Three Level Thoracolumbar Spondylectomy for Recurrent Giant Cell Tumour of the Spine: A Case Report

@#Giant cell tumour (GCT) is a benign tumour but can be locally aggressive and with the potential to metastasise especially to the lungs. Successful treatments have been reported for long bone lesions; however, optimal surgical and medical treatment for spinal and sacral lesions are not well established. In treating spinal GCTs, the aim is to achieve complete tumour excision, restore spinal stability and decompress the neural tissues. The ideal surgical procedure is an en bloc spondylectomy or vertebrectomy, where all tumour cells are removed as recurrence is closely related to the extent of initial surgical excision. However, such a surgery has a high complication rate, such as dura tear and massive blood loss. We report a patient with a missed pathological fracture of T12 treated initially with a posterior subtraction osteotomy, who had recurrence three years after the index surgery and subsequently underwent a three level vertebrectomy and posterior spinal fusion.

Posterior Vertebrectomy and Circumferential Fusion for the Treatment of Advanced Thoracolumbar Kümmell Disease with Neurologic Deficit

STUDY DESIGN: Single-center, retrospective case series. PURPOSE: To investigate the effectiveness of posterior vertebrectomy and circumferential fusion in patients with advanced Kümmell disease with neurologic deficit. OVERVIEW OF LITERATURE: Various surgical options exist for the treatment of Kümmell disease, and determination of the appropriate treatment is based on the clinical and radiologic status of the patient. However, surgical intervention is required for patients with advanced Kümmell disease accompanied by neurologic deficit. METHODS: We retrospectively analyzed 22 neurologically compromised patients with advanced Kümmell disease who were treated surgically at Ewha Womans Hospital between January 2011 and January 2014. The surgical approach used by us was a posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation. The tissue from the corpectomy was histopathologically examined. Anterior vertebral height, kyphotic angle, visual analog scale (VAS) score, and the Frankel classification were used to evaluate the efficacy of the procedure. RESULTS: The mean follow-up period was 26 months (range, 13–40 months). VAS score, anterior vertebral height, kyphotic angle, and neurologic state were significantly improved immediately postoperatively and at the last follow-up compared with preoperatively (p<0.05). Most patients exhibited intravertebral clefts on imaging, and postoperative pathology revealed bone necrosis. CONCLUSIONS: Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective approach for treating patients with advanced Kümmell disease with neurologic deficit.

Utility of a Computed Tomography-Based Navigation System (O-Arm) for En Bloc Partial Vertebrectomy for Lung Cancer Adjacent to the Thoracic Spine: Technical Case Report

We describe successful vertebrectomy from a posterior approach using a computed tomography (CT)-based navigation system (O-arm) in a 53-year-old man with adenocarcinoma of the posterior apex of the right lung with invasion of the adjacent rib, thoracic wall, and T2 and T3 vertebral bodies. En bloc partial vertebrectomy for lung cancer adjacent to the thoracic spine was planned using O-arm. First, laminectomy was performed from right T2 to T3, and pedicles and transverse processes of T2 to T3 were resected. O-arm was used to confirm the location of the cutting edge in the T2 to 3 right vertebral internal body, and osteotomy to the anterior cortex was performed with a chisel. Next, the patient was placed in a left decubitus position. The surgical specimen was extracted en bloc. This case shows that O-arm can be used reliably and easily in vertebrectomy from a posterior approach and can facilitate en bloc resection.

Treatment of severe throracolumar fractures with posterior decompression, subtotal vertebrectomy, intervertebral fusion and internal fixation through unilateral pedicle / 中华创伤骨科杂志

