title: En bloc spondylectomy combined with chest wall excision for spinal tumor via a modified posterior approach: a retrospective study on 21 patients.
abstract: OBJECTIVE
  This study was to investigate the feasibility and efficacy of total en bloc spondylectomy (TES) combined with chest wall excision through a modified posterior approach in treating the patients with thoracic spinal tumor and posterior chest wall invasion.
  
  
  METHODS
  Clinical data of 21 consecutive patients (7 males, 14 females; average age: 41.5, range: 20-69) who underwent the combined TES and chest wall excision through a modified posterior approach from 08/2005 to 01/2014 were retrospectively analyzed. Reconstruction of the spinal defect following TES was accomplished by dorsal stabilization and carbon cage interposition. All resected specimens were examined histologically. Radiotherapy and chemotherapy were performed according to the results of the surgery and histological examination. All patients were followed up on a regular basis.
  
  
  RESULTS
  The surgery was successfully performed in all patients. Histological analysis revealed primary malignant tumors in 16 patients and solitary vertebral metastases in 5 patients. Three patients with preoperative neurologic deficits of Frankel D recovered to Frankel E 1-3 weeks postoperatively. After the mean follow-up of 31 months (9-70), the 16 patients (16/21, 76.2%) with primary bone tumors were free of recurrence and present no evidence of disease. Four cases (4/21, 19%) with metastatic tumor developed recurrence or distant metastases. Three patients presented with cerebrospinal fluid leakage and one patient suffered pneumonia; they were soon recovered after treatment. No other complications were observed.
  
  
  CONCLUSIONS
  The results suggest that the combined TES with chest wall excision via a modified posterior approach seems feasible and effective for treating patients with thoracic spinal tumor and posterior chest wall invasion.
authors.affiliation: Medical Center, Tsinghua University, Beijing, People's Republic of China; Department of Orthopedics, PLA General Hospital, Beijing, People's Republic of China.
authors.forename: Huadong
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Pinggu Hospital of Capital Medical University, Beijing, People's Republic of China.
authors.forename: Kedong
authors.initials: K
authors.lastname: Hou
authors.affiliation: Department of Orthopedics, PLA General Hospital, Beijing, People's Republic of China. Electronic address: luning301@aliyun.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Lu
authors.affiliation: Department of Orthopedics, PLA General Hospital, Beijing, People's Republic of China. Electronic address: xiaosonghua301@aliyun.com.
authors.forename: Songhua
authors.initials: S
authors.lastname: Xiao
authors.affiliation: Department of Orthopedics, PLA General Hospital, Beijing, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D035441:Thoracic Wall / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chest wall invasion; Reconstruction; Spinal tumor; Total en bloc spondylectomy