Efficacy of posterior en bloc spondylectomy for metastatic epidural spinal cord compression

English Keywords:Total en bloc spondylectomy  Metastatic epidural spinal cord compression  Neoplasm metastasis  Treatment outcome

English Abstract:

  【Abstract】 Objectives: To investigate the efficacy and prognosis of posterior en bloc spondylectomy(PES) for metastastic epidural spinal cord compression(MESCC).　Methods: 9 cases suffering from MESCC from December 2008 to June 2011 underwent modified PES, which was defined as removing about 1/3 middle-posterior vertebra by using T-saw first, and then the L shape chisel was used to excise the disc from posterior to anterior under direct vision, finally the truncation of the entire disc was cmpleted. The adjacent disc was performed the same procedure. After temporary fixation, the tumor vertebra was released and ressected. Auto bone graft and titanium mesh implantation was performed, after that, posterior instrumentation was added. VAS score, ASIA motor score, recovery of neurological function and complications were reviewed.　　Results: The tumor vertebrae were resected completely, the operation time was 7-10h(average, 7.4h), and the blood loss was 1300-3200ml(average, 2240ml). 9 cases showed significant pain relief， VAS score decreased from 8.1±1.2 points of pre-operation to 3.0±1.7 points of 2 weeks post-operation with the improvement rate of 62.8%. 1 case had no ASIA grade improvement, and 8 cases had significant improvement, with ASIA motor function score improving from 74.0±15.0 points of pre-operation to 91.9±12.9 points of 3 months post-operation. The average survival time was 19.3±5.2 months (range, 9-26 months).　Conclusions: For MESCC, PES can achieve decompression effectively and circularly,which is indicated for pain relief and neurofunction improvement.