Clinical outcomes of one-stage total en bloc spondylectomy in multi-level spinal tumor

English Keywords:Spine tumor  Multi-level  Total en bloc spondylectomy  Clinical outcome  Survival time

English Abstract:

  【Abstract】 Objectives: A retrospective study was designed to evaluate the clinical outcomes of one-stage total en bloc spondylectomy for multi-level spinal tumor. Methods: From November 2009 to September 2015, 9 patients who suffered from multi-level spinal tumor and accepted total en bloc spondylectomy(TES) were included in this study. There were 8 men and 1 woman with a mean age of 42.0±13.7 years old(24-64 years). 5 cases were with the primary tumor including 2 giant cell tumors, 1 malignant nerve sheath tumor, 1 ameloblastoma and 1 mesenchymal tumor. The other 4 cases were with metastatic tumors including 1 renal carcinoma, 1 hepatocarcinoma, 1 prostate cancer and 1 liposarcoma. The operation time, intraoperative blood loss, blood transfusion, complications, length of stay, preoperative and postoperative pain, and neurological function were recorded. Tumor recurrence, tumor metastasis and survival were observed during follow-up period. Results: The 9 patients were all successfully operated. 6 of them were with 2 levels of spinal tumor, 2 with 3 levels and 1 with 4 levels. The average operation time was 8.9±2.8h(7-16h), the average blood loss was 3422.2±1342.4ml(1700-6000ml), the average blood transfusion was 2200.0±842.6ml(1000-4000ml), and the average length of stay was 31.1±20.3d(14-73d). Postoperative VAS score decreased significantly when compared with preoperative score(P<0.05). There was no death during perioperative period. Three patients suffered from intraoperative dura rupture, 1 patient suffered from intraoperative pleura rupture, 3 patients suffered from postoperative hydrothorax, and 1 patient suffered from thoracic cavity infection. One patient suffered from titanium mesh subsidence. There was no other serious postoperative complication, such as neurological damage or vascular damage. Five patients were Frankel grade E before operation, and still grade E after operation. Three patients were grade D, 2 of them improved to grade E and 1 was still grade D after operation. One patient was grade C, and recovered to grade D after operation. The mean follow-up time was 29.8±15.2 months(12-61 months). There was no local recurrence in 6 patients. And 3 patients suffered from local recurrence on 8, 18 and 28 months after operation, respectively. Three patients died due to systemic metastasis, one died of complications results of local recurrence. The median survival time was 34.75 months. Conclusions: One-stage total en bloc spondylectomy is a still high risk and challenge but effective operation for multi-level spinal tumor. The indication for this procedure needs to be weighed.