Outcome Of Surgery For Solitary Metastasis Of Thoracolumbar Spine:Total En Bloc Spondylectomy Versus Debulking Surgery

BACKGROUND CONTEXT:For the patients with solitary metastasis spinal tumors in thoracolumbar spine, debulking surgery is conventionally used in the past time. However, with the development of total en bloc spondylectomy (TES), it is said that TES has some advantages to treat solitary metastasis spinal tumors comparing to debulking surgery. Nowadays more and more surgeons prefer TES. Nevertheless, few studies have analyzed the differences in outcome, especially in survival, between the two surgical procedures. No study focuses on the patients with isolated solitary spinal metastasis.PURPOSE:To compare the clinical outcomes of two different surgical procedures for the patients with solitary metastatic spinal tumors in thoracolumbar spine.METHODS:A retrospective study. A consecutive series of49patients with solitary thoracolumbar spinal metastasis were retrospectively reviewed from January2003to October2011. TES was performed in25cases since October2008. Debulking surgery, such as piecemeal excision or curettage, was performed in24cases from January2003to September2008. All patients were conventionally followed up with plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scan to detect local recurrence or secondary metastases. Outcome measures included estimated blood loss, operation time, survival status, neurologic function (Frankel grading system), local recurrence, pain (VAS), and perioperative complications.RESULTS:The mean operation time was390.80±72.16minutes in TES group, and331.88±111.96minutes in debulking surgery group (P<0.05). The estimated blood loss was2052.00±745.05ml in TES group, and2273.91±1562.70ml in debulking surgery group (P>0.05). Perioperative complications were found in12cases after TES, and in3cases after debulking surgery, with statistically significant difference between the strategies (P<0.05).The VAS of the patients was significantly decreased after both strategies, with no statistically significant difference between the strategies (P>0.05). TES and debulking surgery both resulted in an acceptable outcome in neurologic function. Local recurrence occurred in3cases after TES. In contrast, local recurrence occurred in13cases after debulking surgery. The difference between TES and debulking surgery concerning local recurrence was statistically significant (P<.05). The mean survival time was22.21±1.62months after TES,15.29±2.00months after Debulking surgery, with statistically significant difference between the strategies (P<0.05).CONCLUTIONS:Debulking surgery has been shown to be associated with shorter operation time, less technical difficulties and less perioperative complications. However, the carefully selected patients were statistically proven to have longer survival time and more successful control of local recurrence after TES procedure. In spite of the fact that the TES technique is becoming more mature, the perioperative complication rate still remains high. TES should only be performed after a thorough discussion of the benefits and risks for the carefully selected patients. Meanwhile, the TES procedure should also be performed by experienced surgeons. In this case, the good prognosis could be expected.