Total Spondylectomy For Primary Malignant And Solitary Metastatic Tumors Of The Thoracolumbar Spine Via The Posterior Approach

Objectives:To compare the perioperative indicators and clinical symptoms of total spondylectomy with piecemeal excision and en bloc excision for the primary malignant and solitary metastatic thoracolumbar spinal tumors via the posterior approach, and to investigate the security and therapeutic effects of total spondylectomy via the posterior approach for thoracolumbar spinal tumors.Methods:From April 2007 to June 2009,25 cases with thoracolumbar spinal tumors were treated with total spondylectomy via the posterior approach. There were 14 cases in the piecemeal group aged from 23 to 73. There were 5 cases with primary malignant tumors, in which 2 cases were giant cell tumor,1 case was plasmocytoma,1 case was chordoma, and 1 case was hemangio-perithelioma. There were 9 cases with metastatic tumors and the primary foci were identified. There was 11 cases in the en bloc group aged from 23 to 77. There were 6 cases with primary malignant tumors, in which 2 cases were giant cell tumor,2 cases were malignant schwannoma,1 case was chordoma, and 1 case was malignant fibrous histocytoma. There were 5 cases with metastatic tumors and the primary foci were identified. The patients were evaluated with perioperative indicators, clinical symptoms and follow up indicators.Results:In the piecemeal group, the average operation time, the average bleeding amount and transfusion amount were 5.7 hours,about 2692ml and 1757ml, respectively.5 cases of death,3 cases of recurrence,1 case of bone cement subsidence and 1 case of bone cement displacement were found in the piecemeal group. In the en bloc group, the average operation time was 7.2 hours; the average bleeding amount and transfusion amount were about 1636ml and 1018ml. No recurrence was found in the en bloc group and only one case was found titanium mesh displaced slightly. Postoperative VAS scores in two groups were lower than the preoperative ones with significant differences, and the improvement rate of VAS scores had no statistical differences between the piecemeal and en bloc group. There were statistical differences in two groups with respect to the operation time, the perioperative hemorrhage and blood transfusion volume. The neurological functions of ASIA grade in all the patients were improved.Conclusions:Total spondylectomy via the posterior approach for the thoracolumbar spinal tumor was effective and safe. The "Two-step" improvement of en bloc spondylectomy was more convenient than the traditional procedure. Compared with those in the piecemeal group, the perioperative hemorrhage,blood transfusion quantity and local recurrence were decreased obviously.