Efficacy of total spondylectomy and spinal stability reconstruction for cervicothoracic spinal tumors

English Keywords:Spinal tumor  Cervicothoracic junction  Total spondylectomy  Surgical strategy  Spinal reconstruction

English Abstract:

  【Abstract】 Objectives: To investigate the surgical technique, spinal reconstruction and outcomes of total spondylectomy for cervicothoracic tumors. Methods: From January 2008 to December 2013, 11 patients with cervicothoracic spinal tumors underwent total spondylectomy in our department. Histological results included 5 giant cell tumors, 1 osteoblastoma, 1 Ewing sarcoma, 2 metastatic thyroid follicular carcinoma and 1 metastatic prostate carcinoma. All patients had chest and back pain, the VAS score was 7.45±0.82. The Frankel grade of neurological function was B in 1, C in 3, D in 6 and E in 1. According to the Tomita surgical classification of vertebral tumors, all the 11 lesions were considered as extracompartment. 4 patients with upper cervicothoracic spinal tumors(C7-T1) received one stage total spondylectomy via combined anterior-posterior approach, the anterior spinal stability was reconstructed by titanium mesh and plate. 7 patients with lower cervicothoracic spinal tumors(T2-T4) received total en-bloc spondylectomy(TES) though the posterior approach, the anterior spinal stability was reconstructed by titanium mesh without plate. The posterior spinal stability of all cases were reconstructed with the screw-rod system. The intra- and post-operative complications and imaging follow-up data were recorded. Results: The mean operation time was 423.9min(298-573min) and the mean blood loss was 2077ml(800-3800ml). Intraoperative complication included matter tearing in 4 patients. Postoperative complications occurred in 7 patients, which included transient decrease of neurological functions in 2 patients, residual slightly chest discomfort in 7 patients with ligated nerve roots. All patients received follow-up with an average time of 34.7 months. One patient with metastatic prostate carcinoma died of severe organs failure and no local recurrence was found in the others. 11 patients showed significant pain relief, VAS score decreased from 7.45±0.82 points at preoperation to 2.55±0.69 points at postoperation(P＜0.05). Postoperative neurological functions were improved except of 2 cases(1 in D and 1 in E had no change) and no instrument failure was noted. Conclusions: Total spondylectomy for cervicothoracic spinal tumors can provide a satisfied local control, pain relief and improvement of neurological status. According to cervicothoracic spinal tumor location, the upper(C7-T1) or lower(T2-T4) should be considered different surgical techniques and spinal reconstructions.