An analysis of therapeutic effects of total en bloc spondylectomy for primary thoracolumbar tumors

LIN Bin; ZHANG Bi; XU Yang; HE Yong; HE Yong-zhi; HE Ming-chang; GUO Zhi-min

doi:10.3969/j.issn.2095-252X.2014.05.003

Abstract：Objective To investigate the curative outcomes of total en bloc spondylectomy ( TES ) in the treatment of primary thoracolumbar tumors. Methods From January 2005 to January 2013, 15 patients with primary thoracolumbar tumors underwent TES. Posterior TES was performed on 12 cases, including 2 cases of plasma cell myeloma in T11, osteosarcoma in Ll, plasma cell myeloma in Ll and histiocytic sarcoma in L3 and 1 case of giant cell tumor of bone in L2, solitary plasmacytoma in L2, chondrosarcoma in L2 and osteosarcoma in T7. TES via combined anterior and posterior approaches was performed on 3 cases, including 2 cases of giant cell tumors of bone and paraspinal huge masses in L4 and 1 case of ifbrosarcoma in L4. According to Tomita surgical classiifcation system, all the 15 patients belonged to type III-VI, among whom the TES operative indications were correct. One-stage spinal reconstruction was performed after the tumor resection. The preoperative and postoperative neurological function was evaluated, and the postoperative survival, complications and recurrence were monitored. Results Tumors were resected completely in the 15 patients. The mean operation time was 365 min, and the mean intraoperative blood loss was 3500 ml. All the patients were followed up for a mean period of 29 months ( range;12-60 months ). No local recurrence or distant metastasis was found but in 1 case. The clinical symptoms were signiifcantly improved after the surgery in all the patients. The patient had recurrence died at 1 year after the operation, and the other 14 patients were alive without tumors. The total survival rate was 93.33%. The neurological function scores were improved from ( 3.81±0.98 ) points preoperatively to ( 4.89±0.19 ) points postoperatively, and the differences between them were statistically signiifcant ( t=-5.619, P<0.05 ). Lymphatic ifstula was detected during the operation in 1 patient with plasma cell myeloma in Ll, and rod fracture and spinal instability occurred to this patient at 1 year after the operation. No cerebrospinal lfuid ifstula or incision infection was found in all the patients. Conclusions TES is a reliable technique in the treatment of primary thoracolumbar tumors of surgical indications, with the advantages of satisfactory outcomes and low recurrence rate. In order to reduce complications, the patients should be followed up for a longer period and the technique should be further improved.