Shah Akash A, Paulino Pereira Nuno R, Pedlow Frank X, Wain John C, Yoon Sam S, Hornicek Francis J, Schwab Joseph H
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 2Division of Thoracic Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts 3Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
J Bone Joint Surg Am. 2017 Sep 6;99(17):1476-1484. doi: 10.2106/JBJS.17.00141.
Total en bloc spondylectomy (TES) for the treatment of spinal tumors decreases local recurrence and improves survival compared with intralesional resection. TES approaches vary in both the number of stages to complete the procedure and instruments with which osteotomies are performed.
We describe a 2-stage technique that employs the use of threadwire saws. We performed a retrospective review of cases of primary tumors and solitary metastases involving the thoracic or lumbar spine treated with use of our modified technique at our institution between 2010 and 2016, identifying eligible patients by searching for specific phrases in operative reports found in our oncologic database. Clinical notes, operative notes, imaging reports, and pathology reports were reviewed for all patients.
Thirty-three patients underwent our modified technique, in which we pass a threadwire saw between the vertebral body and the thecal sac. The most common tumor type was chordoma (64%), and tumors were most commonly located in the lumbar spine (61%). There were no intraoperative injuries to the spinal cord or great vessels. One patient experienced a dural tear secondary to the passage of a saw. Seventeen (52%) of the patients had perioperative complications, with 1 death. Seven (22%) of the patients had complications occurring within 90 days after discharge, and 8 (25%) had complications occurring >90 days after discharge. Instrumentation failure was observed in 8 cases (25%). Negative margins were obtained in 94% of the cases. Local recurrence was observed in 2 cases (6%). The majority of patients had normal motor function at the time of the most recent follow-up.
Our modified en bloc spondylectomy represents an effective technique for the resection of spinal tumors in selected patients, allowing for visualization of vessels anterior to the spine and the avoidance of spinal cord injury.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
与病损内切除相比，全椎体整块切除术（TES）治疗脊柱肿瘤可降低局部复发率并提高生存率。TES手术方法在完成手术的阶段数量以及进行截骨术所使用的器械方面各不相同。
我们描述了一种采用线锯的两阶段技术。我们对2010年至2016年期间在本机构使用我们改良技术治疗的胸椎或腰椎原发性肿瘤和孤立性转移瘤病例进行了回顾性研究，通过在我们肿瘤数据库中的手术报告中搜索特定短语来确定符合条件的患者。对所有患者的临床记录、手术记录、影像学报告和病理报告进行了审查。
33例患者接受了我们的改良技术，即在椎体与硬膜囊之间穿过线锯。最常见的肿瘤类型是脊索瘤（64%），肿瘤最常位于腰椎（61%）。术中无脊髓或大血管损伤。1例患者因锯的穿过导致硬膜撕裂。17例（52%）患者有围手术期并发症，1例死亡。7例（22%）患者在出院后90天内出现并发症，8例（25%）患者在出院后90天以上出现并发症。8例（25%）观察到内固定失败。94%的病例获得了阴性切缘。2例（6%）观察到局部复发。大多数患者在最近一次随访时运动功能正常。
我们改良的整块椎体切除术是一种在特定患者中切除脊柱肿瘤的有效技术，可实现对脊柱前方血管的可视化并避免脊髓损伤。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
