Jiang Dongjie, Zhou Zihuan, Zhang Qi, He Shaohui, Sun Haitao, Cai Xiaopan, Liu Tielong, Yang Xinghai, Wei Haifeng, Xiao Jianru
Spinal Tumor Center, Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
Department of Orthopedic, Shanghai Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
BMC Surg. 2025 Jun 4;25(1):242. doi: 10.1186/s12893-025-02942-5.
The management of recurrent aggressive vertebral hemangiomas (AVHs) with neurological deficits poses a challenge due to their profuse vascularization and propensity for recurrence. The optimal approach to managing recurrence AVHs remains a topic of debate within the academic community.
A retrospective analysis was conducted on a cohort of patients who experienced recurrent AVH in the thoracic and lumbar spine at our institution from August 2015 to July 2022. A total of 31 patients, underwent treatment with either piecemeal intralesional spondylectomy (PIS) or modified total en bloc spondylectomy (MTES). Clinical documentation and surgical outcomes, including pre- and postoperative neurological function assessed by the American Spinal Injury Association (ASIA) score, Numeric Rating Scale (NRS), surgical duration, blood loss, recurrence rate, and complications, were retrospectively presented and analyzed.
The study followed a cohort of 16 males and 15 females with recurrent AVHs in the thoracic or lumbar spine for a period ranging from 12 to 106 months. All patients presented with neurological deficits, with 20 patients undergoing PIS and 11 patients undergoing one-stage MTES. Both treatment modalities resulted in significant reductions in pain-NRS and ASIA scores. The MTES group experienced less intraoperative blood loss compared to the PIS group. During the follow-up period, four patients in the PIS group experienced recurrence. No serious complications or evidence of internal fixation failure were observed.
The modified TES technique presents a comprehensive resection, less blood loss, lower incidence of recurrence, and effective tumor control for recurrent AVHs in thoracic and lumbar spine through post-only approach.
复发性侵袭性椎体血管瘤（AVH）伴神经功能缺损的治疗具有挑战性，因为其血管丰富且易于复发。复发性AVH的最佳治疗方法仍是学术界争论的话题。
对2015年8月至2022年7月在我院发生胸腰椎复发性AVH的一组患者进行回顾性分析。共有31例患者接受了病灶内碎块切除术（PIS）或改良整块椎体切除术（MTES）治疗。回顾性呈现并分析临床记录和手术结果，包括术前和术后通过美国脊髓损伤协会（ASIA）评分、数字评分量表（NRS）评估的神经功能、手术时间、失血量、复发率和并发症。
该研究随访了16例男性和15例女性胸腰椎复发性AVH患者，随访时间为12至106个月。所有患者均有神经功能缺损，其中20例患者接受了PIS，11例患者接受了一期MTES。两种治疗方式均使疼痛NRS评分和ASIA评分显著降低。与PIS组相比，MTES组术中失血量更少。在随访期间，PIS组有4例患者复发。未观察到严重并发症或内固定失败的证据。
改良TES技术通过后路单入路对胸腰椎复发性AVH进行全面切除，术中失血少，复发率低，肿瘤控制有效。
