Total en bloc spondylectomy for spinal tumors of the fourth lumbar spine via a posterior approach: our clinical experience

Objective To study the feasibility and safety of total en bloc spondylectomy (TES) for bone tumors of the fourth lumbar spine and evaluate the clinical outcomes. Methods From March 2011 to December 2013, 21 patients undergone total en bloc spondylectomy in posterior-only approach were retrospectively reviewed. The patients included 9 males and 12 females, with a mean age of 47.1±15.6 years old (range, 15-71 years old). This series included 12 cases of primary bone tumors and 9 cases of solitary metastases. Preoperative evaluation according to clinical, imaging and pathologic features was performed meticulously to select patients. The length of surgery, estimated blood loss, surgical margins, instrumentation failure, perioperative complications, Frankel scale, visual analogue scale (VAS) for pain, local control rate and overall survival were reviewed and analyzed. Results Total en bloc spondylectomy was performed successfully in all patients. Average operative time and estimated blood loss were 297.6±44.6 min (range, 225-420 min) and 2 247.1±904.5 ml (range, 900-4100 ml), respectively. The mean follow-up time was 50.4±17.1 mons (range, 24-79 mons). All patients encountered nerve roots stretch and 5 patients (23.8%) showed lower extremeties neurological dysfunction. All of them improved in 2-4 weeks postoperatively and recovered completely at 6-month follow-up. Cerebrospinal fluid leak was found in 4 patients (19.0%). The VAS score was 1.5±1.4 at post-operation, which was significantly lower than the 6.2±1.6 in average at operation (P=0.008). Three patients with metastatic tumors died during the follow-up. Titanium mesh cage subsidence was observed in 7 patients (33.3%). No implant failure was occurred during the follow-up. Conclusion Total en bloc spondylectomy for tumors of the fourth lumbar spine in a posterior-only approach is feasible. However, there are many intraoperative neurological complications and the indications for TES are extremely limited. Key words: Lumbar spine; Spinal neoplasm; Surgical procedure; Treatment outcome