Shimizu Takaki, Murakami Hideki, Demura Satoru, Kato Satoshi, Yoshioka Katsuhito, Yokogawa Noriaki, Kawahara Norio, Tomita Katsuro, Tsuchiya Hiroyuki
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Medicine (Baltimore). 2018 Sep;97(37):e12366. doi: 10.1097/MD.0000000000012366.
This was a retrospective clinical study.This study aimed to evaluate our institution's experience with total en bloc spondylectomy (TES) in patients treated for primary lumbar spine tumors and investigate postoperative clinical outcomes.TES is a widely accepted by spinal and musculoskeletal surgical oncologists and results in favorable health-related quality of life outcomes. However, this procedure still imposes major risks and complications.The cases of TES performed for primary lumbar spine tumors between 1993 and 2015 were retrospectively analyzed. Primary outcome measures were the rates of perioperative complications and reoperation for instrumentation failure.We enrolled 30 patients (13 men and 17 women; median age and follow-up, 38 years and 87 months, respectively). Three, 7, and 5 cases involved previous radiotherapy, intralesional resection, and chemotherapy, respectively. The most common tumor was giant cell tumor (14 cases) followed by osteosarcoma (4 cases) and plasmacytoma (3 cases). The median estimated blood loss was 1450 mL, and the median operative time was 11 hours. At least 1 perioperative complication occurred in 26 patients (86.7%), with the most common being postoperative muscle weakness (24 patients, 80.0%) followed by surgical site infection and postoperative cerebrospinal fluid leakage (7 patients, respectively; 23.3% each). Revision surgery for instrumentation failure was required in 6 patients (20.0%) at a median of 33 months after the index TES. Four patients experienced local tumor recurrence (13.3%), and their 10-year disease-free rate was 75.0%.TES is a feasible and effective procedure for primary lumbar spine tumors, but the risks of perioperative complications and late instrumentation failure should be acknowledged. Surgical oncologic outcomes were good, especially in patients who underwent TES as their first surgical treatment. Therefore, being familiar with the indications for TES and the surgical technique is important.
这是一项回顾性临床研究。本研究旨在评估我院对原发性腰椎肿瘤患者行整块全脊椎切除术（TES）的经验，并调查术后临床结局。TES已被脊柱和肌肉骨骼外科肿瘤学家广泛接受，且能带来良好的健康相关生活质量结局。然而，该手术仍存在重大风险和并发症。对1993年至2015年间因原发性腰椎肿瘤而行TES的病例进行回顾性分析。主要结局指标为围手术期并发症发生率及因内固定失败而再次手术的发生率。我们纳入了30例患者（13例男性和17例女性；年龄中位数和随访时间分别为38岁和87个月）。分别有3例、7例和5例患者曾接受过放疗、病灶内切除和化疗。最常见的肿瘤是骨巨细胞瘤（14例），其次是骨肉瘤（4例）和浆细胞瘤（3例）。估计失血量中位数为1450毫升，手术时间中位数为11小时。26例患者（86.7%）至少发生1种围手术期并发症，最常见的是术后肌肉无力（24例患者，80.0%），其次是手术部位感染和术后脑脊液漏（各7例患者；各占23.3%）。6例患者（20.0%）因内固定失败在初次TES术后中位数33个月时需要翻修手术。4例患者出现局部肿瘤复发（13.3%），其10年无病生存率为75.0%。TES对于原发性腰椎肿瘤是一种可行且有效的手术，但应认识到围手术期并发症和后期内固定失败的风险。手术肿瘤学结局良好，尤其是对于首次接受TES手术的患者。因此，熟悉TES的适应证和手术技术很重要。
