The Causes And Operative Technique Of Reoperation For Spinal Neoplasms

Objective:The spinal neoplasm recurrence rate is high for the reason that it is difficult to reach the security margin and to reconstruct stably after tumor resection owing to the special anatomical structure of spine. Our research is to investigate the causes and operative technique of reoperation for spinal neoplasms.Methods:Twelve spinal neoplasm patients underwent reoperations between January2001and March2014at this Hospital were retrospectively analyzed. There were8males and4females with average42.5years old (range from17to65years). Pathological types included giant cell tumor in4cases, hemangioma in3cases, giant cell tumor with aneurysmal bone cyst, osteoblastoma with aneurysmal bone cyst, myeloma, chondrosarcoma and chordoma in1case. In nine cases tumors were located in the thoracic vertebra, including T2/3one case, T7one case, T8two cases, T10two cases, T11one case, T12two cases,3cases were located in the lumbar vertebra, including L3one case, L4one case, L5one case. All12patients have X-ray, CT, MRI examinations, and the pathologic diagnoses were made sure before operation. Ten cases had operation in this hospital, two in other hospitals.Ten cases had operations through posterior approach,1through anterior approach,1through combined anterior and posterior approach. The reconstruction methods included:single-segment with posterior pedicle screw-rod system (5cases), multiple-segment with posterior pedicle screw-rod system (6cases), single-segment with anterior screw-rod system (1case); anterior reconstruction was achieved by titanium mesh filled with bone graft (8cases) or bone cement (2cases). Patients began ambulation wearing orthosis after being in bed for1-2months postoperatively.Results:12patients underwent18times of operation (an average of1.5times) totally,8cases had one reoperations,2cases had two reoperations,2cases had three reoperations. The average time interval between primary operation and reoperation was31months (range from6months to92months), the reasons for reoperation include:tumor recurrence (9cases), tumor recurrence with internal fixation disruption (1case), loosening of internal fixation (2cases), disruption of the internal fixation (4cases), infection (2case). All patients were followed up from12months to157months (average,63months),3cases died due to tumor recurrence,2cases were infected after revision surgery, and cured after removing the internal fixation and lavaging.2cases underwent3times of reoperation, one case was osteoblastoma of T12, the intervals were50months,10months,6months, the other was chordoma of T7, the intervals were12months,14months,6months.Conclusions:the surgical treatment of spinal neoplasm faces many challenges, including the high rate of recurrence, the failure of reconstruction and infections, which lead to reoperation. Reoperation can relieve the symptom of nerve damage, treat the complication, improve the quality of life, and prolong the survival time.