Total En Bloc Spondylectomy for Lumbar Spinal Tumors by Paraspinal Approach

To report and describe a modified posterior-only approach (paraspinal approach) for total en bloc spondylectomy (TES) of lumbar spinal tumors.

From February 2013 to June 2014, 5 patients with lumbar spinal tumors who underwent TES through a posterior-only paraspinal approach were studied retrospectively; operative time, blood loss, complications, neurologic outcomes, and degree of resection were recorded to evaluate the efficacy of this surgical method.

Patients included 3 men and 2 women with a mean age of 48.4 years (range, 46-52 years). Two lesions were located in L2, 2 lesions were located in L3, and 1 lesion was located in L4. Three patients had solitary metastatic tumors (lung cancer in 2 cases, breast cancer in 1 case), and 2 patients had primary tumors (osteosarcoma and plasma cell tumor). According to the surgical classification of spinal tumors by Tomita et al., 4 cases were type 4 and 1 case was type 1. Mean operative time was 464 minutes (range, 420-510 minutes), and mean blood loss was 1280 mL (range, 1000-1500 mL). One patient had cerebrospinal fluid leakage, and 1 had transient motor weakness because of nerve root traction. Mean follow-up time was 20.6 months (range, 12-30 months), and all patients had improved or stable neurologic function. No local recurrence was observed at last follow-up.

The posterior-only paraspinal approach is a valid alternative for TES of lumbar spinal tumors, especially for overweight or muscular patients.