Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine.
BACKGROUND
Total en bloc spondylectomy (TES) was devised to minimize the incidence of local recurrence following resection of spinal tumor. Successful local control with TES has been reported for patients with primary malignant or aggressive benign spinal tumors. As for metastatic spinal tumors, however, only a few surgeons except for the inventor group have reported the outcome of TES. The purpose of this study was to investigate whether TES could provide radical resection of the tumor in patients with solitary spinal metastases.


METHODS
Twelve patients underwent TES for a solitary metastatic tumor of the thoracolumbar spine. Primary malignancies included breast cancer in four patients, thyroid cancer in three, renal cell carcinoma in three, lung cancer in one, and unknown in one. All patients were regularly followed up with plain radiographs, computed tomography scans, and magnetic resonance imaging to detect local recurrence.


RESULTS
In two of the four cases with paraspinal tumor extension, local recurrences developed at 25 months after surgery. Seven patients have survived for an average of 61 months, while the remaining five died of disseminated metastases with a mean survival of 23 months after surgery. Local recurrences were common in patients with paraspinal extensions. TES for lesions with paraspinal extensions failed to provide curative resection of the tumor.


CONCLUSIONS
Given the great technical demands and potential risks of TES, the indication for TES with spinal metastases should be limited to cases with solitary lesions that do not extend to the paraspinal area.
Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan. sakaurah@ort.med.osaka-u.ac.jp
Hironobu
H
Sakaura
Noboru
N
Hosono
Yoshihiro
Y
Mukai
Takahiro
T
Ishii
Kazuo
K
Yonenobu
Hideki
H
Yoshikawa
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013123:Spinal Fusion / Q000379:methods*; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome