Therapy for thoracic lumbar and sacral vertebrae tumors using total spondylectomy and spine reconstruction through posterior or combined anterior-posterior approaches

Abstract

Abstract.The present study aimed to analyze the indications, feasibility, safety and clinical effects of total spondylectomy and spine reconstruction through posterior or combined anterior-posterior approaches for thoracic lumbar and sacral vertebrae tumors. Between December 2009 and May 2012, 10 patients with thoracic lumbar and sacral vertebrae tumors were retrospectively analyzed. Different surgical indications and approaches were used according to the affected segments, the extent of lesion involvement and the specific pathology results. One-stage posterior or combined anterior-posterior total spondylectomy and reconstruction was used for the treatment of complicated thoracic lumbar and sacral vertebral malignant tumors and invasive benign tumors. The duration of surgery, levels of intraoperative blood loss and transfusions, and the clinical effects were observed. The average surgical duration was 6.8 h (range, 4.8-12 h), with an average blood loss level of 3,200 ml (range, 1,500-10,000 ml) and an average transfusion level of 2,500 ml. During the average 15 months (range, 3-29 months) follow up, two patients succumbed and one patient experienced tumor recurrence. Neither tumor reoccurrence nor metastasis was observed in all other patients. Personalized surgical indications and approaches according to the affected segments, the extent of lesion involvement and the specific pathology results would aid in the reduction of pain, the improvement of nerve function and the reduction of tumor recurrence.

En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the “rotation–reversion” technique: Feasibility, safety, and clinical outcome of 11 cases

“…However, none of the patients in the present study died intraoperatively or experienced other fatal complications. In comparison, the mortality rate of patients who have undergone en bloc resection of spinal tumors was reported to range from 0% to 7.7% ( 22 , 29 , 30 ). The most frequent major complication observed in the present study was wound healing problems, occurring in four (36%) of the 11 patients.…”

One-stage En bloc resection of thoracic spinal chondrosarcoma with huge paravertebral mass through the single posterior approach by dissociate longissimus thoracis

“…The single posterior approach is associated with less surgical injury, a shorter duration of operation, and a lower risk ( 22 ). But the posterior approach imposes high technical demands on the surgeon due to the narrow field of vision, the limited surgical space and the easily damaged spinal cord ( 23 ). Neither costotransversectomy nor lateral extracavitary approach could expose the anterior aspects of the huge paravertebral mass ( 24 , 25 ).…”

Clinical Efficacy of Laminectomy with Instrumented Fixation in Treating Thoracolumbar Intradural Extramedullary Schwannomas: A Comparative Study

“…Surgical resection of tumors by laminectomy is still regarded as the best treatment for spinal intradural extramedullary schwannomas. Total laminectomy without internal fixation can lead to iatrogenic spinal instability, and even progress towards spinal deformity, due to damage to the posterior column structure, including the bony structure of the posterior ligament complex [6,[11][12][13][14]. Standard surgery usually includes laminectomy for sufficient exposure of the tumor, with facetectomy needed in some cases.…”

“…Surgical resection of tumors by laminectomy is still the best therapeutic strategy for intradural extramedullary schwannomas. However, laminectomy without internal fixation can result in spinal instability, even spinal deformity formation, due to damage to the posterior column structure [11][12][13][14].…”