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Four- and Five- Level En Bloc Spondylectomy for Malignant Spinal Tumors

Luzzati, Alessandro D. MD*; Shah, Sambhav P. MBBS, MS*; Gagliano, Fabio S. MD*; Perrucchini, Giuseppe G. MD*; Fontanella, Walter MD; Alloisio, Marco MD

doi: 10.1097/BRS.0000000000000072
Surgery

Study Design. Retrospective study.

Objective. To report results of 4- and 5-level en bloc spondylectomy (EBS) in the treatment of malignant spinal tumors.

Summary of Background Data. EBS is widely used to avoid local recurrence in the treatment of spinal malignant tumors. Four- and 5-level EBS are aggressive procedures associated with complications and morbidity.

Methods. We conducted a retrospective study of all patients treated with minimum 4-level EBS. Patient and surgical data were noted. Radiographs, magnetic resonance images, and computed tomographic scans were studied for local recurrence, graft, and instrumentation failures at subsequent follow-up. Type of excision was classified into intralesional, marginal, and wide margins. Complications were divided into major or minor and were further classified as intraoperative, early, and late postoperative. At the last follow-up, the patients were classified as alive with no evidence of local or systemic disease, alive with evidence of local or systemic disease or both, dead with evidence of local disease, or systemic disease or both, and dead without evidence of local and systemic disease.

Results. Nine patients were identified who required a minimum 4-level en bloc resection. Five males and 4 females. Average age was 41.66 years (11–66). There were 8 primary malignant tumors: 3 chordomas, 3 osteosarcomas, 1 chondrosarcoma, 1 primary lung tumor and 1 metastatic alveolar soft part sarcoma. Six were operated with 4-level en bloc and 3 with 5 levels. The mean surgical time was 713 minutes and estimated blood loss was 4.5 L. Mean follow-up was 27.7 months (8–84). At the last follow-up, 6 patients were alive with no evidence of local or systemic disease, 1 alive with evidence of systemic disease, 1 dead with evidence of local disease, or systemic disease or both, and 1 DNLS. Only 1 (11%) patient had a local recurrence. Three patients with Frankel D had full neurological recovery. Histopathological assessment showed marginal margins in 7 patients and wide in 2. There were 9 major and 9 minor complications in 7 patients. Five of 7 patients (71%) with complications, had fully recovered from their complications at the last follow-up.

Conclusion. Multilevel EBS, can be offered to a patient to prevent local recurrence of disease. Even in experienced hands, the risks of intra- and postoperative complications are high (78%). However, most of the patients with complications, recovered completely (71%). Although the surgery itself may prove beneficial, patients should be well informed regarding the morbidity associated with it.

Level of Evidence: 4

En bloc spondylectomy is widely used to avoid local recurrence in the treatment of spinal malignant tumors. Four- and 5-level en bloc spondylectomy, can be offered to a patient to prevent local recurrence of disease. Even in experienced hands, the risks of complications are high. However, most of the patients with complications recovered completely.

*Department of Orthopaedics, Section for Oncological Orthopaedics and Reconstruction of the Spine, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

Department of Otorhinolarynology, ORL Unit, Istituto Nazionale Tumori, Milan, Italy; and

Department of Thoracic Surgery, Istituto Clinico Humanitas, Milan, Italy.

Address correspondence and reprint requests to Alessandro D. Luzzati, MD, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4-20161, Milano; E-mail: alessandroluzzati@gmail.com

Acknowledgment date: May 15, 2013. First revision date: July 18, 2013. Second revision date: September 23, 2013. Acceptance date: October 2, 2013.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins