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Modified Standard Total en bloc Spondylectomy for Solitary Thoracic or Lumbar Spinal Metastasis: A 1-Stage Posterior
Wei Xu1, Shangbin Zhou1,2, Danyang Bai1
1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Military Medical University, Shanghai, People's Republic of China.
The Journal of Bone and Joint Surgery. American Volume
|September 20, 2024
Summary
A modified posterior approach for total en bloc spondylectomy (TES) offers a safe and effective method for treating solitary spinal metastasis (SM). This technique enhances visualization, reducing risks associated with conventional TES for thoracic and lumbar tumors.
Area of Science:
- Spine surgery
- Oncology
- Surgical techniques
Background:
- Solitary spinal metastasis (SM) necessitates surgical intervention, often total en bloc spondylectomy (TES).
- Conventional TES poses risks to anterior great vessels due to limited visualization.
- A modified TES technique was developed to improve anterior structure visualization via a posterior approach.
Purpose of the Study:
- To evaluate the safety and efficacy of a modified standard TES technique.
- To assess the feasibility of achieving direct visualization of anterior structures in a 1-stage posterior approach for solitary thoracolumbar SM.
Main Methods:
- Retrospective analysis of 71 patients (≥18 years) with solitary thoracic or lumbar SM who underwent modified standard TES (Jan 2017-Oct 2022).
- Minimum 3-month postoperative follow-up.
- Data collected on intraoperative and perioperative complications, operative time, blood loss, transfusion, hospitalization, and oncological outcomes.
Main Results:
- 71 East Asian patients (median age 57) with thoracic (n=38) or lumbar (n=33) SM. Lung cancer was most common.
- 19.7% intraoperative complications (predominantly pleural rupture); no spinal cord or great vessel injuries.
- 38.0% acute perioperative complications; 73.4% achieved negative surgical margins. Median follow-up: 31.5 months.
Conclusions:
- The modified standard TES technique is safe and effective for solitary thoracolumbar SM.
- This posterior approach allows direct visualization, mitigating risks of anterior great vessel injury.
- The technique facilitates oncological goals, achieving negative margins in most patients.
