The analysis of overall effects for spinal metastasis after total spondylectomy

English Keywords:Spinal metastasis  Total spondylectomy  Local recurrence  New distant metastasis

English Abstract:

  【Abstract】 Objectives: To investigate the overall effects for spinal metastasis after total spondylectomy, especially the new distant metastasis after operation. Methods: From January 2004 to December 2014, 11 patients with spinal metastasis underwent total spondylectomy in our department were reviewed retrospectively. Histological results included 3 thyroid carcinoma, 5 breast carcinoma, 1 renal carcinoma, 1 lung cancer, and 1 pancreatic carcinoma. Five patients with thoracolumbar spinal metastasis all underwent total en bloc spondylectomy(TES), 6 patients with subaxial or cervicothoracic junction spinal metastasis received piecemeal excision. The Tomita scores were 2 points in 3 patients, 3 points in 5, and more than 3 points in 3; the preoperative visual analogue score(VAS) was 7.18±1.19; the Frankel grade of neurologic function was E in 6, D in 4, C in 1. Results: All operations were successful and the patients were followed up. The average operation time was 358.3±155.9min, the average blood loss was 1850.0±969.8ml, the surgical sites showed no residual within 1-2 weeks after surgery, and 3 cases had postoperative complications which relieved after conservative treatment. All patients showed significant pain relief(P<0.001), the VAS score decreased to 1.64±0.77, with the excellent and good rate of 100%. There was no neurological deficit, the Frankel grades of patients with neurological dysfunction all improved by 1 grade. All patients received postoperative follow-up with an average time of 42.4±16.2 months(18-73 months), 4 cases died due to the progression of cancer. Three cases(27.3%) had disease-free survival, 4 cases(36.4%) had local recurrence, including 1 case(20%) with TES and 3 cases(50%) with piecemeal excision, so the local recurrence rate of TES was higher than that of piecemeal excision(P<0.05). Four cases(36.4%) had new distant metastasis in 1 year after total spondylectmoy, all were bone metastases. Conclusions: Total spondylectomy is an effective method for the cases under strict indications and can significantly improve the pain and neurofunction; while the rate of new distant metastasis after total spondylectomy is high, which should be paid attention.