Choosing of surgical approach for total spondylectomy in thoracic or lumbar spine tumor

English Keywords:Tumor  Thoracic spine  Lumbar spine  Surgical approach  Total spondylectomy

English Abstract:

  【Abstract】 Objectives: To discuss the choosing of surgical approach for total spondylectomy in thoracic on lumbar spine tumor. Methods: 74 cases with thoracic or lumbar spine tumor underwent total spondylectomy from October 2001 to December 2013. The study included 31 males and 43 females with a mean age of 40.2 years(range 11-69 years). The clinical difference of Weinstein-Boriani-Biagini spinal tumor classification system, location, primary or not among the posterior approach, the combined posterior and anterior approach, or combined posterior and lateral approach was analyzed respectively. Results: Twenty-five cases underwent the posterior approach. B-D levels with 3-9 sectors(12 single segment and 3 double segments) were involved in 15 cases; B-D levels with 1-12 sectors(3 single segment and 1 double segments) were involved in 4 cases. A-D/E levels with 3-9 sectors(3 single segment and 1 double segments) were involved in 4 cases, A-D/E levels with 1-12 sectors(single segment) were involved in 2 cases. 2 cases had diseased level in the upper thoracic vertebra, 21 cases in thoracic or thoracolumbar spine and 2 in lumbar spine(L4-L5). 30 cases underwent the combined posterior and anterior approach. A-D/E levels with 1-12 sectors(11 single segment and 9 more segments with 12 recurrence) were involved in 20 cases; A-D/E levels with 3-9 sectors(5 single segment and 3 more segments with 2 recurrence) were involved in 8 cases. B-D levels with 3-9 sectors(one in L4, the other in L5) were involved in 2 cases. 7 cases had diseased level in the upper thoracic vertebra, which contained 5 cases of the upper thoracic vertebra(2 cases recurrence); 5 in the lumbar spine(L4-L5) and 18 in thoracic or thoracolumbar spine. 19 cases underwent the combined posterior and lateral approach. A-D/E levels with 1-12 sectors(9 single segment and 1 more segments with 2 recurrence) were involved in 10 cases; A-D/E levels with 3-9 sectors(single segment) were involved in 5 cases. B-D levels with 3-9 sectors(2 in L4-L5 and 2 in the thoracolumbar spine) were involved in 4 cases. 10 cases had diseased level in the thoracic or thoracolumbar spine and 9 in lumbar spine(L4-L5). Conclusions: The surgical approach should be determined according to the tumor lesion and location. Tumor limited in the spine or with small extent of paravertebra progression in single and double segments, the posterior approach is appropriate for the total spondylectomy. For tumor combined with large soft tissue infiltration in front of vertebra, tumor recurrence combined posterior and anterior approach should be choosed. Tumor combined with large soft tissue infiltration at lateral side of vertebra, the combined posterior and lateral approach is appropriate for the total spondylectomy.