Three-level En Bloc Spondylectomy through a single posterior approach for malignant spinal tumors

FAN Hong-bin; FU Jun; XUE Ying-sen; GUO Zheng; WANG Zhen

doi:10.3969/j.issn.2095-252X.2019.01.004

Abstract：Objective Total En Bloc Spondylectomy (TES) is widely used to avoid local recurrence in the treatment of spinal malignant tumors.Three-level EBS are aggressive procedures associated with complications and morbidity.This study aims to report the surgical technique and results of tumor control after 3-level TES for spinal tumors.Methods We conducted a retrospective study of 5 patients treated with 3-level TES between 2010 and2012.Surgical data were noted.Radiographs, magnetic resonance images, and computed tomographic scans were studied for local recurrence, graft, and instrumentation failures at subsequent follow-up.There were 5 malignant tumors:2 metastatic breast cancer, 1 metastatic kidney clear cell carcinoma, 1 chondrosarcoma, 1 epithelioid haemangioendothelioma.All patients belonged to Tomita's Type 6.The mean score of Tomita grading system and Karnofsky performance were 3.4 and 48％, respectively.Four patients with spinal injury were classified into Frankel C and 1 into Frankel D.All patients received pre-operative arterial embolization expect one with chondrosarcoma.Results The mean surgical time was 6.8 h and estimated blood loss was 6260 ml.The mean follow-up was 45 months (range:30-62 months).At the last follow-up, 3 patients were alive with no evidence of diseases, 1 alive with pulmonary metastasis, and 1 dead of diseases.Only 1 patient had local recurrence.Five patients with Frankel C and D had full neurological recovery.Histopathological assessment of specimen showed the margins were free of tumor.The mean VAS score decreased from 7.8 to 1.6 after operation.Conclusions 3-level TES can be offered to patients to prevent local recurrence.With strict surgical indication and skillful surgical technique, it is proven to be beneficial.