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A Novel Technique for Total En bloc Spondylectomy of the Fifth Lumbar Tumor Through Posterior-Only Approach.

STUDY DESIGN
A retrospective study.


OBJECTIVE
To describe a new surgical technique for total en bloc spondylectomy (TES) of the fifth lumbar (L5) tumor and evaluate the efficacy and safety of this new technique.


SUMMARY OF BACKGROUND DATA
TES has been considered an optimal treatment for tumor, including certain spinal tumors, but it requires a combined posterior-anterior approach, which is often complicated by a long operation time, considerable blood loss and severe trauma.


METHODS
Seven patients with primary or solitary metastatic tumors of L5 were treated with this new technique in our center between March 2014 and November 2017. The critical points were fabrication of the iliac graft, dissection, resection, and reconstruction. Other parameters including surgical time, blood loss, complications, pre- and postoperative neurological function, tumor control, and overall survival (OS) were presented and analyzed.


RESULTS
All the included patients received one stage TES. The mean surgical time was 365.7 minutes with an average blood loss of 2514.3 mL. No serious perioperative complication was observed or reported during the mean follow-up period of 27.4 months. Wound disruption occurred in one patient and numbness of the left lower limb in another, but both recovered rapidly after appropriate management. Adventitial avulsion of the abdominal aorta occurred during dissection in one patient. Two patients died during the follow-up period due to advanced malignancy. One patient was alive but developed a newly diagnosed thoracolumbar tumor in 40 months. The other four patients recovered well without evidence of disease. All patients were able to walk independently 3 to 4 weeks after operation, with satisfied fusion of the iliac grafts in a mean period of 6.7 months after operation. No evidence of internal fixation failure occurred.


CONCLUSION
This new technique offers satisfactory surgical exposure, total en bloc spondylectomy, reliable reconstruction, and good tumor control for certain L5 tumors through the posterior-only approach.


LEVEL OF EVIDENCE
4.