Neurospine.
2022 Mar;19(1):146-154. 10.14245/ns.2244092.046.
Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery
- Affiliations
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- 1Department of Neurosurgery, Incheon Veterans Hospital, Incheon, Korea
- 2Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- 3Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- 4Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Korea
- 5Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
- 6Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, Seoul, Korea
- 7Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- 8Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
- 9Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- 10Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
- KMID: 2528386
- DOI: http://doi.org/10.14245/ns.2244092.046
Abstract
Objective
Total en bloc spondylectomy (TES) is a curative surgical method for spinal tumors. After resecting the 3 spinal columns, reconstruction is of paramount importance. We present cases of mechanical failure and suggest strategies for salvage surgery.
Methods
The medical records of 19 patients who underwent TES (9 for primary tumors and 10 for metastatic tumors) were retrospectively reviewed. Previously reported surgical techniques were used, and the surgical extent was 1 level in 16 patients and 2 levels in 3 patients. A titanium-based mesh-type interbody spacer filled with autologous and cadaveric bone was used for anterior support, and a pedicle screw/rod system was used for posterior support. Radiotherapy was performed in 11 patients (pre-TES, 5; post-TES, 6). They were followed up for 59 ± 38 months (range, 11–133 months).
Results
During follow-up, 8 of 9 primary tumor patients (89%) and 5 of 10 metastatic tumor patients (50%) survived (mean survival time, 124 ± 8 months vs. 51 ± 13 months; p = 0.11). Mechanical failure occurred in 3 patients (33%) with primary tumors and 2 patients (20%) with metastatic tumors (p = 0.63). The mechanical failure-free time was 94.4 ± 14 months (primary tumors, 95 ± 18 months; metastatic tumors, 68 ± 16 months; p = 0.90). Revision surgery was performed in 4 of 5 patients, and bilateral broken rods were replaced with dual cobalt-chromium alloy rods. Repeated rod fractures occurred in 1 of 4 patients 2 years later, and the third operation (with multiple cobalt-chromium alloy rods) was successful for over 6 years.
Conclusion
Considering the difficulty of reoperation and patients’ suffering, preemptive use of a multiple-rod system may be advisable.
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