The Clinical Result Of Total Vertebrectomy For Single Thoracic Tumor And Spine Stability Reconstruction

Objectives To evaluate the clinical result of total vertebrectomy and spine stability reconstruction for single-level thoracic vertebra tumors .Methods 36 patients (20 males and 16 females) of single-level thoracic vertebra tumors were included in this group, who accepted total vertebrectomy and stability reconstruction from Feb, 1997 to Apr, 2005. The pre-operative Frankel grading was A in 6 cases, B in 8 cases, C in 10 cases, D in 8 cases, E in 4 cases.17 cases (8 males and 9 females) were primary tumors, ranging from 14 to 52 years old (mean 22 yrs). There were 4 neoplastic lesions (3 aneurysmal bone cysts and 1 bone cyst), 8 benign tumors(3 hemangioma, 2 myelomata, 2 eosinophilic granulomata and 1 teratoma) and 5 malignant tumors(3 giant cell tumors and 2 osteosarcomas). The sites of tumors were 1 T₄, 2 T₅, 2 T₆, 1 T7, 3 T₈, 2 T₉, 2 T₁₀, 3 T₁₁ and 1 T₁₂.19 cases (12 males and 7 females) were metastatic tumors, ranging from 34 to 71 years old (mean 57yrs). The primary diseases were 5 lung cancers, 3 prostate cancers, 2 breast cancers, 1 thyroid cancer, 1 liver cancer and 7 metastatic tumors of unknown origin. The affected levels were 2 T₁, 1 T₄, 1 T₆, 1 T7, 2 T₈, 3 T9, 3 T₁₀, 5 T₁₁ and 1 T₁₂.The spinal reconstruction was obtained by pure autograft or titanium mesh filled with autograft for benign and low-grade malignant tumors, methyl methacrylate-filled titanium mesh for high-grade malignant tumors. The spinal stability was enhanced by anterior screw-plate system and posterior rod-screw system.Results The follow-up was 6 months 8 years. 33 cases presented by pain, among which 23 cases gained complete relief and 11 cases relieved partially. In 32 cases with neurological deficit, 18 cases recovered completely, 11 cases improved and 3 cases did not acquire any recovery. The complication appeared in 10 cases,including 8 pleural ruptures, 2 postoperative hemopneumothoraxes, 1 CSF leakage, 1 postoperative costal nerve pain, 1 spondylolisthesis, 1 transient paraplegia. Recurrence of primary tumor occurred in 3 cases, including 2 malignant tumors and 1 benign tumor. 2 case of primary tumor died 7 years and 1.5 years respectively after operation, and 4 metastatic cases died within 2 years. The others survived till the latest follow-up. The mean survival time was 45 months in primary malignant tumors, while in metastasis tumors was 27 months.Conclusion Total vertebrectomy through single posterior approach or combined anterior and posterior approaches is feasible, safe, and effective in tumor resection and stability reconstruction. The effect of total spondylectomy is positive and satisfactory in prolonging the lifetime, relieving the pain, improving the life quality and curing the tumors.