title: Oncosurgical results of multilevel thoracolumbar en-bloc spondylectomy and reconstruction with a carbon composite vertebral body replacement system.
abstract: METHODS
  Retrospective clinical study for patients receiving multilevel en-bloc spondylectomy resection for sarcomas and solitary metastases of the thoracolumbar spine.
  
  
  OBJECTIVE
  Assess the clinical and radiologic outcome after multilevel en-bloc spondylectomy and reconstruction.
  
  
  BACKGROUND
  Monolevel en-bloc spondylectomies have proven their oncosurgical effectiveness while reports on multilevel resections for extracompartmental tumor localizations are rare.
  
  
  METHODS
  Patients treated by multilevel en-bloc spondylectomy and restoration with a carbon composite vertebral body replacement system were investigated. Patient charts, and clinical follow-up investigations were analyzed for histopathological tumor origin, preoperative symptoms, surgical peri- and postoperative data, applied adjuvant therapies, as well as the course of disease. Solitary metastases time until occurrence and prognostic scores were evaluated (Tomita/Tokuhashi Score). CT-scans were performed and analyzed at follow up. Oncological status was evaluated including local recurrence rates, cumulative disease specific, and metastases-free survival.
  
  
  RESULTS
  Multilevel (2-5 segments) en-bloc spondylectomy of the thoracolumbar spine was performed in 20 patients (15 sarcomas and 5 solitary spinal metastases 9 male/11 female, mean age at surgery: 54 ± 15 years.). Wide and marginal surgical margins were achieved in 7 and 13 patients, respectively. Mean follow-up period was 25.0 (9-53) months. Thirteen patients received adjuvant therapy. No implant breakage or loosening was observed. Local recurrence occurred in one patient. Thirteen of the 18 surviving patients showed no evidence of the disease, two died of systemic disease.
  
  
  CONCLUSIONS
  Multilevel en-bloc spondylectomy offers a radical resection option for extracompartmental tumor involvement. It provides oncologically adequate resection margins with low local recurrence. However, the procedures are complex; the patient's stress is high and metastatic disease developed in one-third of patients. A judicious patient selection and a realistic feasibility evaluation must precede the decision for surgery. Reconstruction using a carbon composite cage system showed low complication rates and offers advantages for oncosurgical procedures.
authors.affiliation: Center for Musculoskeletal Surgery, Spine Surgery and Musculoskeletal Tumor Surgery Section, Campus Virchow, Charité-University Medicine Berlin, Germany. alexander.disch@charite.de
authors.forename: Alexander Carl
authors.initials: AC
authors.lastname: Disch
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Schaser
authors.forename: Ingo
authors.initials: I
authors.lastname: Melcher
authors.forename: Franco
authors.initials: F
authors.lastname: Feraboli
authors.forename: Werner
authors.initials: W
authors.lastname: Schmoelz
authors.forename: Claudia
authors.initials: C
authors.lastname: Druschel
authors.forename: Alessandro
authors.initials: A
authors.lastname: Luzzati
mesh_terms: D018786:Bone Substitutes; D002244:Carbon; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*
chemical_list: D018786:Bone Substitutes; D002244:Carbon