Mesfin Addisu, El Dafrawy Mostafa H, Jain Amit, Hassanzadeh Hamid, Kebaish Khaled M
Orthopedics. 2015 Nov;38(11):e995-e1000. doi: 10.3928/01477447-20151020-08.
This study reports the surgical and clinical outcomes of spinal tumors managed with total en bloc spondylectomy. The authors searched their prospectively maintained database for patients undergoing total en bloc spondylectomy between 2001 and 2013. Ten patients (9 men, 1 woman; average age, 50.7 years; range, 42-68 years) were identified. The authors obtained demographic information, surgical outcomes (estimated blood loss, complications), and clinical outcomes (recurrence, survival). All patients had pain and were classified as American Spinal Injury Association grade E. The lesions were located in the thoracic (8 patients) and lumbar (2 patients) spine. Anterior column reconstruction was performed with strut allograft (7 patients), mesh cage (2 patients), and polymethyl methacrylate (1 patient). An average of 2.3 (range, 2-4) of 6 portions of the vertebrae were involved, according to the Kostuik classification. Mean estimated blood loss, operative time, and hospital stay were 3.5 L, 500 minutes, and 7.8 days, respectively. Perioperative complications included pleural tear (2 patients) and aortic tear, vena cava tear, retained sponge, pulmonary embolism, urinary tract infection, pneumothorax, anterior column support failure, and prominent instrumentation requiring removal (1 patient each). Postoperatively, all patients remained classified as American Spinal Injury Association grade E. Two patients had recurrence at distant spinal segments, and 1 had a new lesion in the thigh. Five patients had died (mean, 34.5 months after surgery), and 5 were alive a mean of 19.6 months after surgery (range, 6-48 months). Total en bloc spondylectomy is challenging, but in appropriately selected patients, it can be used to treat primary and metastatic spinal lesions.
本研究报告了采用整块全脊椎切除术治疗脊柱肿瘤的手术及临床结果。作者在其前瞻性维护的数据库中搜索了2001年至2013年间接受整块全脊椎切除术的患者。共确定了10例患者（9例男性，1例女性；平均年龄50.7岁；范围42 - 68岁）。作者获取了人口统计学信息、手术结果（估计失血量、并发症）及临床结果（复发、生存情况）。所有患者均有疼痛症状，且美国脊髓损伤协会分级均为E级。病变位于胸椎（8例患者）和腰椎（2例患者）。前路椎体重建采用支撑异体骨（7例患者）、网笼（2例患者）和聚甲基丙烯酸甲酯（1例患者）。根据Kostuik分类，平均每例患者6个椎体节段中有2.3个（范围2 - 4个）受累。平均估计失血量、手术时间和住院时间分别为3.5升、500分钟和7.8天。围手术期并发症包括胸膜撕裂（2例患者）以及主动脉撕裂、腔静脉撕裂、海绵残留、肺栓塞、尿路感染、气胸、前路支撑失败和内固定突出需取出（各1例患者）。术后，所有患者美国脊髓损伤协会分级仍为E级。2例患者在远处脊柱节段复发，1例患者大腿出现新病灶。5例患者死亡（平均术后34.5个月），5例患者存活，平均术后19.6个月（范围6 - 48个月）。整块全脊椎切除术具有挑战性，但在适当选择的患者中，可用于治疗原发性和转移性脊柱病变。
