Perioperative complications of total en bloc spondylectomy for spinal tumours

Abstract

Aims To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. Methods In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae. Results Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors. Conclusion The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: Bone Joint J 2021;103-B(5):976–983.

Anterior Endoscopy Combining with Modified Total En Block Spondylectomy for Synovial Sarcoma in Thoracic Paraspine Causing Neurological Deficits: Case Report and Literature Review

“…This significantly reduced the amount of bleeding during surgery. In this report, the operation time was 280 min, shorter than that of Melcher et al ., 14 who reported at 9.2 ± 3.1 h (range 5.3–16.4 h), and the intraoperative bleeding was 900 ml, which was shorter than that of 2000 ml reported by Demura and colleagues 15 ; (2) We detached the paraspinal muscles under periosteum that not only significantly reduced intraoperative bleeding and blood transfusion but also avoided the massive hemorrhage and blood transfusion that could induce internal disorders and diffusive intravascular coagulation. The current patient exhibited no such complications; (3) Modified total en bloc resection was applied to cut the anterior vertebral body, which was a simple and ingenious design to avoid the complications of spinal cord injury; (4) Motor and somatosensory evoked potential was used during the operation to detect the traction and injury of the spinal cord time, and reduce the recovery time; (5) A double‐lumen endotracheal tube was used to control respiration, and can be good to deal with the emergency during operation.…”

Characteristics and risk factors of instrumentation failure following total en bloc spondylectomy

“…The incidence of IF after TES in this study was as high as those in previous reports. [7][8][9][10][11][12][13] Although previous studies showed that most IFs were posterior instrument breakage, the mechanism and preceding condition had not yet been investigated in detail. [8][9][10]12,14 In our study, most IFs after TES were rod fractures preceded by CS and following kyphotic enhancement of the reconstructed level.…”

“…6 However, the incidence of instrumentation failure (IF) after TES is high (20% to 40%) due to the destabilization of all three columns of the affected spine. [7][8][9][10][11][12][13] Several studies have focused on IF after TES, and established certain risk factors such as perioperative radiotherapy, TES in the lumbar spine, multiple vertebral body resection, high BMI, inappropriate cage position, and large cage subsidence (CS). [8][9][10]13,14 However, most of these studies have small sample sizes, and only a few have conducted a multivariate risk factor analysis using a sufficient sample size.…”

“…6 However, the incidence of instrumentation failure (IF) after TES is high (20% to 40%) due to the destabilization of all three columns of the affected spine. 7-13…”

Medium to Long-Term Clinical Outcomes of Spinal Metastasectomy

“…In the 1990s, Tomita et al reported on total en bloc spondylectomy (TES), which aimed to achieve a complete resection of spinal tumors while reducing the risk of tumor recurrence and complications ( Figure 1 ) [ 12 ]. However, spondylectomy is still an extraordinary type of surgery among general spine surgeons, and several authors have reported a higher rate of perioperative complications [ 13 , 14 , 15 , 16 ]. Improvements in TES surgical techniques over the years have enabled surgeons to achieve good outcomes with lowered significant complications [ 17 , 18 , 19 ].…”