Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
Spine (Phila Pa 1976). 2011 Jan 1;36(1):74-82. doi: 10.1097/BRS.0b013e3181cded6c.
Ten patients with a spinal tumor of the lower lumbar spine underwent total en bloc spondylectomy (TES) by combined posterior-anterior approach. The oncological and neurologic results are analyzed.
To describe the surgical technique and evaluate the clinical outcome of this surgery.
TES at lower lumbar spine is technically challenging because of its anatomy such as the presence of major vessels and lumbosacral plexus nerves.
Six aggressive benign tumors and 4 solitary spinal metastases involving L4 or L5 were treated. The approache of operative procedure are discussed as follows: Posterior approach: Dissection of the lumbar nerve roots to the conjunction of the adjacent nerves were performed after en bloc laminectomy by T-saw pediculotomy. The psoas muscle was dissected away, from the vertebral body. The posterior halves of the anterior column at the craniocaudal adjacent levels of the lumbar tumor were cut. Anterior approach: Major vessels were dissected from the vertebral body. Anterior halves of the anterior column were cut at the corresponding levels. The tumor vertebral body was removed en bloc, followed by anterior spinal reconstruction.
Seven of 10 cases had no evidence of disease at 57 months on average, 1 case was alive with disease at 66 months, 1 case had death of disease at 42 months, and 1 case had death of another disease at 14 months after surgery. All patients improved or preserved neurologic in the last follow up. The resected specimen of vertebral bodies and laminae showed marginal or wide margin in all cases, although pedicles showed intralesional margin in 8 cases. No local recurrence was observed during lifetime with mean 52 months.
TES for spinal tumor of L4 or L5 preserving lumbar nerves was achieved by combined posterior- anterior approach.
十名患有下腰椎脊柱肿瘤的患者通过前后联合入路行全脊椎整块切除术（TES）。分析了肿瘤学和神经学结果。
描述该手术的技术并评估其临床结果。
由于存在主要血管和腰骶丛神经等解剖结构，下腰椎 TES 技术具有挑战性。
治疗 6 例侵袭性良性肿瘤和 4 例 L4 或 L5 单发脊柱转移瘤。讨论手术入路如下：后路：整块椎板切除术后，通过 T 形锯椎弓根切开术将腰椎神经根解剖至相邻神经根交界处。将腰大肌从椎体上分离。沿肿瘤所在的腰椎头尾相邻水平切除前柱的后半部分。前路：从椎体上解剖主要血管。在相应水平切开前柱的前半部分。整块切除肿瘤椎体，然后进行前路脊柱重建。
10 例中有 7 例在平均 57 个月时无疾病证据，1 例在 66 个月时存活有疾病，1 例在 42 个月时死于疾病，1 例在手术后 14 个月时死于另一种疾病。所有患者在最后一次随访时神经功能均改善或保留。所有病例的椎体和椎板切除标本均显示边缘或宽切缘，尽管 8 例椎弓根显示瘤内切缘。在 52 个月的平均生存期内未观察到局部复发。
通过前后联合入路行 L4 或 L5 脊柱肿瘤的 TES 可保留腰椎神经。
