Artikel
En bloc spondylectomy – analyse of incidence and type of complications
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Autoren
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Ioan Branea
- Klinik für Wirbelsäulenchirurgie, SRH Klinikum Karlsbad-Langensteinbach
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Charalampos Christodoulopoulos
- Asklipio General Hospital of Voula, Athens, Greece
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Michael Ruf
- Klinik für Wirbelsäulenchirurgie, SRH Klinikum Karlsbad-Langensteinbach
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Tobias Pitzen
- Klinik für Wirbelsäulenchirurgie, SRH Klinikum Karlsbad-Langensteinbach
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: En bloc tumor excision in the spine is an extremely demanding surgery and may be expected to be associated with higher complication rates. Moreover, tumor patient presents cancer associated comorbidities and are often compromised from malignancy. Preoperative radiotherapy contributes to the technical difficulties and to additional complications.The study objectives were to analyze the incidence and type of complications within patients treated via total en bloc spondylectomy.
Method: This is a retrospective study of 20 consecutive patients operated between 6/2011 and 6/2014 with total en bloc spondylectomy. The pathology involved included metastatic and primary tumors of the cervical (6), thoracic (10) and lumbar spine (4). All but 2 of cases were performed through a combined approach. Mean age, gender, length of hospital stay, operation time, blood loss, readmission rate and incidence of peri- and postoperative complications were measured. In 9 cases dorsal fusion was intentionally postponed for 12 months after the spondylectomy operation.
Results: Overall complication incidence was 45%. The complication were: iatrogenic dural tear (4), cerebrospinal postoperative fluid leakage (2), deep wound infection (3), neurological impairment (2), Horner's syndrome (2), lesion of the thoracic duct (2), pseudarthrosis with repeated rod and cage fracture (3), early tumor recurrence (1). Mean operative time, mean blood loss was 482 minutes and 2970 ml respectively. Hospital length of stay was 22.8 days. Readmission rate and reoperation rate, postponed fusion included, was 80%. The overall patient survival at 6 months was 95%.
Conclusions: Total spondylectomy is associated with a high rate of different complications, long hospital stay and readmission. Thus these patients should be treated in a specialized center with in-depth experience with both the primary procedures and complication management. In spite of the high complication rate, serious complications were rare. There were no fatal complications perioperative.
