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Multilevel En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine Is Challenging But Rewarding

  • Symposium: 2013 Meetings of the Musculoskeletal Tumor Society and the International Society of Limb Salvage
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Over the years, en bloc spondylectomy has proven its efficacy in controlling spinal tumors and improving survival rates. However, there are few reports of large series that critically evaluate the results of multilevel en bloc spondylectomies for spinal neoplasms.

Questions/purposes

Using data from a large spine tumor center, we answered the following questions: (1) Does multilevel total en bloc spondylectomy result in acceptable function, survival rates, and local control in spinal neoplasms? (2) Is reconstruction after this procedure feasible? (3) What complications are associated with this procedure? (4) is it possible to achieve adequate surgical margins with this procedure?

Methods

We retrospectively investigated 38 patients undergoing multilevel total en bloc spondylectomy by a single surgeon (AL) from 1994 to 2011. Indications for this procedure were primary spinal sarcomas, solitary metastases, and aggressive primary benign tumors involving multiple segments of the thoracic or lumbar spine. Patients had to be medically fit and have no visceral metastases. Analysis was by chart and radiographic review. Margin quality was classified into intralesional, marginal, and wide. Radiographs, MR images, and CT scans were studied for local recurrence. Graft healing and instrumentation failures at subsequent followup were assessed. Complications were divided into major or minor and further classified as intraoperative and early and late postoperative. We evaluated the oncologic status using cumulative disease-specific and metastases-free survival analysis. Minimum followup was 24 months (mean, 39 months; range, 24–124 months).

Results

Of the 38 patients, 34 (89%) were alive and walking without support at final followup. Thirty-one (81%) had no evidence of disease. Two patients died postoperatively and another two died of systemic disease (without local recurrence). Only three patients (8%) had a local recurrence. There were 14 major complications and 22 minor complications in 25 patients (65%). Only one patient required revision of implants secondary to mechanical failure. Two cases of cage subsidence were noted but had no clinical significance. Wide margins were achieved in nine patients (23%), marginal in 25 (66%), and intralesional in four (11%).

Conclusions

In patients with multisegmental spinal tumors, oncologic resections were achieved by multilevel en bloc spondylectomy and led to an acceptable survival rate with reasonable local control. Multilevel en bloc surgery was associated with a high complication rate; however, most patients recovered from their complications. Although the surgical procedure is challenging, our encouraging mid-term results clearly favor and validate this technique.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Section for Oncological Orthopaedics and Reconstruction of the Spine, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4-20161, Milan, Italy

    Alessandro Davide Luzzati MD, Sambhav Shah MS, Fabio Gagliano MD & Giuseppe Perrucchini MD

  2. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Giuseppe Perrucchini MD & Gennaro Scotto MD

  3. Instituto Clinico Humanitas, Milan, Italy

    Marco Alloisio MD

Authors
  1. Alessandro Davide Luzzati MD
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  2. Sambhav Shah MS
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  3. Fabio Gagliano MD
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  4. Giuseppe Perrucchini MD
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  5. Gennaro Scotto MD
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  6. Marco Alloisio MD
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Corresponding author

Correspondence to Alessandro Davide Luzzati MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

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Luzzati, A.D., Shah, S., Gagliano, F. et al. Multilevel En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine Is Challenging But Rewarding. Clin Orthop Relat Res 473, 858–867 (2015). https://doi.org/10.1007/s11999-014-3578-x

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  • DOI: https://doi.org/10.1007/s11999-014-3578-x

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