title: Repeated total en bloc spondylectomy for spinal metastases at different sites in one patient.
abstract: OBJECTIVE
  Total en bloc spondylectomy (TES) is accompanied by preoperative embolization of segmental arteries, which is limited to three consecutive levels to avoid the risk of spinal cord ischemia. We retrospectively examined the efficacy and safety of repeated TES with embolization of more than three levels of segmental arteries.
  
  
  METHODS
  Seven patients underwent TES twice for spinal metastases at different levels. Every patient underwent embolization of the bilateral segmental arteries before each surgery. We assessed the total number of segmental arteries embolized, the existence of Adamkiewicz arteries during the embolization procedure, intraoperative blood loss, and the motor function of the lower limbs, using the American Spinal Injury Association (ASIA) motor score.
  
  
  RESULTS
  No patient experienced any motor deficit after embolization. During the embolization procedure, an Adamkiewicz artery was depicted in five patients, which precluded embolization at that level. The median number of segmental arteries embolized in total was 9 (9-11). Intraoperative blood loss (median, IQR) was 480 (420-630) ml during the first surgery and 520 (280-600) ml during the second surgery. The ASIA motor scores (median, IQR) were as follows; 100 (98-100) (first admission), 100 (100-100) (first discharge), 100 (98-100) (second admission), and 97 (94-100) (second discharge). No patients had developed statistically significant neurological deterioration, and there had been no local recurrence after a median follow-up of 17.8 months (range 1-51 months).
  
  
  CONCLUSIONS
  Repeated TES procedures can be performed safely even if more than three levels of segmental arteries are embolized.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan. ssugita-tky@umin.ac.jp.
authors.forename: Shurei
authors.initials: S
authors.lastname: Sugita
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yokogawa
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Nerve root ligation and cut; Preoperative artery embolization; Repeated times; Spinal metastases; Total en bloc spondylectomy