Total en bloc spondylectomy combined with the satellite rod technique for spinal tumors

Abstract

Background Instrumentation failure (IF) is a common complication after total en bloc spondylectomy (TES) in spinal tumors. This study aims to evaluate the clinical outcomes of TES combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors. Methods The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with the satellite rod technique by a single posterior approach from June 2015 to September 2018 were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively, and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded. Results The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI, and ASIA scores significantly improved from before to after surgery (P < 0.05). The LKA, AVH, and PVH significantly improved from before to immediately after surgery and to the final follow-up (P < 0.05), and the postoperative and final follow-up values did not significantly differ (P > 0.05). Conclusions TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.

Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

“…Nonetheless, several recent reports have presented results on mechanical failure after TES, such as screw loosening, screw back-out, cage breakage, screw fracture, and rod fracture; these studies identified rod fracture as the most common type of failure, and it often led to reoperation [ 8 , 11 , 12 , 22 , 23 ]. Shinmura et al [ 8 ] showed that instrumentation failure occurred in 43% of patients at a mean interval of 32 months (range, 11–92 months).…”

“…This suggestion is also applicable after TES [ 21 - 24 ]. Wei et al [ 12 ] preemptively used multiple rods after TES and showed no implant-related complications during a mean follow-up of 31 months. Although cost was a concern, they addressed this issue by using multiple rods cut from a long rod, and it did not increase costs to the expected extent [ 12 ].…”

“…Wei et al [ 12 ] preemptively used multiple rods after TES and showed no implant-related complications during a mean follow-up of 31 months. Although cost was a concern, they addressed this issue by using multiple rods cut from a long rod, and it did not increase costs to the expected extent [ 12 ]. Preemptively using a multiple-rod system for patients expecting a long survival period may be a rewarding surgical strategy.…”

“…Although the surgical procedures were in accordance with previous studies, the large difference in the rate of mechanical failure among several papers merits further attention. Second, although we recommended using a multiplerod system for patients expecting a long survival period, especially in revision surgery, this suggestion is not based on strong evidence [ 12 ]. Chemotherapy, radiosurgery, and proton-beam therapy have recently been suggested as primary or adjuvant treatment, but discussing those issues was beyond the scope of this paper [ 16 , 33 , 34 ].…”

“…Initially, mechanical failure was reported in approximately 5% of patients after TES, but it rarely occurred after the introduction of titanium-based mesh-type vertebral spacers [ 1 , 3 , 9 , 10 ]. However, mechanical failure is a concerning issue for long-term survivors, especially for patients who have undergone radiotherapy and/or chemotherapy [ 3 , 11 , 12 ]. For long-term survivors, mechanical failure was reported in 27%–43% of patients [ 8 , 11 , 13 ].…”