Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

• Type of Material: Article
• Authors: Shin W Kwon, Incheon Veterans Hospital; Chun Kee Chung, Seoul National University Hospital; Young II Won, Chungnam National University; Woon Tak Yuh, Seoul National University Hospital; Sung Bae Park, Seoul National University; Seung Heon Yang, Seoul National University; Chang Hyun Lee, Seoul National University; John Rhee, Emory University; Kyoung-Tae Kim, Kyungpook National University Hospital; Chi Heon Kim, Seoul Natl Univ Hosp
• Language: English
• Date: 2022-03-01
• Publisher: KOREAN SPINAL NEUROSURGERY SOC
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the Korean Spinal Neurosurgery Society
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.14245/ns.2244092.046
• Title of Journal or Parent Work: NEUROSPINE
• Volume: 19
• Issue: 1
• Start Page: 146
• End Page: 154
• Grant/Funding Information: This work was supported by the New Faculty Startup Fund from Seoul National University. This study was supported by grant from Seoul National University Hospital research fund (grant No. no. 04-2021-0540).
• Keywords: Reoperation; Spinal neoplasm; Science & Technology; INSTRUMENTATION FAILURE; Life Sciences & Biomedicine; Clinical Neurology; RECONSTRUCTION; Spinal fusion; SURGICAL TECHNIQUE; THORACIC SPINE; TUMORS; Operation; Neurosciences & Neurology; Surgery; Spine; Arthrodesis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objective: Total en bloc spondylectomy (TES) is a curative surgical method for spinal tu-mors. 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 pa-tients. 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 lat-er, 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.