Operative Orthopädie und Traumatologie

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

Die einzeitige kombinierte Vertebrektomie bei Tumoren der Stammwirbelsäule

  • Archibald von Strempel
Article

Schlüsselwörter

Wirbelsäulenmalignome Kombinationseingriff Spondylodese Vertebrektomie 

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

Summary

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.

Indication

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

Contraindication

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.

Results

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 

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Copyright information

© Urban & Vogel 1996

Authors and Affiliations

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

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