited motor and sensory recovery. Spinal metastases, especially in the context of liposarcoma, significantly impact patient well-being. Surgical resection remains the primary treatment, but challenges arise due to tumor size and anatomical complexities. Bone mineral density (BMD) and pedicle screw stability are closely related, emphasizing the importance of addressing BMD-related issues in surgical planning. Augmented cement, such as PMMA, can enhance screw anchoring, but the risk of cement leakage must be considered. Exoskeleton cement is a promising technique but necessitates further research for comprehensive evaluation and refinement. In conclusion, the rise in spinal metastatic disease underscores the need for effective management strategies. MLS’s propensity to metastasize to the spine highlights the importance of tailored treatment approaches. Techniques like exoskeleton cement show promise in addressing screw anchoring issues but require additional investigation.