En bloc spondylectomy for thoracolumbar spinal malignant tumors via posterior approach

English Keywords:Spinal tumor  Total spondylectomy  En bloc resection  Piecemeal resection  Posterior approach

English Abstract:

  【Abstract】 Objective：To investigate the feasibility，safety and clinical outcome of en bloc spondylectomy via posterior approach for thoracolumbar spinal malignant tumors.Method：From May 2004 to December 2009，a total of 40 cases with thoracolumbar spinal malignant tumors underwent spondylectomy via posterior approach in our institute.The mean fellow-up was 18 months（range，6-68 months）.23 cases experienced piecemeal spondylectomy and 17 cases experienced en bloc spondylectomy.The surgical time，amount of intraoperative blood loss，blood transfusion volume，VAS scores and Frankel grade of each patient were evaluated and compared.Result：In piecemeal group，the average operation time was 5.8 hours（range，4.8-7 hours）；the average blood loss was 2705ml（range，1500-5000ml） and the average intraoperative transfusion volume was 1769ml.5 death，8 recurrence，1 bone cement subsidence and 1 bone cement displacement were noted in piecemeal group.While in en bloc group，the average operation time was 7.3 hours（range，6.5-8 hours）；the average blood loss and transfusion volume was 1678ml（range，1000-2000ml）and 1087ml respectively.No recurrence was found in en bloc group and only one case was complicated with slight titanium mesh displacement.Postoperative VAS scores in both groups were significantly lower than the preoperative ones（P<0.05），while no statistical differences were found between two groups（P>0.05）.Statistical difference was noted between the two groups with regard to operative time，amount of intraoperative blood loss and intraoperative blood transfusion volume（P<0.05）.Thirty-two patients had neurofunction improved at least one Frankel grade after surgery.Conclusion：En bloc via the posterior approach for the thoracolumbar spinal malignant is reliable，which is superior over piecemeal spondylectomy in intraoperative blood loss，blood transfusion volume and local recurrence.