Glennie R Andrew, Rampersaud Y Raja, Boriani Stefano, Reynolds Jeremy J, Williams Richard, Gokaslan Ziya L, Schmidt Meic H, Varga Peter P, Fisher Charles G
Department of Orthopedics, Dalhousie University, Halifax, NS, Canada.
Department of Surgery, Division of Orthopaedic Surgery, University of Toronto and University Health Network, Toronto Western Hospital, Toronto, ON, Canada.
Spine (Phila Pa 1976). 2016 Oct 15;41 Suppl 20:S205-S211. doi: 10.1097/BRS.0000000000001835.
Systematic literature review and consensus expert opinion.
To provide recommendations on reconstructive constructs for large tumor resections of the spinal column. Four questions were studied: (1) What are the best reconstructive options for single versus multilevel resections? (2) Should short segment fixation be considered in primary tumor reconstruction? (3) How should reconstructive techniques differ at various regions of the spine? (4) Does planned postoperative radiation change the fusion strategy?
Primary spinal tumors requiring en bloc resection are rare. Most studies focus on disease-free survival and local recurrence rates. Few studies focus on reconstructive options and outcomes with respect to fusion rates and need for revision.
A literature search was performed from January 1990 to December 2013. Data were combined and construct survivorship summarized. A survey was administered to international spine tumor surgeons, evaluating reconstructive preferences.
The search yielded 381 articles, 12 included in the final analysis. Revision rates for anterior reconstruction were similar for autogenous strut grafts (10%), cages (7.7%), and allograft strut grafts (8.3%). There were two reports of revision from short to long segment constructs and three reports of broken pedicle screws, one requiring revision. Expert survey results revealed that most surgeons preferred cages packed with morcelized allograft and autograft (75%) for anterior reconstruction of single-level vertebrectomies, and strut bone grafting at the cervicothoracic junction (65%) and when more than one vertebrae was resected in the mid-thoracic spine (75%). Surgeons may alter their fusion technique if postoperative radiation is planned.
Posterior reconstruction with at least two vertebral levels above and below is recommended. Cages should be used for single-level defects and structural bone graft alone, or in combination with a cage, should be used when spanning a defect greater than two vertebral bodies. Planned postoperative radiation may affect fusion strategy.
N/A.
系统文献综述与专家共识意见。
为脊柱大肿瘤切除术的重建结构提供建议。研究了四个问题：（1）单节段与多节段切除术的最佳重建选择是什么？（2）在原发性肿瘤重建中是否应考虑短节段固定？（3）脊柱不同区域的重建技术应如何不同？（4）计划中的术后放疗是否会改变融合策略？
需要整块切除的原发性脊柱肿瘤很少见。大多数研究集中在无病生存率和局部复发率上。很少有研究关注融合率和翻修需求方面的重建选择和结果。
于1990年1月至2013年12月进行文献检索。汇总数据并总结结构生存率。对国际脊柱肿瘤外科医生进行了一项调查，评估重建偏好。
检索得到381篇文章，最终分析纳入12篇。自体支撑植骨（10%）、椎间融合器（7.7%）和同种异体支撑植骨（8.3%）的前路重建翻修率相似。有两篇关于从短节段结构翻修为长节段结构的报告，三篇关于椎弓根螺钉断裂的报告，其中一例需要翻修。专家调查结果显示，大多数外科医生在单节段椎体切除的前路重建中更喜欢用碎骨同种异体骨和自体骨填充的椎间融合器（75%），在颈胸交界处（65%）以及中胸椎切除一个以上椎体时（75%）更喜欢支撑植骨。如果计划进行术后放疗，外科医生可能会改变他们的融合技术。
建议在上下至少两个椎体节段进行后路重建。单节段缺损应使用椎间融合器，跨越大于两个椎体的缺损时应单独使用结构性骨移植或与椎间融合器联合使用。计划中的术后放疗可能会影响融合策略。
无。
