Spondylectonmy en bloc for thoracic and lumbar tumors via posterior approach

Objective:To investigate the management and clinical effect of spondylectomy en bloc via posterior approach for thoracic and lumbar tumors.Method:6 consecutive cases(3 males,3 females) from Jan 2005 to July 2007 with bone tumors involving thoracic and lumbar spine were evaluated retrospectively.The group age was from 20 to 77 years old.According to Tomita grading system,there were 1 case of type Ⅲ,3 cases of type Ⅳ and 2 cases of type Ⅴ,and the site of the tumors was T3 in 1 case,T8 in 2 cases,T9 in 1 case,T11 in 1 case,L1 in 1 case.There were 1 giant cell tumor of bone,1 solitary myeloma,4 metastatic adenocarcinoma.Preoperative Frankel classification showed grade B in 2 cases,grade D in 1 cases,grade E in 3 cases.All patients underwent one-stage modified spondylectomy en bloc combined with implantation of titanium mesh filled by either iliac bone or bone cement and posterior pedicle screw system via posterior approach.The Operating duration,blood loss,local pain,as well as tumor recurrence,status of bony fusion and stability were followed-up and reviewed.Result:All patients experienced operations successfully.The average operating time was 230min(range,200min to 270min) with the mean blood loss of 1400ml(range,1100ml to 3000ml).The follow-up period was from 6 months to 3 years.The clinical results showed satisfactory early outcome with relieve of local pain neurological deficit tosome degree.The preoperative VAS score was 8 which decreased to 2 with the mean decrease of 6 points.All patients had neurological function increased from Frankel B to E except to D in 1 case.1 case of bone giant cell tumor had tumor recurrence after 15 months following surgery and underwent reoperation.1 case died of multiple organ failure due to metastatic adenocarcinoma 14 months after surgery,the other 4 cases were found alive at final follow-up with good bony fusion and no incidence of instrument failure and local recurrence.Conclusion:Spondylectomy en bloc and reconstruction via posterior approach is effective to improve neurofunction as well as decrease local recurrence.