An analysis of therapeutic effects of one-stage posterior total en bloc spondylectomy for primary and metastatic tumors of the thoracolumbar spine
LI Xiang-dong
WANG Zhen
GUO Zheng
LI Jing
FAN Hong-bin
FU Jun
CHEN Guo-jing
SHI Lei
Abstract：Objective To evaluate the clinical outcomes of one-stage posterior total en bloc spondylectomy ( TES ) in the treatment of primary and metastatic tumors of the thoracolumbar spine. Methods From January 2007 to July 2012, 21 patients with primary and metastatic tumors of the thoracolumbar spine underwent TES, whose clinical data were retrospectively analyzed. There were 11 males and 10 females, whose average age was 47.8 years old ( range;21-66 years ). There were 8 cases of primary tumors and 13 cases of solitary metastatic tumors. Among the 8 cases of primary tumors, there were 3 cases of giant cell tumors of bone, 2 cases of plasmacytoma, 1 case of osteosarcoma, 1 case of chondrosarcoma and 1 case of epithelioid hemangioendothelioma. Among the 13 cases of metastatic tumors, there were 4 cases of breast cancer, 3 cases of lung cancer, 2 cases of renal cancer, 1 case of thyroid cancer, 1 case of prostate cancer, 1 case of bladder cancer and 1 case of unknown adenocarcinoma. The tumors were located from T3 to L3, including the thoracic vertebra ( n=12 ) and the lumbar vertebra ( n=9 ). The tumors were detected in the single vertebral body in 19 cases and multiple vertebral bodies ( 3 adjacent vertebral bodies ) in 2 cases. According to Tomita surgical classiifcation system, there were 5 cases of type I, 10 cases of type II, 1 case of type III, 2 cases of type V and 3 cases of type VI. All the patients had intractable back pain or neurologic disturbances before the operation. Vertebral bone defects were repaired, and internal ifxation and reconstruction were performed with titanium mesh, allograft or autograft and pedical screws. The operation was completed in all patients through the posterior approach at the ifrst stage. Results The mean operation time was 6.4 hr ( range;4.0-8.5 hr ). The average amount of blood loss was 4500 ml ( range;1300-11 600 ml ). Perioperative complications occurred in 2 cases, including 1 case of pleural effusion and pulmonary infection and 1 case of pneumothorax and bilateral pulmonary infection. All patients were followed up for an average period of 40 months ( range;12-80 months ). Remarkable relief of local back pain was achieved after the surgery. As to the patients with spinal cord injuries, at least a one-grade improvement was obtained after the surgery based on the Frankel scale, when compared with that before the operation. The differences between them were statistically signiifcant ( Z=-2.232, P<0.05 ). A total of 3 patients died, and the mean death time was at 16 months after the operation. Four patients lived with tumors and 14 patients lived without tumors. The total survival rate was 85.7%. Local recurrence was detected in 3 patients, and the recurrence rate was 14.3%. The mean recurrence time was at the 22nd months after the operation ( range;12-36 months ). No serious complications were noticed, and the complication rate was 14.3%. No uncontrollable bleeding in the great vessels or segmental vessels was found during the operation. All patients obtained bone union, without internal ifxation failure or titanium mesh displacement. Conclusions One-stage posterior TES is an effective surgical method in the treatment of primary malignant tumors, invasive benign tumors and solitary metastatic tumors of the thoracolumbar spine, with the advantages of lower local recurrence rate and no serious complications.
Keywords：Spinal neoplasmsNeoplasm metastasisThoracic vertebraeLumbar vertebraeTotal en bloc spondylectomy
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 336-340 )