Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine.
To report outcomes after total en bloc spondylectomy (TES) for primary aggressive/malignant tumors of the lumbar spine.



We performed a retrospective review of 23 neurosurgical patients operated between 2004 and 2014. Outcomes included perioperative complication rates and reoperation rates for instrumentation failure. The relationship between patient/operative parameters and complication development/instrumentation failure was investigated.



There were 15 men (65.2 %) and eight women (24.8 %), with a median of 47 years. The most common tumor was chordoma in 11 patients (47.8 %), followed by sarcoma in four (17.4 %), and giant cell tumor in three (13.0 %). All patients but one underwent a two-staged operation; median total estimated blood loss was 3200 mL and median total operative time was 18.5 h. Fifteen patients developed at least one perioperative complication (65.2 %), with the most common being wound infection and ileus (26.1 % each). There was one case of intraoperative iliac vein injury (4.4 %). Instrumentation failure occurred in 9 patients (39.1 %) at a median time of 23 months after index spondylectomy. Following logistic regression, there were no factors associated with complication development. On the other hand, postoperative radiation was significantly associated with instrumentation failure (OR 7.49; 95 % CI, 1.02-54.9). Local recurrence and 5-year survival was 8.7 and 84.4 %, respectively. Median follow-up time was 50 months.



Although favorable oncological outcomes after en bloc resection of spinal tumors may be achieved in terms of recurrence and survival, TES in the lumbar spine remains a challenging procedure. Future investigation into complication avoidance and reconstruction techniques is encouraged.
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA. dsciubb1@jhmi.edu.
Daniel M
DM
Sciubba
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA.
Rafael
R
De la Garza Ramos
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA.
C Rory
CR
Goodwin
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA.
Risheng
R
Xu
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA.
Ali
A
Bydon
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA.
Timothy F
TF
Witham
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Ziya L
ZL
Gokaslan
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA.
Jean-Paul
JP
Wolinsky
D000328:Adult; D000368:Aged; D002817:Chordoma / Q000601:surgery*; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D061646:Operative Time; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery*; D055009:Spondylosis / Q000209:etiology / Q000601:surgery; D016019:Survival Analysis
Chordoma; Lumbar spine; Sarcoma; Spinal tumor; Total en bloc spondylectomy