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Open Access 01-12-2020 | Spinal Tumor | Research article

Revision surgery for instrumentation failure after total en bloc spondylectomy: a retrospective case series

Authors: Kazuya Shinmura, Satoshi Kato, Satoru Demura, Noriaki Yokogawa, Noritaka Yonezawa, Takaki Shimizu, Norihiro Oku, Ryo Kitagawa, Makoto Handa, Ryohei Annen, Hideki Murakami, Hiroyuki Tsuchiya

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

There have been several reports of instrumentation failure after three-column resections such as total en bloc spondylectomy (TES) for spinal tumors; however, clinical outcomes of revision surgery for instrumentation failure after TES are seldom reported. Therefore, this study assessed the clinical outcomes of revision surgery for instrumentation failure after TES.

Methods

This study employed a retrospective case series in a single center and included 61 patients with spinal tumors who underwent TES between 2010 and 2015 and were followed up for > 2 years. Instrumentation failure rate, back pain, neurological deterioration, ambulatory status, operation time, blood loss, complications, bone fusion after revision surgery, and re-instrumentation failure were assessed. Data were collected on back pain, neurological deterioration, ambulatory status, and management for patients with instrumentation failure, and we documented radiological bone fusion and re-instrumentation failure in cases followed up for > 2 years after revision surgery.

Results

Of the 61 patients, 26 (42.6%) experienced instrumentation failure at an average of 32 (range, 11–92) months after TES. Of these, 23 underwent revision surgery. The average operation time and intraoperative blood loss were 204 min and 97 ml, respectively. Including the six patients who were unable to walk after instrumentation failure, all patients were able to walk after revision surgery. Perioperative complications of reoperation were surgical site infection (n = 2) and delayed wound healing (n = 1). At the final follow-up, bone fusion was observed in all patients. No re-instrumentation failure was recorded.

Conclusion

Bone fusion was achieved by revision surgery using the posterior approach alone.

Tomita K, Kawahara N, Baba H, Tsuchiya H, Nagata S, Toribatake Y. Total en bloc spondylectomy for solitary spinal metastases. Int Orthop. 1994;18:291–8.CrossRef

Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y. Total en bloc spondylectomy: a new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976). 1997;22:324–33.CrossRef

Schwab J, Gasbarrini A, Bandiera S, Boriani L, Amendola L, Picci P, et al. Osteosarcoma of the mobile spine. Spine. 2012;37:E381–6.CrossRef

Kato S, Murakami H, Demura S, Yoshioka K, Kawahara N, Tomita K, et al. More than 10-year follow-up after total en bloc spondylectomy for spinal tumors. Ann Surg Oncol. 2014;21:1330–6. https://doi.org/10.1245/s10434-013-3333-7.CrossRefPubMed

Amendola L, Cappuccio M, De Iure F, Bandiera S, Gasbarrini A, Boriani S. En bloc resections for primary spinal tumors in 20 years of experience: effectiveness and safety. Spine J. 2014;14:2608–17. https://doi.org/10.1016/j.spinee.2014.02.030.CrossRefPubMed

Schoenfeld AJ, Hornicek FJ, Pedlow FX, Kobayashi W, Raskin KA, Springfield D, et al. Chondrosarcoma of the mobile spine: a review of 21 cases treated at a single center. Spine. 2012;37:119–26. https://doi.org/10.1097/BRS.0b013e31823d2143.CrossRefPubMed

Shimizu T, Murakami H, Demura S, Kato S, Yoshioka K, Yokogawa N, et al. Total en bloc spondylectomy for primary tumors of the lumbar spine. Medicine. 2018;97:e12366. https://doi.org/10.1097/MD.0000000000012366.CrossRefPubMedPubMedCentral

Yokogawa N, Murakami H, Demura S, Kato S, Yoshioka K, Shimizu T, et al. Total spondylectomy for Enneking stage III giant cell tumor of the mobile spine. Eur Spine J. 2018;27:3084–91. https://doi.org/10.1007/s00586-018-5761-3.CrossRefPubMed

Demura S, Kawahara N, Murakami H, Abdel-Wanis ME, Kato S, Yoshioka K, et al. Total en bloc spondylectomy for spinal metastases in thyroid carcinoma. J Neurosurg Spine. 2011;14:172–6. https://doi.org/10.3171/2010.9.SPINE09878.CrossRefPubMed

10.

Park SJ, Lee CS, Chang BS, Kim YH, Kim H, Kim SI, Chang SY. Korean Spine Tumor Study Group Rod fracture and related factors after total en bloc spondylectomy. Spine J. 2019;19:1613–9. https://doi.org/10.1016/j.spinee.2019.04.018.CrossRefPubMed

11.