Objective To evaluate the effects of posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle in the treatment of severe throracolumar fractures.Methods A retrospective study was conducted to evaluate the outcomes of 11 patients with severe thmracolumar fracture who had been treated with posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle at our department from March 2009 to March 2012.They were 10 males and one female,aged from 20 to 42 years (mean,31.1 years).According to AO classification,there were 2 cases of type B1,3 cases of type B2 and 6 cases of type C2.The Gaines scores for anterior column stability were more than 6 in all.All the patients had neurological disorders.The fracture reduction,fusion of bone grafting and recovery of neurological function were followed up.Results Their operation time ranged from 200 to 300 minutes,averaging 243.2 minutes;the amount of bleeding ranged from 800 to 1,600 mL,averaging 1,023.3 mL.No deterioration of neurological symptoms or no new neurological symptoms were observed postoperatively.Cerebrospinal fluid leakage was found in 3 patients who healed spontaneously following extubation,compressive dressing and elevation of the bed end.All the patients were followed up for 12 to 30 months (average,18.3 months).A loosened screw cap was found in one patient after 6 months who had no discomfort and received no treatment.X-ray films showed satisfactory fracture reduction and fine bone grafting locations.No spinal canal stenosis was found by CT scans.It took 3 to 6 months (mean,4.3 months) for the bone grafts to get fused.No height loss of the injured vertebrae was no found at the last follow-ups.No functional recovery was found in the patients with complete spinal cord injury whose Frankle grade remained A.The spinal function recovered from Frankel grade B to grade D in one patient with incomplete spinal injury.Of the 8 patients with medullary cone injury,7 recovered Frankle grade E and one Frankle grade D.The symptoms were relieved in one patient with simple cauda equine injury.Conclusion Posterior decompression,subtotal vertebrectomy,intervertebral fusion and internal fixation through unilateral pedicle is an effective alternative for treatment of severe throracolumar fractures,because it can lead to satisfactory fracture reduction,thorough decompression of the spinal canal and good reconstruction of spinal stability.

One-stage partial vertebrectomy, titanium mesh implantation and pedicle screw fixation in the treatment of thoracolumbar burst fractures through a posterior approach

OBJECTIVE: To analyze the clinical results of a partial vertebrectomy with titanium mesh implantation and pedicle screw fixation using a posterior approach to reconstruct the spine in the treatment of thoracolumbar burst fractures. METHOD: From January 2006 to August 2008, 20 patients with severe thoracolumbar fractures were treated.For vertebral bodies associated with one injured intervertebral disk, subtotal vertebrectomy surgery and single-segment fusion were performed. For vertebral bodies with two injured adjacent intervertebral disks, partial vertebrectomy surgery and two-segment fusion were performed. RESULTS: All 20 patients were followed up for 12 to 24 months (average of 18 months). There were no complications such as wound infections, hemopneumothorax or abdominal infections in any of the patients. The neurological status of all of the patients was improved by at least one American Spinal Injury Association grade by the last follow-up. The anterior vertebral body height was an average of 50.77% before surgery, 88.51% after surgery and 87.86% at the last follow up; the sagittal Cobb angle was improved, on average, from 26.15° to 5.39° and was 5.90° at the last follow up. The percentage of spinal stenosis was improved, on average, from 26.07% to 4.93%° and was 6.15% at the last follow up. There were significant differences ...

La corpectomía transpedicular en fracturas de columna toracolumbar / Transpedicular vertebrectomy in thoracolumbar spine fractures / La corpectomie transpédiculaire dans les fractures du rachis thoraco-lombaire

INTRODUCCIÓN. El objeto de este estudio fue analizar la evolución clínica de una serie de pacientes con fracturas vertebrales postraumáticas y trastornos neurológicos añadidos, operados mediante la técnica de corpectomía transpedicular, y relacionar además esta evolución con el tiempo preoperatorio transcurrido. MÉTODOS. Se realizó un estudio prospectivo de intervención, de 18 pacientes con paraplejia postraumática, a los cuales se les realizó descompresión medular por corpectomía transpedicular e instrumentación con la técnica de Luque. Los pacientes fueron atendidos entre 1987 y 1989 en el Hospital «Hermanos Ameijeiras¼. RESULTADOS. De 15 pacientes que no deambulaban, 9 recuperaron esa función (60 %). No se halló relación entre el tiempo de la lesión y la recuperación neurológica. La complicación más frecuente fue la infección, y hubo un fallecido. El tiempo promedio de duración de la lesión fue de 11,7 meses, y el tiempo promedio de evolución posoperatoria fue de 10,7 meses. CONCLUSIONES. Se concluyó que la descompresión del canal y la instrumentación vertebral en pacientes con lesiones medulares postraumáticas puede mejorar el estado neurológico de éstos, independientemente del tiempo de lesión preoperatorio.

