En-Bloc Spondylectomy for spinal metastases: outcomes, indications, and cost analysis in a 40-patient retrospective...

The spine is a primary site for metastases; While only 10% of malignant tumors develop symptomatic spinal metastases, these cases significantly impair quality of life. En-Bloc Spondylectomy (EBS) is a rarely employed but potentially curative surgical option for patients with favorable prognoses. This study evaluates the clinical presentation, surgical procedures, outcomes, and complications associated with EBS in patients with spinal metastasis.

This retrospective series included 40 consecutive patients who underwent EBS for spinal metastases between June 2010 and October 2021. Clinical characteristics, treatments, complications, recurrence rates, and survival outcomes were analyzed.

Thoracic spine metastases accounted for 80% of cases. The most common histologies were clear cell carcinoma of the kidney and follicular thyroid tumor. Wide margins were achieved in 38% of cases, marginal in 17%, and intralesional in 45%. The average blood loss was 1665 ml, and surgeries averaged 7.5 h.Early complications occurred in 32.5% of patients, with neurological deterioration being the most frequent. The 5-year local recurrence-free survival (LRFS) rate was 64.0%, and the 5-year overall survival (OS) rate was 34.5%.

Despite significant technical challenges, EBS offers a viable treatment option for select patients with spinal metastases, particularly in cases of radioresistant histologies. Achieving oncologically adequate margins and careful preoperative planning are crucial for successful outcomes.

EBS represents a complex but feasible surgical option that may provide durable local control in carefully selected patients with spinal metastases.