Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine

Daniel M. Sciubba*, Rafael De la Garza Ramos, C. Rory Goodwin, Risheng Xu, Ali Bydon, Timothy F. Witham, Ziya L. Gokaslan, Jean Paul Wolinsky

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Purpose: To report outcomes after total en bloc spondylectomy (TES) for primary aggressive/malignant tumors of the lumbar spine. Methods: We performed a retrospective review of 23 neurosurgical patients operated between 2004 and 2014. Outcomes included perioperative complication rates and reoperation rates for instrumentation failure. The relationship between patient/operative parameters and complication development/instrumentation failure was investigated. Results: There were 15 men (65.2 %) and eight women (24.8 %), with a median of 47 years. The most common tumor was chordoma in 11 patients (47.8 %), followed by sarcoma in four (17.4 %), and giant cell tumor in three (13.0 %). All patients but one underwent a two-staged operation; median total estimated blood loss was 3200 mL and median total operative time was 18.5 h. Fifteen patients developed at least one perioperative complication (65.2 %), with the most common being wound infection and ileus (26.1 % each). There was one case of intraoperative iliac vein injury (4.4 %). Instrumentation failure occurred in 9 patients (39.1 %) at a median time of 23 months after index spondylectomy. Following logistic regression, there were no factors associated with complication development. On the other hand, postoperative radiation was significantly associated with instrumentation failure (OR 7.49; 95 % CI, 1.02–54.9). Local recurrence and 5-year survival was 8.7 and 84.4 %, respectively. Median follow-up time was 50 months. Conclusions: Although favorable oncological outcomes after en bloc resection of spinal tumors may be achieved in terms of recurrence and survival, TES in the lumbar spine remains a challenging procedure. Future investigation into complication avoidance and reconstruction techniques is encouraged.

Original languageEnglish (US)
Pages (from-to)4080-4087
Number of pages8
JournalEuropean Spine Journal
Volume25
Issue number12
DOIs
StatePublished - Dec 1 2016

Keywords

  • Chordoma
  • Lumbar spine
  • Sarcoma
  • Spinal tumor
  • Total en bloc spondylectomy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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