INTRODUCTION: The aim of present study was to analyze the clinical course of a group of patients presenting with post-traumatic vertebral fractures and added neurologic disorders operated on by transpedicular vertebrectomy and to relate this course to intervening preoperative time. METHODS: An interventional and descriptive study was conducted in 18 patients presenting with post-traumatic paraplegia underwent medullar decompression by transpedicular vertebrectomy and instrumentation using Luque’s technique. Patients were seen in “Hermanos Ameijeiras” Clinical Surgical Hospital from 1987 to 1989. RESULTS: From 15 non-ambulatory patients 9 recovered that function (60%). There was not relation between the lesion time and neurologic recovery. The more frequent complication was the infection with deceased patient. Mean time of lesion duration was of 11,7 months, and the mean time of postoperative course was of 10,7months. CONCLUSIONS: We conclude that canal decompression and vertebral instrumentation in patients presenting with post-traumatic lesions, can to improve the neurologic status independently of preoperative lesion time.

INTRODUCTION. Le but de cette étude est d'analyser l'évolution clinique d'une série de patients atteints de fractures vertébrales post-traumatiques et de troubles neurologiques qui ont été opérés par la technique de corpectomie transpédiculaire, et d'associer aussi cette évolution au temps préopératoire écoulé. MÉTHODES. Une étude prospective de 18 patients atteints de paraplégie post-traumatique et traités par décompression médullaire (corpectomie transpédiculaire et instrumentation), selon la technique de Luque, a été réalisée. Les patients ont été soignés entre 1987 et 1989 à l'Hôpital “Hermanos Ameijeiras”. RÉSULTATS. Neuf patients sur quinze ont récupéré cette fonction (60%). Il n'y a pas eu de relation entre le temps de la lésion et la récupération neurologique. La complication la plus fréquente a été l'infection, et un patient est décédé. Le temps moyen de la lésion a été 11,7 mois tandis que le temps moyen de l'évolution postopératoire a été 10,7 mois. CONCLUSIONS. On a conclu que la décompression du canal et la instrumentation rachidienne chez des patients atteints des lésions médullaires post-traumatiques peuvent améliorer leur état neurologique, indépendemment du temps préopératoire de la lésion.

Combined Anterior and Posterior En Bloc Vertebrectomy for Lumbar Chordoma

Chordoma is a rare bone tumor derived from remnants of the notochord. The majority of chordomas involve the sacrum or skull base. We report a rare case of a L4 vertebral body chordoma treated with anterior en bloc vertebrectomy and posterior stabilization. No tumor recurrence was observed at the 5 year follow-up examination.

Surgical Correction of Fixed Kyphosis

STUDY DESIGN: A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. PURPOSE: To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. OVERVIEW OF LITERATURE: Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. METHODS: There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. RESULTS: The average kyphotic angle was 71.8degrees preoperatively, 31.0degrees postoperatively, and the average final angle was 39.2degrees. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. CONCLUSIONS: Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees.

Titanium Mesh Cage for Anterior Stabilization in Tuberculous Spondylitis : Is It Safe?

OBJECTIVE: The safety of titanium metal cages in tuberculous spondylitis has not been investigated. We evaluated the outcome and complications of titanium mesh cages for reconstruction after thoracolumbar vertebrectomy in the tuberculous spondylitis. METHODS: There were 17 patients with 18 operations on the tuberculous spondylitis in this study. Sixteen patients were operated with anterior corpectomy and reconstruction with titanium mesh cage followed by posterior transpedicular screw fixations on same day, two pateints were operated by either anterior or posterior approach only. After the affected vertebral body resection and pus drainage from the psoas muscle, titanium mesh cage, filled with morselized autogenous bone, was inserted. All the patients had antituberculosis medication for 18 months. The degree of kyphosis correction and the subsidence of cage were measured in the 15 patients available at a minimum of 2 years. Outcome was assessed with various cross-sectional outcome measures. Recurrent infection was identified by serial ESR(Erythrocyte Sedimentation Rate) and CRP(Cross Reactive Protein) . RESULTS: There was no complication from the use of a titanium mesh cage. Recurrent infection was not detected in any case. Average preoperative of 9.2degrees was reduced to -2degrees at immediate postoperative period, and on final follow up period kyphotic angle was measured to be 4.5degrees. Postoperatively, subsidence was detected in most patients especially at ambulation period, however further subsidence was prevented by the titanium mesh cage. Osseous union was identified in all cases at the final follow-up. CONCLUSION: The cylindrical mesh cage is a successful instrument in restoring and maintaining sagittal plane alignment without infection recurrence after vertebrectomy for tuberculous spondylitis.