Complications of total enbloc spondylectomy in primary thoracolumbar spine tumor

English Keywords:Spinal tumor  Total enbloc spondylectomy  Complications  Thoracolumbar  Prevention

English Abstract:

  【Abstract】 Objectives: To summarize intraoperative and postoperative complications of total enbloc spondylectomy(TES) in primary thoracolumbar spine tumor, and to discuss the preventive strategies. Methods: From January 2005 to December 2014, 41 cases of primary thoracolumbar spine tumor received TES surgery, including 23 males and 18 females. The average age was 41.7±3.5 years old(27 to 60 years old). Pathological segments included: T7 in 1 case, T11 in 3 cases, T12 in 6 cases, L1 in 10 cases, L2 in 10 cases, L3 in 7 cases, L4 in 4 cases. Pathological diagnosis included: 18 cases of giant cell tumor, 10 cases of osteosarcoma, 4 cases of osteoclastoma, 7 cases of histiocytoma, and 2 cases of chordoma. Tomita staging was 3-5 in all the 51 cases. Tumors site: WBB 4-8/5-9 in 29 cases and WBB 4-9 in 12 cases. Among them, 30 cases underwent single posterior total enbloc spondylectomy, 11 cases underwent combined anterior and posterior approaches. The spinal reconstruction was performed immediately after tumors resected by using anterior titanium mesh or artificial vertebral body with posterior two segmental pedicle screw fixation. Statistic analysis was applied to analyze the intraoperative and postoperative complications. Results: All patients were operated successfully. The average operation time was 215±49min(150-350min). The average blood loss was 2800±340ml(1900-3600ml). Patients were followed up for 15 to 120 months with an average of 42.0±7.1 months. There were 17 complications in 12 patients, 9 intraoperative and 8 postoperative complications. Of the intraoperative complications, 1 case of unilateral iliac vascular injury received intraoperative suture; 2 cases of hemorrhoea received intraoperative blood transfusion, ligature and hemostasis; 1 case of spinal cord injury and 2 cases of nerve root traction injury received intraoperative steroid impulse and postoperative neurotrophic agents. At the last follow-up, the Frankel grade of patient with spinal cord injury changed from grade B to grade C. The radicular pain gradually relieved at 1-month follow-up. 2 cases of dural tear and 1 case of lymphatic rupture received intraoperative repair and compression bandage. Of the postoperative complications, 1 case occurred shallow wound infection, the incision was healed after debridemen and antibiotic treatment; 1 case occurred hydrothorax, the pleural effusion was completely absorbed after closed drainage and antibiotic treatment. 1 case of CSF leakage combined with lymphatic fistula and 1 case of CSF leakage healed after plain pressure drainage at dorsal elevated position; 2 cases of titanium mesh subsidence combined with internal fixation failure received revision operation; 2 cases of recurrence but received no second operations. Conclusions: The incidence rate of intraoperative and postoperative complications of primary thoracolumbar tumors is high, which can be controlled by carefully intraoperative procedure.