Operative Orthopädie und Traumatologie

, Volume 8, Issue 1, pp 43–54 | Cite as

Die einzeitige kombinierte Vertebrektomie bei Tumoren der Stammwirbelsäule

  • Archibald von Strempel


Wirbelsäulenmalignome Kombinationseingriff Spondylodese Vertebrektomie 

One stage combined anterior and posterior vertebrectomy for resection of tumours of the vertebral column


Goal of Surgery

Resection of tumor as complete as possible without injury to the spinal cord or nerve roots.

Maintenance of stability of the spinal column.


Painful instability or imminent quadriplegia due to primary and secondary malignant tumors.


Multiple metastases, poor general health.

Positioning and Anaesthesia

Lateral, followed by a knee-chest position.

Surgical Technique

Through a standard approach for a left thoracophrenotomy resection of the involved vertebra, decompression of the dural sack, insertion of an adjustable intervertebral spreader which will maintain the distance between the vertebrae and serve as replacement for the removed vertebra. After turning the patient into prone position transpedicular fixation of the vertebral segment. (Example is given for resection of the first lumbar vertebra.)

Postoperative Management

Regular control of sensory and motoric nerve function of the limbs hourly on the day of surgery and two hourly on 1. and 2. postoperative day.

Removal of drains 2 to 3 days postoperatively.

Pharmacological stimulation of bowels.

Daily radiographic control of chest till 1 day after the removal of drains.

Mobilization within 1 week without corset.

Possible Complications

Injury to lungs, ureters, large vessels, intestines, lumbar plexus, dura, and plexus sympathici.

Haemothorax, Chylothorax, Infection.


Between 1982 and 1993 thirty-seven patients underwent vertebral resection of tumors.

For analysis of retrospective results refer to Tables 1 to 3.

Average surgical blood loss: 2378 ml (800 to 6500).

Average duration of surgery: 238 minutes (120 to 550).

Complications: 2 bronchopneumonia, 2 deep infections, 2 thrombophlebitis, 3 transient mental confusion, 1 breakage of implant after 18 months.

Key Words

Maligne tumors of the spine Combined procedure Spondylodesis Vertebrectomy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bauer, R., F. Kerschbaumer, S. Poisel: Operative Zugangswege in Orthopädie und Traumatologie. Thieme, Stuttgart 1986.Google Scholar
  2. 2.
    Bauer, R., A. Mostegl, M. Eichenauer: An analysis of the results of Dwyer and Zielke instrumentations of scoliosis. Arch. orthop. Trauma Surg. 105 (1986), 302–309.CrossRefPubMedGoogle Scholar
  3. 3.
    Bauer, R., F. Kerschbaumer, S. Poisel: Orthopädische Operationslehre, Bd. 1. Thieme, Stuttgart 1991.Google Scholar
  4. 4.
    De Wald, R., K. Bridwell, C. Prodromas, M. Rodts: Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine 10 (1985), 21.CrossRefGoogle Scholar
  5. 5.
    Enneking, W. E.: Musculoskeletal tumor surgery. Ch. Livingstone, New York 1983.Google Scholar
  6. 6.
    Frankel, H. L., D. O. Hancock, G. Hyslop, J. Melzak, L. S. Michaelis, G. H. Ungar, J. D. S. Vernon, J. J. Walsh: The value of postural reduction in the inital management of closed injuries of the spine with paraplegia and tetraplegia. Part 1. Paraplegia 7 (1979), 179–192.CrossRefGoogle Scholar
  7. 7.
    Griss, P.: Osteosynthesen und Wirbelkörperersatz bei Wirbelsäulentumoren. Orthopäde 16 (1987), 415–421.PubMedGoogle Scholar
  8. 8.
    Harrington, K. D.: Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin. Orthop. 233 (1988), 177–197.Google Scholar
  9. 9.
    Hodgson, A. R., F. E. Stock: Anterior spinal fusion-preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Brit. J. Surg. 44 (1956), 266.CrossRefPubMedGoogle Scholar
  10. 10.
    Kostuik, J. P., T. J. Errico, T. F. Gleasow, C. C. Errico: Spinal stabilization of vertebral column tumors. Spine 13 (1988), 250.CrossRefPubMedGoogle Scholar
  11. 11.
    Leavitt, F.: Detecting psychological disturbance using vertebral pain measurement. The back pain classification scale. In: Melzack, R. (ed.). Pain measurement and assessment. Raven Press, New York 1983.Google Scholar
  12. 12.
    Mutschler, W., O. Wörsdörfer, M. Schulte: Tumorresektionen und rekonstruktive Eingriffe bei Wirbelsäulentumoren. Orthopäde 22 (1993), 189–199.PubMedGoogle Scholar
  13. 13.
    Strempel, A. von: Die vordere Wirbelsäulenbegradigung bei Skoliosen mit der ventralen Derotations-spondylodese nach Zielke. Operat. Orthop. Traumatol. 7 (1995), 143–153.CrossRefGoogle Scholar
  14. 14.
    Sundaresan, N., H. Schmiddek: Tumors of the spine. Diagnosis and clinical management. W. B. Saunders, Philadelphia 1990.Google Scholar

Copyright information

© Urban & Vogel 1996

Authors and Affiliations

  • Archibald von Strempel
    • 1
  1. 1.Orthopädische Klinik III im Annastift e.V.Hannover

Personalised recommendations