Stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors / 中华骨科杂志

ABSTRACT

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.