Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan.
Bone Joint J. 2021 May;103-B(5):976-983. doi: 10.1302/0301-620X.103B5.BJJ-2020-1777.R1.
To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection.
In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae.
Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors.
The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: 2021;103-B(5):976-983.
根据肿瘤切除的范围和水平，评估脊柱肿瘤患者行全脊椎整块切除术（TES）的围手术期并发症。
回顾性分析在单中心行 TES 的 307 例患者。患者中有 164 名男性和 143 名女性，手术时的平均年龄为 52.9 岁（标准差 13.3）。225 例患者为脊柱转移瘤，34 例为恶性原发性肿瘤，41 例为侵袭性良性肿瘤，7 例为原发灶不明。主要病变位于胸椎 213 例，腰椎 94 例。97 例患者行超过连续两个椎体的 TES。
122 例（39.7%）和 84 例（27.4%）患者出现主要和次要围手术期并发症。并发症如下：60 例（19.5%）患者出血量>2000ml，82 例（26.7%）患者内固定失败，46 例（15.0%）患者神经损伤，23 例（7.5%）患者手术部位感染，16 例（5.2%）患者伤口裂开，45 例（14.7%）患者脑脊液漏，52 例（16.9%）患者呼吸系统并发症，11 例（3.6%）患者心血管并发症，19 例（6.2%）患者消化系统并发症。术后 2 个月内死亡 4 例（1.3%）。单椎体切除组的每例手术并发症总数为 1.01（标准差 1.0），超过两个椎体切除组为 1.56（标准差 1.2）。心血管和呼吸系统并发症以及内固定失败在切除两个以上椎体的患者中发生率更高。此外，在该组中，腰椎病变患者的出血量和胸段病变患者发生呼吸系统并发症的几率更高。多变量分析显示，当行多个椎体切除时，采用前路和后路联合入路是显著的独立因素。
TES 后围手术期并发症的特点取决于肿瘤切除的范围和水平。除了术前的临床和病理因素外，对于行脊柱肿瘤整块切除术的患者，还需要考虑这些因素。
