Oncological and Reconstructive Surgery Unit, IRCCS-Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
Arch Orthop Trauma Surg. 2024 May;144(5):2027-2038. doi: 10.1007/s00402-024-05274-w. Epub 2024 Apr 8.
Wide Surgery is the reference treatment for malignant and aggressive benign primary bone tumors in the spine. When located in the lumbar spine, En-Bloc Spondylectomy (EBS) remains a complex challenge. Moreover, surgery is complicated by the presence of the diaphragm in the thoracolumbar junction and the hinderance of the iliac wings at the lumbosacral levels. Therefore, EBS in the lumbar spine frequently requires combined approaches. The purpose of this study is to describe clinical presentation, tumor characteristics and results of a series of 47 consecutive patients affected by malignant primary bone tumors of the lumbar spine who underwent EBS.
47 patients were reviewed. Complications were distinguished in early and late whether they occurred before or after 30 days from surgery. Overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) were calculated by the Kaplan-Meier product-limit method from surgery until relapse or death.
27 patients presented to observation after a first intralesional approach in a non-specialized center. Chordoma was the most represented histotype. Vertebrectomies were: 23 one-level, 10 two-level, 12 three-level and 2 four-level. Reconstructions were always carried out with screws and rods. The main postoperative complication was blood loss, while hardware failure was the main long-term complication. The 5-year LRFS was 75.5%, the 5-year DFS was 54.3%, and 5-year OS was 63.6%.
The surgical margin obtained during the index surgery was statistically associated with Local Recurrence, DFS and OS, underlining the importance of treating patients in reference centers.
广泛切除术是脊柱恶性和侵袭性良性原发性骨肿瘤的标准治疗方法。当肿瘤位于腰椎时，整块脊柱切除术（EBS）仍然是一个复杂的挑战。此外，由于在胸腰椎交界处存在膈肌以及在腰骶部存在髂骨翼，手术变得更加复杂。因此，腰椎的 EBS 经常需要联合入路。本研究旨在描述一系列 47 例连续接受 EBS 治疗的腰椎恶性原发性骨肿瘤患者的临床表现、肿瘤特征和结果。
回顾了 47 例患者。并发症分为早期和晚期，分别为手术后 30 天内和 30 天后发生的并发症。通过 Kaplan-Meier 乘积限法从手术到复发或死亡计算总体生存率（OS）、无病生存率（DFS）和局部无复发生存率（LRFS）。
27 例患者在非专科中心初次行肿瘤内切除术（肿瘤内切除术）后观察。脊索瘤是最常见的组织学类型。椎体切除术为：23 例单节段，10 例双节段，12 例三节段，2 例四节段。重建均采用螺钉和棒。主要术后并发症是失血，而主要的长期并发症是内固定失败。5 年 LRFS 为 75.5%，5 年 DFS 为 54.3%，5 年 OS 为 63.6%。
在指数手术中获得的手术切缘与局部复发、DFS 和 OS 具有统计学相关性，这强调了在参考中心治疗患者的重要性。
