[Radical surgery in tumors of the thoraco-lumbar spine]

In this retrospective study, the outcomes of anterior and posterior approaches, performed either simultaneously or consecutively, in the radical surgical treatment of tumors of the thoracolumbar spine were compared in terms of surgery duration, intra-operative blood loss, neurological findings and complications.

A total of 547 patients with malignant tumors of the spine were treated between 1981 and 2001. Of these, the thoracolumbar spine was affected in 422 cases. Spondylectomy from the combined anterior and posterior approach with decompression, vertebral body replacement and stabilization was indicated in 117 patients, 69 men and 48 women (59% and 41%, respectively). Etiology included metastases in 63 subjects (54%), primary malignant tumor in 37 (32%), benign tumors in 11 (9%) and tumor-like lesions in six patients (5%). Surgery involving two procedures carried out simultaneously by two teams of surgeons was used in 45 cases (38%) and approaches performed consecutively (in either the anteroposterior or the posteroanterior order) were applied in 72 cases (62%). Both groups were nearly identical in relation to the patients' average age and disease etiology.

In young patients with a solitary tumor of the thoracolumbar spine whose disease had a good prognosis, radical surgery including complete removal of the vertebra affected, decompression of nervous structures, vertebral body replacement and stabilization with 360 degrees fusion was carried out. The simultaneous and consecutive procedures were compared in terms of operative time, intra-operative blood loss, neurological findings and complications.

The approaches carried out simultaneously by two teams reduced the total time of surgery and permitted a better correction of the spine affected. This surgical procedure, however, was more demanding in terms of operative skills and involved increased intraoperative blood losses. In 45 patients treated by this procedure, the average operative time was 244 min and intra-operative blood loss was 3313 ml. In 72 patients undergoing consecutive surgery, the average operative time was 345 min and blood loss was 2500 ml. The neurological finding was generally better or unchanged. Of the patients treated consecutively, four (5.5%) experienced deterioration; of those operated on simultaneously, only one patient (2.2%) got worse. Two patients died in each group (2.8% and 4.4%, respectively).

In order to provide the optimal therapy, each cancer patient should be considered individually with respect to all basic rules of cancer treatment. In this, the radical approach is nowadays preferred. Some authors, however, use only the posterior approach. At our department, the combined anteroposterior approach under one anesthesia is our method of choice with the exception of a serious intra-operative complication such as large blood loss. In this case, the treatment is completed at a subsequent operation one week later.

We prefer an active and radical approach to the therapy of spinal tumors. The simultaneous surgery resulted in an operative time reduced by about 100 min (29%). The consecutive treatment, on the other hand, produced lower blood losses by 813 ml (24%). Complete surgery under one anesthesia was preferred.