Safety and efficacy of sagittal vertebral resection of thoracolumbar spinal tumors

English Keywords:Thoracic vertebral tumors  Lumbar vertebral tumor  Sagittal resection  Complication  Type

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and effectiveness of sagittal vertebral resection in thoracolumbar spinal tumors and explore the guiding significance of vertebral partitioning and classification for surgery. Methods: The anatomic sites of vertebra were symmetrically divided into Ⅰ/Ⅱ/Ⅲ zones by the inner and outer edges of the pedicle and the midline of the vertebral body. The surgical classification of the vertebral tumors for sagittal excision in our system was based on the tumor involvement in different anatomic zones of the vertebra, which was classified into type Ⅰ: tumor involved zone Ⅰ, sagittal osteotomy across ipsilateral zone Ⅰ-Ⅱ; type Ⅱ: tumor involved zone Ⅱ, sagittal osteotomy across ipsilateral zone Ⅰ-Ⅲ; and type Ⅲ: tumor involved in the vertebral body of zone Ⅲ, sagittal osteotomy across ipsilateral zone Ⅰ-Ⅲ and contralateral zone Ⅲ. According to the inclusion and exclusion criteria, 8 patients with thoracolumbar spinal tumors who underwent sagittal resection in our department from June 2018 to December 2021 were collected and analyzed, including 6 males(75%) and 2 females(25%) with an average age of 37.8±4.8 years. There were 2 cases of osteosarcoma, 2 cases of soft tissue sarcomas, 2 cases of metastatic cancers and 2 cases of benign locally aggressive tumor. And 1 case of the patients was of type Ⅰ, 2 were of type Ⅱ and 5 were of type Ⅲ. The general information and perioperative clinical data including tumor involved zone, operation time, intraoperative blood loss, reconstruction method, surgical complications, recurrence rate, long-term complications, and Frankel grade of the patients were collected and analyzed. Results: The average follow-up time was 22.3±3.9 months(12-40 months), average intraoperative blood loss was 1812.5±333.0ml, and average operation time was 369.6±27.7min. 1 case with positive margin of soft tissue resection due to dural adhesions caused by the first operation in another hospital underwent a second surgery in our hospital, and after which the margin of bone resection was negative. The results of oncology included 1 case with local recurrence and distant metastasis with a local recurrence rate of 12.5%(1/8), 1 case with distant metastasis, none infection or death, and none failed internal fixation. No deterioration was observed in Frankel grading after surgery. Conclusions: Our proposed zoning and classification system can effectively guide the sagittal vertebral resection in thoracolumbar spinal tumors and preserve partial vertebral bodies, therefore reduce the surgical complications.