Clinical outcomes of total en bloc spondylectomy in spinal metastasis

English Keywords:Spinal metastasis  Total en bloc spondylectomy  Local recurrence  Distant metastasis  Survival benefit

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcomes for total en bloc spondylectomy in spinal metastasis, including advantages and complications. Methods: From January 2004 to December 2016, 32 patients(21 males and 11 females) with spinal metastasis treated by spondylectomy in multicenter were reviewed, including 14 cases by total en bloc and 18 cases by piecemeal spondylectomy. Histological results included 10 cases of lung cancer, 3 cases of breast carcinoma, 3 cases of renal carcinoma, 2 cases of prostate cancer, 2 cases of thyroid carcinoma, 2 cases of cervical cancer, 3 cases of gastrointestinal cancer, 2 cases of nervous system tumor, 1 case of liver cancer, 4 cases of unknown primary cancer. The general data of operation, VAS score, Frankel grade, postoperative recurrence, complications as well as survival time were analyzed. Results: The average operation time was 256.9±77.1min, the average blood loss was 2160.0±1174.3ml. The average follow-up time was 20.8±3.5 months (2-72 months), the mean overall survival time was 17.4±3.0 months(2-60 months). Patients treated by total en bloc spondylectomy had a higher overall survival time than those by piecemeal spondylectomy(P<0.05). The VAS score decreased from 6.0±1.3 to 0.9±1.2(P<0.05) at 1 month after surgery and all patients showed significant pain relief with the excellent rate of 100%. 3 cases(9.4%) had local recurrence at 4, 6 and 12 months after operation respectively. 6 cases(18.8%) had new distant metastasis in 1 year after operation. 9 cases had postoperative complications which relieved after conservative treatment. Conclusions: Total en bloc spondylectomy for spinal metastasis can significantly improve the pain and neurologic function as well as prevent local recurrence effectively. But it is still a difficult surgical procedure with high-risk and high-complications.