title: One-stage combined posterior and anterior approaches for excising thoracolumbar and lumbar tumors: surgical and oncological outcomes.
abstract: METHODS
  Retrospective clinical and radiologic evaluation.
  
  
  OBJECTIVE
  To investigate the feasibility of a 1-stage combined posterior and anterior approaches for excising thoracolumbar and lumbar tumors with the patient lying in the lateral position.
  
  
  BACKGROUND
  Traditional anteroposterior approaches for total spondylectomy require a 2-stage operation or changing the patient's position, with secondary sterilization in the one stage. So the surgical time, cost and trauma, as well as blood loss, would be increased. One-stage en bloc spondylectomy with the patient lying in the lateral position may be a good way for improving it.
  
  
  METHODS
  This study retrospectively reviewed 18 patients with thoracolumbar and lumbar spinal tumors who underwent spondylectomy. All patients were observed up, and their status was evaluated by clinical and imaging studies.
  
  
  RESULTS
  Total en bloc spondylectomy was performed successfully in 15 patients, and 3 patients underwent bulk vertebrectomy. All patients were observed up for 18 months to 3 years (mean, 2 years). Posterior pedicle screw fixation and anterior intervertebral titanium mesh placement were stable in all patients, with satisfactory positions. Two patients with preoperative neurologic deficits recovered less than 3 weeks after surgery. One patient with thyroid metastasis underwent artificial joint replacement 5 months after surgery. Two patients with metastatic tumor died 6 months and 8 months, respectively, after surgery. Ten months after surgery, local tumor recurred in one patient with chondrosarcoma. One patient with Ewing's sarcoma died due to distal metastasis 1 year after surgery.
  
  
  CONCLUSIONS
  The 1-stage combined posterior and anterior approaches with the patient lying in the lateral position, used to excise thoracolumbar and lumbar spinal tumors, is feasible and permits sufficient exposure, reduces the risk of neurovascular injury and blood loss during surgery, facilitates total en bloc spondylectomy and spinal reconstruction, and reduces the surgical time of a 2-stage procedure and repositioning the patient. This method can be used effectively for excising spinal tumors.
authors.affiliation: Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin, China. yongchenghu@yahoo.com.cn
authors.forename: Yongcheng
authors.initials: Y
authors.lastname: Hu
authors.forename: Qun
authors.initials: Q
authors.lastname: Xia
authors.forename: Jingtao
authors.initials: J
authors.lastname: Ji
authors.forename: Jun
authors.initials: J
authors.lastname: Miao
mesh_terms: D000328:Adult; D000368:Aged; D002813:Chondrosarcoma / Q000601:surgery; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome