title: A Systematic Review With Consensus Expert Opinion of Best Reconstructive Techniques After Osseous En Bloc Spinal Column Tumor Resection.
abstract: METHODS
  Systematic literature review and consensus expert opinion.
  
  
  OBJECTIVE
  To provide recommendations on reconstructive constructs for large tumor resections of the spinal column. Four questions were studied: (1) What are the best reconstructive options for single versus multilevel resections? (2) Should short segment fixation be considered in primary tumor reconstruction? (3) How should reconstructive techniques differ at various regions of the spine? (4) Does planned postoperative radiation change the fusion strategy?
  
  
  BACKGROUND
  Primary spinal tumors requiring en bloc resection are rare. Most studies focus on disease-free survival and local recurrence rates. Few studies focus on reconstructive options and outcomes with respect to fusion rates and need for revision.
  
  
  METHODS
  A literature search was performed from January 1990 to December 2013. Data were combined and construct survivorship summarized. A survey was administered to international spine tumor surgeons, evaluating reconstructive preferences.
  
  
  RESULTS
  The search yielded 381 articles, 12 included in the final analysis. Revision rates for anterior reconstruction were similar for autogenous strut grafts (10%), cages (7.7%), and allograft strut grafts (8.3%). There were two reports of revision from short to long segment constructs and three reports of broken pedicle screws, one requiring revision. Expert survey results revealed that most surgeons preferred cages packed with morcelized allograft and autograft (75%) for anterior reconstruction of single-level vertebrectomies, and strut bone grafting at the cervicothoracic junction (65%) and when more than one vertebrae was resected in the mid-thoracic spine (75%). Surgeons may alter their fusion technique if postoperative radiation is planned.
  
  
  CONCLUSIONS
  Posterior reconstruction with at least two vertebral levels above and below is recommended. Cages should be used for single-level defects and structural bone graft alone, or in combination with a cage, should be used when spanning a defect greater than two vertebral bodies. Planned postoperative radiation may affect fusion strategy.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Orthopedics, Dalhousie University, Halifax, NS, Canada.
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Glennie
authors.affiliation: Department of Surgery, Division of Orthopaedic Surgery, University of Toronto and University Health Network, Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.affiliation: Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
authors.affiliation: Oxford Spinal Unit, Oxford University Hospitals, Oxford, UK.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Reynolds
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, UT.
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
authors.affiliation: National Center for Spinal Disorders, Budapest, Hungary.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Varga
authors.affiliation: Division of Spine, Department of Orthopaedics, The University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*