En Bloc Resection of Tumors of the Lumbar Spine: A Systematic Review of Outcomes and Complications

Jones, Morgan; Alshameeri, Zeiad; Uhiara, Okezika; Rehousek, Petr; Grainger, Melvin; Hughes, Simon; Czyż, Marcin

doi:10.14444/8155

Cited by 8 publications

(10 citation statements)

References 33 publications

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“…Prior to the start of this study, we anticipated a significant increase in blood loss for tumours located in the lumbar region ( 31 ), long operation duration and with increasing number of vertebral levels instrumented. We noticed a trend towards our predictions however, significance levels were not reached when groups were compared to one another.…”

Section: Discussionmentioning

confidence: 99%

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years

Smith¹,

Bleibleh²,

Hartley³

et al. 2022

J Spine Surg

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Background Total en bloc spondylectomy (TES) is a widely accepted surgical technique for primary spinal bone tumours but is frequently accompanied by substantial peri-operative blood loss. Prior studies have reported estimated blood loss (EBL) can reach up to 3,200 mL. The aim of this study is to estimate the blood loss during TES procedures performed in the last ten years at our tertiary referral centre and compare EBL with actual blood loss (ABL). Methods We performed a retrospective review of all cases managed surgically with TES referred to our centre between 2005 and 2015. We recorded the oncological characteristics of each tumour and surgical management in terms of resection margins, operative duration and instrumentation. Data relating to peri-operative blood loss was also recorded including an estimation of total blood loss, the use of cell salvage where applicable and transfusion rates. Results A total of 21 patients were found to meet our inclusion criteria. There were 11 men and 10 women, with a median age of 40 years. The mean total ABL was 3,310 mL. Total operation time ranged from 6.53 to 19.7 h. Compared to ABL, in 59% of cases EBL had been underestimated by an average of 78% by volume. The EBL of the remaining 41% cases had been overestimated by 43%. This was not statistically significant (P=0.373). Cell salvage was used in 62% patients with a mean blood loss of 2,845 mL (884–4,939 mL) and transfusion of 3.8 units (0–12 units) versus 4,069 mL (297–8,335 mL) and 9.3 units (0–18 units) in those not managed with cell salvage. There was no significant difference in ABL between the cell salvage and non-cell salvage groups. Conclusions We report one of the largest case series in TES for primary bone tumours. EBL is not a reliable predictor for ABL. A large blood loss should be anticipated and use of cell salvage is recommended.

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Section: Discussionmentioning

confidence: 99%

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years

Smith¹,

Bleibleh²,

Hartley³

et al. 2022

J Spine Surg

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“…Hypervascular tumors, en-bloc surgery, and the presence of extraosseous tumor mass have been shown to be independent variables for blood loss [16]. Estimated blood loss for EBS from systematic reviews varies from 1742ml to 4867ml [1,17]. Transfusion rates for combined anterior-posterior thoracic oncological procedures are reported from 17-70% [18].…”

Section: Blood Lossmentioning

confidence: 99%

“…However, evidence is generally based on shorter surgical times and there is a paucity of data for long operations. The average operative length for EBS varies from 390 min [17] to 1195 min [1] (two-stage combined approach). It is logical that blood loss can increase with longer operative times but other factors also come into play such as tissue hypoperfusion, oxygenation, and end-organ injury which although highly dependent on dynamic cardiovascular stability are likely to be cumulative effects.…”

Section: Anesthetic Timementioning

confidence: 99%

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Spinal Tumour en Bloc Surgery: A Series of Abandoned Surgical Cases

