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Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine

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Abstract

Purpose

To report outcomes after total en bloc spondylectomy (TES) for primary aggressive/malignant tumors of the lumbar spine.

Methods

We performed a retrospective review of 23 neurosurgical patients operated between 2004 and 2014. Outcomes included perioperative complication rates and reoperation rates for instrumentation failure. The relationship between patient/operative parameters and complication development/instrumentation failure was investigated.

Results

There were 15 men (65.2 %) and eight women (24.8 %), with a median of 47 years. The most common tumor was chordoma in 11 patients (47.8 %), followed by sarcoma in four (17.4 %), and giant cell tumor in three (13.0 %). All patients but one underwent a two-staged operation; median total estimated blood loss was 3200 mL and median total operative time was 18.5 h. Fifteen patients developed at least one perioperative complication (65.2 %), with the most common being wound infection and ileus (26.1 % each). There was one case of intraoperative iliac vein injury (4.4 %). Instrumentation failure occurred in 9 patients (39.1 %) at a median time of 23 months after index spondylectomy. Following logistic regression, there were no factors associated with complication development. On the other hand, postoperative radiation was significantly associated with instrumentation failure (OR 7.49; 95 % CI, 1.02–54.9). Local recurrence and 5-year survival was 8.7 and 84.4 %, respectively. Median follow-up time was 50 months.

Conclusions

Although favorable oncological outcomes after en bloc resection of spinal tumors may be achieved in terms of recurrence and survival, TES in the lumbar spine remains a challenging procedure. Future investigation into complication avoidance and reconstruction techniques is encouraged.

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Acknowledgments

No funds were received in support of this work. Daniel M. Sciubba (DMS) has consulting relationships with Medtronic, Depuy-Synthes, Orthofix and Globus.

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Authors and Affiliations

  1. Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA

    Daniel M. Sciubba, Rafael De la Garza Ramos, C. Rory Goodwin, Risheng Xu, Ali Bydon, Timothy F. Witham & Jean-Paul Wolinsky

  2. Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Ziya L. Gokaslan

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  1. Daniel M. Sciubba
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Correspondence to Daniel M. Sciubba.

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Sciubba, D.M., De la Garza Ramos, R., Goodwin, C.R. et al. Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine. Eur Spine J 25, 4080–4087 (2016). https://doi.org/10.1007/s00586-016-4641-y

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