Spondylectomy in the Treatment of Neoplastic Spinal Lesions – A Retrospective Outcome Analysis of 582 Patients Using a Patient-Level Meta-Analysis

Abstract

Background: En-bloc spondylectomy in the treatment of spinal tumors is a complex procedure with potential complications. This study aims at identifying predictors of postoperative complications, lesion recurrence and overall survival. Methods: A systematic review of the literature was conducted, and patient-level data extracted from the included studies. Multiple linear-regression models were calculated to predict the occurrence of postoperative complications, lesion recurrence and overall survival based on age, tumor etiology, surgical approach, mode of resection (en-bloc versus intralesional), tumor extension based on Weinstein-BorianiBiagini classification system and number of levels treated. Results: Data of 582 individual adult and pediatric patients were extracted from the literature; Patient characteristics are: 45% female, median age of 46 years (range 5-78); most common etiologies were: sarcoma (46%), metastases (31%) and chordoma (11%). The surgical technique was: anterior (2.5%), combined (45%) and posterior approach (52.4%); 68.5% underwent en-bloc spondylectomy; average levels resected were 1.6 (1-6); 65% of patients had neurologic deficits at presentation, average survival was 2.6 years; Direct procedure-related complications were observed in 17.7%, with the most prevalent being CSF leaks, wound infections and neural injury. For postoperative complications, recurrence and 5-year survival significant regression equations were found (F(7,90)=2.57, p=0.018) with an R2 of 0.1; (F(5,147)=2.35, p=0.044) with an R2 of 0.07 and (F(4,101)=7.2, p=0.01) with an R2 of 0.38. Odds ratio for predicted complications was 1.35 for en-bloc resection and 1.25 for more than one level treated. The odds ratio for tumor recurrence was 0.78 for en-bloc resection; odds ratio for 5-year survival were 0.79 for increased patient age, 0.65 for increasing tumor grade, 0.79 for tumor dissemination at diagnosis and 1.68 for en-bloc resection. Conclusion: En-bloc spondylectomy provides improved survival and lower recurrence rates but also higher operative complication rates when compared to intralesional resections. Interestingly the complication rate was not influenced by tumor stage (WBB scale) and tumor etiology.

Application of Image-Fusion 3D Printing Model in Total En Bloc Spondylectomy for Spinal Malignant Tumors

“…On this basis, TES has been applied more and more frequently. Since the vertebral body periosteum, anterior longitudinal ligament, ligamentum flavum, and to a lesser extend the posterior longitudinal ligament are considered barriers in the spread of vertebral tumors, an extra-lesional TES has been shown to result in superior oncologic outcome [ 7 ]. However, at the same time, the difficulty of the operation and the requirement of the operative experience are also quite high, which is the reason for high incidence rates of surgery related complications.…”

“…However, at the same time, the difficulty of the operation and the requirement of the operative experience are also quite high, which is the reason for high incidence rates of surgery related complications. Some researchers found that the complication rate was not charged by tumor extension or tumor etiology [ 7 ], indicating that the operator's subjective awareness played a decisive role in the outcome of the surgery. The difficulty of TES lies in the accurate cognition of tumor size and surrounding important anatomical structures.…”