Daniel M Sciubba1, Rafael De la Garza Ramos2, C Rory Goodwin2, Risheng Xu2, Ali Bydon2, Timothy F Witham2, Ziya L Gokaslan3, Jean-Paul Wolinsky2. 1. Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA. dsciubb1@jhmi.edu. 2. Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-113, Baltimore, MD, 21287, USA. 3. Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Abstract
PURPOSE: To report outcomes after total en bloc spondylectomy (TES) for primary aggressive/malignant tumors of the lumbar spine. METHODS: We performed a retrospective review of 23 neurosurgical patients operated between 2004 and 2014. Outcomes included perioperative complication rates and reoperation rates for instrumentation failure. The relationship between patient/operative parameters and complication development/instrumentation failure was investigated. RESULTS: There were 15 men (65.2 %) and eight women (24.8 %), with a median of 47 years. The most common tumor was chordoma in 11 patients (47.8 %), followed by sarcoma in four (17.4 %), and giant cell tumor in three (13.0 %). All patients but one underwent a two-staged operation; median total estimated blood loss was 3200 mL and median total operative time was 18.5 h. Fifteen patients developed at least one perioperative complication (65.2 %), with the most common being wound infection and ileus (26.1 % each). There was one case of intraoperative iliac vein injury (4.4 %). Instrumentation failure occurred in 9 patients (39.1 %) at a median time of 23 months after index spondylectomy. Following logistic regression, there were no factors associated with complication development. On the other hand, postoperative radiation was significantly associated with instrumentation failure (OR 7.49; 95 % CI, 1.02-54.9). Local recurrence and 5-year survival was 8.7 and 84.4 %, respectively. Median follow-up time was 50 months. CONCLUSIONS: Although favorable oncological outcomes after en bloc resection of spinal tumors may be achieved in terms of recurrence and survival, TES in the lumbar spine remains a challenging procedure. Future investigation into complication avoidance and reconstruction techniques is encouraged.
PURPOSE: To report outcomes after total en bloc spondylectomy (TES) for primary aggressive/malignant tumors of the lumbar spine. METHODS: We performed a retrospective review of 23 neurosurgical patients operated between 2004 and 2014. Outcomes included perioperative complication rates and reoperation rates for instrumentation failure. The relationship between patient/operative parameters and complication development/instrumentation failure was investigated. RESULTS: There were 15 men (65.2 %) and eight women (24.8 %), with a median of 47 years. The most common tumor was chordoma in 11 patients (47.8 %), followed by sarcoma in four (17.4 %), and giant cell tumor in three (13.0 %). All patients but one underwent a two-staged operation; median total estimated blood loss was 3200 mL and median total operative time was 18.5 h. Fifteen patients developed at least one perioperative complication (65.2 %), with the most common being wound infection and ileus (26.1 % each). There was one case of intraoperative iliac vein injury (4.4 %). Instrumentation failure occurred in 9 patients (39.1 %) at a median time of 23 months after index spondylectomy. Following logistic regression, there were no factors associated with complication development. On the other hand, postoperative radiation was significantly associated with instrumentation failure (OR 7.49; 95 % CI, 1.02-54.9). Local recurrence and 5-year survival was 8.7 and 84.4 %, respectively. Median follow-up time was 50 months. CONCLUSIONS: Although favorable oncological outcomes after en bloc resection of spinal tumors may be achieved in terms of recurrence and survival, TES in the lumbar spine remains a challenging procedure. Future investigation into complication avoidance and reconstruction techniques is encouraged.
Entities:
Keywords:
Chordoma; Lumbar spine; Sarcoma; Spinal tumor; Total en bloc spondylectomy
Authors: Damian Bragg; Ahmed M El-Sharkawy; Emmanouil Psaltis; Charles A Maxwell-Armstrong; Dileep N Lobo Journal: Clin Nutr Date: 2015-01-31 Impact factor: 7.324
Authors: Michelle J Clarke; Wesley Hsu; Ian Suk; Edward McCarthy; James H Black; Daniel M Sciubba; Ali Bydon; Reza Yassari; Timothy F Witham; Ziya L Gokaslan; Jean-Paul Wolinsky Journal: Neurosurgery Date: 2011-06 Impact factor: 4.654
Authors: Patrick C Hsieh; Khan W Li; Daniel M Sciubba; Ian Suk; Jean-Paul Wolinsky; Ziya L Gokaslan Journal: Neurosurgery Date: 2009-12 Impact factor: 4.654
Authors: Wyatt G Payne; Deepak K Naidu; Chad K Wheeler; David Barkoe; Marni Mentis; R Emerick Salas; David J Smith; Martin C Robson Journal: Eplasty Date: 2008-01-11