Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin, China.
Spine (Phila Pa 1976). 2010 Mar 1;35(5):590-5. doi: 10.1097/BRS.0b013e3181b967ca.
Retrospective clinical and radiologic evaluation.
To investigate the feasibility of a 1-stage combined posterior and anterior approaches for excising thoracolumbar and lumbar tumors with the patient lying in the lateral position.
Traditional anteroposterior approaches for total spondylectomy require a 2-stage operation or changing the patient's position, with secondary sterilization in the one stage. So the surgical time, cost and trauma, as well as blood loss, would be increased. One-stage en bloc spondylectomy with the patient lying in the lateral position may be a good way for improving it.
This study retrospectively reviewed 18 patients with thoracolumbar and lumbar spinal tumors who underwent spondylectomy. All patients were observed up, and their status was evaluated by clinical and imaging studies.
Total en bloc spondylectomy was performed successfully in 15 patients, and 3 patients underwent bulk vertebrectomy. All patients were observed up for 18 months to 3 years (mean, 2 years). Posterior pedicle screw fixation and anterior intervertebral titanium mesh placement were stable in all patients, with satisfactory positions. Two patients with preoperative neurologic deficits recovered less than 3 weeks after surgery. One patient with thyroid metastasis underwent artificial joint replacement 5 months after surgery. Two patients with metastatic tumor died 6 months and 8 months, respectively, after surgery. Ten months after surgery, local tumor recurred in one patient with chondrosarcoma. One patient with Ewing's sarcoma died due to distal metastasis 1 year after surgery.
The 1-stage combined posterior and anterior approaches with the patient lying in the lateral position, used to excise thoracolumbar and lumbar spinal tumors, is feasible and permits sufficient exposure, reduces the risk of neurovascular injury and blood loss during surgery, facilitates total en bloc spondylectomy and spinal reconstruction, and reduces the surgical time of a 2-stage procedure and repositioning the patient. This method can be used effectively for excising spinal tumors.
回顾性临床和影像学评估。
探讨侧卧位 1 期后路与前路联合入路切除胸腰椎和腰椎肿瘤的可行性。
全脊椎切除术的传统前后入路需要 2 期手术或改变患者体位，在一期手术中进行二次灭菌。因此，手术时间、成本和创伤以及失血量都会增加。侧卧位 1 期整块脊椎切除术可能是一种改善方法。
本研究回顾性分析了 18 例胸腰椎和腰椎脊柱肿瘤患者行脊椎切除术的病例。所有患者均进行了随访，并通过临床和影像学研究对其情况进行了评估。
15 例患者成功进行了全脊椎整块切除术，3 例患者进行了大块椎体切除术。所有患者均随访 18 个月至 3 年（平均 2 年）。所有患者后路椎弓根螺钉固定和前路椎间钛网植入均稳定，位置满意。2 例术前有神经功能缺损的患者术后 3 周内恢复不佳。1 例甲状腺转移患者术后 5 个月行人工关节置换术。2 例转移性肿瘤患者分别于术后 6 个月和 8 个月死亡。软骨肉瘤患者术后 10 个月局部肿瘤复发。1 例尤文肉瘤患者术后 1 年因远处转移死亡。
侧卧位 1 期后路与前路联合入路切除胸腰椎和腰椎脊柱肿瘤是可行的，可提供充分的暴露，降低手术中神经血管损伤和失血的风险，便于整块脊椎切除术和脊柱重建，并减少 2 期手术和重新定位患者的手术时间。这种方法可有效地用于切除脊柱肿瘤。