Yoshioka K, Murakami H, Demura S, Kato S, Yokogawa N, Kawahara N, et al. Risk factors of instrumentation failure after multilevel total en bloc spondylectomy. Spine Surg Relat Res. 2017;1:31–9. https://doi.org/10.22603/ssrr.1.2016-0005.CrossRefPubMedPubMedCentral

12.

Matsumoto M, Watanabe K, Tsuji T, Ishii K, Nakamura M, Chiba K, et al. Late instrumentation failure after total en bloc spondylectomy. J Neurosurg Spine. 2011;15:320–7. https://doi.org/10.3171/2011.5.SPINE10813.CrossRefPubMed

13.

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine. 2001;26:298–306.CrossRef

14.

Sciubba DM, De la Garza RR, Goodwin CR, Xu R, Bydon A, Witham TF, et al. Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine. Eur Spine J. 2016;25:4080–7. https://doi.org/10.1007/s00586-016-4641-y.CrossRefPubMed

15.

Kawahara N, Tomita K, Murakami H, Demura S, Yoshioka K, Kato S. Total en bloc spondylectomy of the lower lumbar spine: a surgical techniques of combined posterior-anterior approach. Spine. 2011;36:74–82. https://doi.org/10.1097/BRS.0b013e3181cded6c.CrossRefPubMed

16.

Disch AC, Schaser KD, Melcher I, Feraboli F, Schmoelz W, Druschel C, et al. Oncosurgical results of multilevel thoracolumbar en-bloc spondylectomy and reconstruction with a carbon composite vertebral body replacement system. Spine (Phila Pa 1976). 2011;36:E647–55. https://doi.org/10.1097/BRS.0b013e3181f8cb4e.CrossRef

17.

Luzzati AD, Shah S, Gagliano F, Perrucchini G, Scotto G, Alloisio M. Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is challenging but rewarding. Clin Orthop Relat Res. 2015;473:858–67. https://doi.org/10.1007/s11999-014-3578-x.CrossRefPubMed

18.

Barton C, Noshchenko A, Patel V, Cain C, Kleck C, Burger E. Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series. Scoliosis. 2015;10:30. https://doi.org/10.1186/s13013-015-0056-5.CrossRefPubMedPubMedCentral

19.

Murakami H, Kato S, Demura S, Yoshioka K, et al. Novel reconstruction technique using a frozen tumor-bearing vertebra from a total en bloc sponydylectomy for spinal tumors. Orthopedics. 2013;36:605–7. https://doi.org/10.3928/01477447-20130724-04.CrossRefPubMed

20.

Kawahara N, Tomita K, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: surgical techniques and related basic background. Orthop Clin North Am. 2009;40:47–63. https://doi.org/10.1016/j.ocl.2008.09.004.CrossRefPubMed

21.

Elder BD, Sankey EW, Goodwin CR, Kosztowski TA, Lo SF, Bydon A, et al. Surgical outcomes in patients with high spinal instability neoplasm score secondary to spinal giant cell tumors. Global Spine J. 2016;6:21–8. https://doi.org/10.1055/s-0035-1555657.CrossRefPubMed

22.

Garofalo F, di Summa PG, Christoforidis D, Pracht M, Laudato P, Cherix S, et al. Multidisciplinary approach of lumbosacralchordoma: from oncological treatment to reconstructive surgery. J Surg Oncol. 2015;112:544–54. https://doi.org/10.1002/jso.24026.CrossRefPubMed

23.

Greco C, Pares O, Pimentel N, Moser E, Louro V, Morales X, et al. Spinal metastases: from conventional fractionated radiotherapy to single-dose SBRT. Rep Pract Oncol Radiother. 2015;20:454–63. https://doi.org/10.1016/j.rpor.2015.03.004.CrossRefPubMedPubMedCentral

24.

Joaquim AF, Powers A, Laufer I, Bilsky MH. An update in the management of spinal metastases. Arq Neuropsiquiatr. 2015;73:795–802. https://doi.org/10.1590/0004-282X20150099.CrossRefPubMed

25.

Shinmura K, Murakami H, Demura S, Kato S, Yoshioka K, Hayashi H, et al. A histological examination of spinal reconstruction using a frozen bone autograft. PLoS One. 2018;13:e0191679. https://doi.org/10.1371/journal.pone.0191679.CrossRefPubMedPubMedCentral

Title: Revision surgery for instrumentation failure after total en bloc spondylectomy: a retrospective case series
Authors: Kazuya Shinmura
Satoshi Kato
Satoru Demura
Noriaki Yokogawa
Noritaka Yonezawa
Takaki Shimizu
Norihiro Oku
Ryo Kitagawa
Makoto Handa
Ryohei Annen
Hideki Murakami
Hiroyuki Tsuchiya
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Spinal Tumor
Back Pain
Back Pain
Back Pain
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03622-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Revision surgery for instrumentation failure after total en bloc spondylectomy: a retrospective case series

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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