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A Novel Technique for Total En bloc Spondylectomy of the Fifth Lumbar Tumor Through Posterior-Only Approach

Yang, Xinghai MD; Yang, Jian MD; Jia, Qi MD; Zhong, Nanzhe MD; Jiao, Jian MD; Hu, Jinbo MD; Peng, Dongyu MD; Liu, Weibo MD∗,†; Wan, Wei MD; Xiao, Jianru MD

doi: 10.1097/BRS.0000000000003003

Study Design. A retrospective study.

Objective. To describe a new surgical technique for total en bloc spondylectomy (TES) of the fifth lumbar (L5) tumor and evaluate the efficacy and safety of this new technique.

Summary of Background Data. TES has been considered an optimal treatment for tumor, including certain spinal tumors, but it requires a combined posterior–anterior approach, which is often complicated by a long operation time, considerable blood loss and severe trauma.

Methods. Seven patients with primary or solitary metastatic tumors of L5 were treated with this new technique in our center between March 2014 and November 2017. The critical points were fabrication of the iliac graft, dissection, resection, and reconstruction. Other parameters including surgical time, blood loss, complications, pre- and postoperative neurological function, tumor control, and overall survival (OS) were presented and analyzed.

Results. All the included patients received one stage TES. The mean surgical time was 365.7 minutes with an average blood loss of 2514.3 mL. No serious perioperative complication was observed or reported during the mean follow-up period of 27.4 months. Wound disruption occurred in one patient and numbness of the left lower limb in another, but both recovered rapidly after appropriate management. Adventitial avulsion of the abdominal aorta occurred during dissection in one patient. Two patients died during the follow-up period due to advanced malignancy. One patient was alive but developed a newly diagnosed thoracolumbar tumor in 40 months. The other four patients recovered well without evidence of disease. All patients were able to walk independently 3 to 4 weeks after operation, with satisfied fusion of the iliac grafts in a mean period of 6.7 months after operation. No evidence of internal fixation failure occurred.

Conclusion. This new technique offers satisfactory surgical exposure, total en bloc spondylectomy, reliable reconstruction, and good tumor control for certain L5 tumors through the posterior-only approach.

Level of Evidence: 4

Total en bloc spondylectomy through the posterior-only approach is still a great challenge for fifth lumbar (L5) tumor. In this study, we present a new technique that assisted by the use of iliac flap. With this new technique employed, satisfied exposure, total en-bloc spondylectomy, reliable reconstruction, and well tumor control can be attained for L5 tumors through the posterior-only approach.

Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Huangpu District, Shanghai, China

Department of Spine Surgery, Qingdao Central Hospital, Shibei District, Qingdao, Shandong Province, China.

Address correspondence and reprint requests to Wei Wan, MD, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China; E-mail:; Jianru Xiao, MD, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China; E-mail:

Received 26 September, 2018

Revised 6 December, 2018

Accepted 21 January, 2019

X.Y., J.Y., Q.J., and N.Z. have contributed equally to this study.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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