Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine

Clinical article

Restricted access

Object

The object of this study was to compare the mini-open anterior corpectomy procedure with posterior total en bloc spondylectomy (TES) in treating patients with solitary metastases of the thoracolumbar spine.

Methods

From 2004 to 2010, 41 patients with solitary metastases of the thoracolumbar spine were treated in our hospital using either a mini-open anterior corpectomy or posterior TES. Intraoperative and diagnostic data, including perioperative complications, were collected using retrospective chart review. The surgical outcomes were assessed according to survival status, neurological function, local recurrence, and pain before and after surgery.

Results

Seventeen patients underwent posterior TES and 24 underwent mini-open anterior corpectomy. Mean blood loss (TES, 1721 ± 293 ml; mini-open corpectomy, 1058 ± 263 ml; p < 0.05), and mean operative time (TES, 403 ± 55 minutes; mini-open corpectomy, 175 ± 38 minutes; p < 0.05) were recorded and calculated. Neurological improvement by at least 1 American Spinal Injury Association Impairment Scale grade was noted in 35 (97.2%) of the 36 cases with preoperative deficits. After the operation, 68.4% of nonambulatory patients became ambulatory again, including 84.6% after mini-open corpectomy and 33.3% after posterior TES (p > 0.05). The visual analog scale scores of the patients were significantly reduced after both procedures, with no difference between the procedures (p > 0.05). The local tumor recurrence rate of the TES group was significantly lower than that of the mini-open corpectomy group (p < 0.05), while the postoperative survival rates within 2 years after surgery were similar. The complication rate in the mini-open corpectomy group (29.2%) was higher than that in the TES group (11.8%), but this difference was not statistically significant (p = 0.185). There was no hardware failure and no loss of the sagittal Cobb angle in either group. Slight subsidence (< 3 mm) of the mesh cage was observed with a successful fusion in 3 (17.6%) of 17 patients in the TES group. No subsidence of polymethylmethacrylate block/autograft was recorded in the mini-open group.

Conclusions

Mini-open anterior corpectomy can be accomplished with less blood loss, fewer fixation instrumentations, and shorter surgical time than that required for TES, but patients who undergo a mini-open corpectomy might have a greater tendency to experience local recurrence. A mini-open anterior corpectomy has a relatively mild learning curve and involves fewer technical difficulties. With smaller incisions, mini-open anterior corpectomy is an option in treating solitary metastases of the thoracolumbar spine.

Abbreviations used in this paper:ASIA = American Spinal Injury Association; PMMA = polymethylmethacrylate; TES = total en bloc spondylectomy; VAS = visual analog scale.

Article Information

Address correspondence to: Jian Dong, M.D., Ph.D., Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China. email: dong.jian@zs-hospital.sh.cn.

Please include this information when citing this paper: published online August 10, 2012; DOI: 10.3171/2012.7.SPINE111086.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Images obtained in a 48-year-old woman with metastatic cancer at T-11 who underwent anterior mini-open corpectomy and died 26 months postoperatively. A: Sagittal MR image showing the collapse of the T-11 vertebra because of metastatic lung cancer. B: Using the miaspas mini TTA (Aesculap), a retractor system for a transthoracic approach, can reduce the size of the incision to approach the region. C: After the sutures were removed, the incision was approximately 10 cm long and healed well. D: Anteroposterior radiograph obtained 3 months after the anterior reconstruction with the MACS TL plate system and autografts, showing no loss of fixation.

  • View in gallery

    Images obtained in a 52-year-old woman who suffered from back pain, had ASIA Grade D neurological function, and underwent a posterior TES procedure. She has remained alive with regular follow-up evaluations. A: Sagittal MR image showing metastatic cancer at T-10. B and C: Intraoperative photographs. After pediculotomy, the posterior elements and vertebral body underwent en bloc resection. The resected vertebral body is indicated by the triangle. D and E: Anteroposterior (D) and lateral (E) radiographs obtained 3 months after TES.

  • View in gallery

    Line graph of postoperative survival status in the 2 groups. The difference in postoperative survival rates in patients treated with mini-open corpectomy and posterior TES was not statistically significant (p = 0.244).

  • View in gallery

    Assessment of VAS scores in each group and between groups before the operation and 3 months postoperatively.

References

1

Abe EKobayashi TMurai HSuzuki TChiba MOkuyama K: Total spondylectomy for primary malignant, aggressive benign, and solitary metastatic bone tumors of the thoracolumbar spine. J Spinal Disord 14:2372462001

2

Aebi MSteffen T: Synframe: a preliminary report. Eur Spine J 9:Suppl 1S44S502000

3

American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury ChicagoAmerican Spinal Injury Association2000. 123

4

Barcena ALobato RDRivas JJCordobes Fde Castro SCabrera A: Spinal metastatic disease: analysis of factors determining functional prognosis and the choice of treatment. Neurosurgery 15:8208271984

5

Beisse R: Endoscopic surgery on the thoracolumbar junction of the spine. Eur Spine J 19:Suppl 1S52S652010

6

Cahill DWKumar R: Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach. J Neurosurg 90:1 Suppl42471999

7

Choi DCrockard ABunger CHarms JKawahara NMazel C: Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 19:2152222010

8

Feiz-Erfan IRhines LDWeinberg JS: The role of surgery in the management of metastatic spinal tumors. Semin Oncol 35:1081172008

9

Fourney DRGokaslan ZL: Thoracolumbar spine: surgical treatment of metastatic disease. Curr Opin Orthop 14:1441522003

10

Heary RFBono CM: Metastatic spinal tumors. Neurosurg Focus 11:6e12001

11

Hsieh PCLi KWSciubba DMSuk IWolinsky JPGokaslan ZL: Posterior-only approach for total en bloc spondylectomy for malignant primary spinal neoplasms: anatomic considerations and operative nuances. Neurosurgery 65:6 Suppl1731812009

12

Hussein AAEl-Karef EHafez M: Reconstructive surgery in spinal tumours. Eur J Surg Oncol 27:1961992001

13

Kaplan EMeier P: Nonparametric estimation from incomplete observation. J Am Stat Assoc 53:4574811958

14

Kim DHJaikumar SKam AC: Minimally invasive spine instrumentation. Neurosurgery 51:5 SupplS15S252002

15

King GJKostuik JPMcBroom RJRichardson W: Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976) 16:2652711991

16

Kossmann TJacobi DTrentz O: The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. Eur Spine J 10:3964022001

17

McAfee PCComplications. Regan JMcAfee PCMack M: Atlas of Endoscopic Spine Surgery St. LouisQuality Medical Publishing1995. 8390

18

Mühlbauer MPfisterer WEyb RKnosp E: Minimally invasive retroperitoneal approach for lumbar corpectomy and anterior reconstruction. Technical note. J Neurosurg 93:1 Suppl1611672000

19

Payer MSottas C: Mini-open anterior approach for corpectomy in the thoracolumbar spine. Surg Neurol 69:25322008

20

Regan JJGuyer RD: Endoscopic techniques in spinal surgery. Clin Orthop Relat Res 335:1221391997

21

Rompe JDEysel PHopf CHeine J: Decompression/stabilization of the metastatic spine. Cotrel-Dubousset-Instrumentation in 50 patients. Acta Orthop Scand 64:381993

22

Sakaura HHosono NMukai YIshii TYonenobu KYoshikawa H: Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine. J Spinal Disord Tech 17:2973002004

23

Sasso RCRenkens KHanson DReilly TMcGuire RA JrBest NM: Unstable thoracolumbar burst fractures: anterioronly versus short-segment posterior fixation. J Spinal Disord Tech 19:2422482006

24

Sciubba DWitham TGokaslan Z: Management of metastatic spine disease with spinal cord compression. Neurosurg Q 17:40472007

25

Sciubba DMPetteys RJDekutoski MBFisher CGFehlings MGOndra SL: Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 13:941082010

26

Shimizu KShikata JIida HIwasaki RYoshikawa JYamamuro T: Posterior decompression and stabilization for multiple metastatic tumors of the spine. Spine (Phila Pa 1976) 17:140014041992

27

Sundaresan NRothman AManhart KKelliher K: Surgery for solitary metastases of the spine: rationale and results of treatment. Spine (Phila Pa 1976) 27:180218062002

28

Tomita KKawahara NBaba HTsuchiya HFujita TToribatake Y: Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976) 22:3243331997

29

Tomita KKawahara NBaba HTsuchiya HNagata SToribatake Y: Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18:2912981994

30

Tomita KKawahara NKobayashi TYoshida AMurakami HAkamaru T: Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26:2983062001

31

Tomita KKawahara NMurakami HDemura S: Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci 11:3122006

32

Vrionis FDSmall J: Surgical management of metastatic spinal neoplasms. Neurosurg Focus 15:5E122003

33

Wai EKFinkelstein JATangente RPHolden LChow EFord M: Quality of life in surgical treatment of metastatic spine disease. Spine (Phila Pa 1976) 28:5085122003

34

Weigel BMaghsudi MNeumann CKretschmer RMüller FJNerlich M: Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976) 24:224022461999

35

Wewers MELowe NK: A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:2272361990

36

Yao KCBoriani SGokaslan ZLSundaresan N: En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 15:5E62003

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 6 6 6
Full Text Views 19 19 11
PDF Downloads 66 66 41
EPUB Downloads 0 0 0

PubMed

Google Scholar