Xiong Wei, Xu Yong, Fang Zhong, Li Feng
Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
World Neurosurg. 2018 Dec;120:28-35. doi: 10.1016/j.wneu.2018.08.061. Epub 2018 Aug 23.
To report and describe a modified posterior-only approach (paraspinal approach) for total en bloc spondylectomy (TES) of lumbar spinal tumors.
From February 2013 to June 2014, 5 patients with lumbar spinal tumors who underwent TES through a posterior-only paraspinal approach were studied retrospectively; operative time, blood loss, complications, neurologic outcomes, and degree of resection were recorded to evaluate the efficacy of this surgical method.
Patients included 3 men and 2 women with a mean age of 48.4 years (range, 46-52 years). Two lesions were located in L2, 2 lesions were located in L3, and 1 lesion was located in L4. Three patients had solitary metastatic tumors (lung cancer in 2 cases, breast cancer in 1 case), and 2 patients had primary tumors (osteosarcoma and plasma cell tumor). According to the surgical classification of spinal tumors by Tomita et al., 4 cases were type 4 and 1 case was type 1. Mean operative time was 464 minutes (range, 420-510 minutes), and mean blood loss was 1280 mL (range, 1000-1500 mL). One patient had cerebrospinal fluid leakage, and 1 had transient motor weakness because of nerve root traction. Mean follow-up time was 20.6 months (range, 12-30 months), and all patients had improved or stable neurologic function. No local recurrence was observed at last follow-up.
The posterior-only paraspinal approach is a valid alternative for TES of lumbar spinal tumors, especially for overweight or muscular patients.
报告并描述一种改良的单纯后路（椎旁入路）用于腰椎肿瘤全椎体整块切除术（TES）的方法。
回顾性研究2013年2月至2014年6月期间5例行单纯后路椎旁入路腰椎肿瘤TES的患者；记录手术时间、失血量、并发症、神经功能结果及切除程度，以评估该手术方法的疗效。
患者包括3名男性和2名女性，平均年龄48.4岁（范围46 - 52岁）。2个病灶位于L2，2个病灶位于L3，1个病灶位于L4。3例患者有孤立性转移瘤（2例为肺癌，1例为乳腺癌），2例患者有原发性肿瘤（骨肉瘤和浆细胞瘤）。根据Tomita等人的脊柱肿瘤手术分类，4例为4型，1例为1型。平均手术时间为464分钟（范围420 - 510分钟），平均失血量为1280 mL（范围1000 - 1500 mL）。1例患者发生脑脊液漏，1例因神经根牵拉出现短暂性运动无力。平均随访时间为20.6个月（范围12 - 30个月），所有患者神经功能均有改善或稳定。末次随访时未观察到局部复发。
单纯后路椎旁入路是腰椎肿瘤TES的一种有效替代方法，尤其适用于超重或肌肉发达的患者。