Land¹,

Chowdhury²,

Woo³

et al. 2022

Cureus

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Select spinal tumors can be treated with en bloc spondylectomy (EBS) but the surgical complexity and relatively low frequency of eligible tumors render EBS an uncommon procedure. The expanded surgical access encompasses acceptance of relatively high morbidity as a trade-off against improved oncological results and survival. EBS durations can be long with dynamic changes affecting the risk-benefit ratio as the surgery proceeds.We present a series of cases where we have elected to "abandon" EBS due to adverse findings or rising intraoperative risk along with our lessons learned.A search of our surgical database for all "en bloc" spinal tumor procedures over a three-year period was performed and 27 operations were identified. Of these, four were abandoned. Two of the four surgeries were halted owing to adverse anatomical findings. One involved significant tumor growth from the interval imaging bringing into question disease control and the other displayed tumor adherence to the lung requiring significant dissection. The further two cases incurred significant blood loss and associated physiological complications of end-organ dysfunction.Pre-operative embolization (POE), anesthetic monitoring, controlled hypotension, volume replacement, and transfusion optimize our chance of achieving the surgical plan. However, cardiovascular instability must be managed promptly and early warning signs of end-organ injury (lactate, renal output) should not be overlooked. In some situations abandoning the procedure may be in the best interests of the patient.

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“…Moreover, successful en-bloc resection results in fewer local recurrences and improved prognoses in both primary and isolated spinal metastases [6]. However, the complex structures around the spine make TES in the lumbar spine region challenging and increase the risk of complications which in turn may impact the postoperative survival rate [7]. Acute vascular injury, although rare, is a life-threatening intraoperative complication that should be identi ed and treated timely [8,9].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal circulation through peripheral vascular successful rescue Abdominal Aortic Iatrogenic Injury During Total en bloc Spondylectomy for L4 Ewing’s sarcoma: A Case Report

Qiao

Bai

et al. 2023

Preprint

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Introduction: Abdominal aortic iatrogenic injury can result in massive hemorrhage and is a potentially fatal complication of total en-bloc spondylectomy surgery (TES) for primary malignant spinal tumors (PMST). Currently, there is no definite management for this complication. We report a case of a patient with abdominal aorta iatrogenic injury at the intervertebral disc of lumbar 3 (L3) to lumbar 4 (L4) level during TES performed via a posterior approach. Fortunately, our patient had a good outcome with prompt intervention. Patient concerns: A 16-year-old male was admitted to our department with a chief complaint of low lumbar pain, especially pain at night, since the past 6 months. Diagnosis: PMST at L4 (Ewing's sarcoma) with abdominal aorta iatrogenic injury at the L3 − L4 level that occurred during TES that was performed via a posterior approach. Interventions and outcomes: Multi-disciplinary treatment (MDT), including extracorporeal circulation (ECC) through the peripheral vasculature, was immediately performed to allow for the suturing of the abdominal aortic injury. After the abdominal aorta iatrogenic injury repair, the patient’s hemodynamic parameters stabilized. Two weeks later, TES was reattempted and successfully performed for L4 PMST. Conclusion Intraoperative vascular injury during posterior TES is rare; however, it cannot be avoided with surety since the anterior vertebral manipulation during TES is performed blindly. This complication is often lethal and not diagnosed. Consequently, surgeons must have a wide knowledge of the lumbar spine anatomy and its surrounding structures and conduct a detailed preoperative radiological assessment of the tumor and its surrounding structure. Furthermore, the surgeon should be aware of the risk of vascular injury and familiar with its clinical characteristics for prompt and effective diagnosis and intervention once an injury is suspected to avoid serious consequences. For abdominal aortic injury, the immediate establishment of ECC through peripheral vasculature to suture the vascular laceration may be a quick, safe, and effective management.

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En Bloc Resection of Tumors of the Lumbar Spine: A Systematic Review of Outcomes and Complications

Cited by 8 publications

References 33 publications

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years

Spinal Tumour en Bloc Surgery: A Series of Abandoned Surgical Cases

Extracorporeal circulation through peripheral vascular successful rescue Abdominal Aortic Iatrogenic Injury During Total en bloc Spondylectomy for L4 Ewing’s sarcoma: A Case Report

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