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. 2021 Dec;15(6):1223-1233.
doi: 10.14444/8155.

En Bloc Resection of Tumors of the Lumbar Spine: A Systematic Review of Outcomes and Complications

Morgan Jones  1 , Zeiad Alshameeri  2 , Okezika Uhiara  1 , Petr Rehousek  1 , Melvin Grainger  1 , Simon Hughes  1 , Marcin Czyz  1
Affiliations

En Bloc Resection of Tumors of the Lumbar Spine: A Systematic Review of Outcomes and Complications

Morgan Jones et al. Int J Spine Surg. 2021 Dec.

Abstract

Background: The literature on total en bloc spondylectomy (TES) of bone tumors of the lumbar spine is sparse and heterogeneous. Therefore, the aim was to systematically pool the data from the published studies to quantitatively summarize the morbidity and mortality and to identify factors associated with favorable outcomes and complications.

Method: A systematic literature search for studies with individual patient-level data was conducted using specific medical subject heading(MeSH) terms. The outcome measures assessed included complications, tumor recurrence, survival, and function. Individual patient data were pooled from all the studies and quantitatively analyzed to assess the association of different factors with outcomes and complications.

Results: Twelve studies were included in this review with a total of 145 TES cases. Of all patients, 50% had at least 1 reported complication post surgery and this was associated with advancing age (OR 1.04, P < 0.001), metastatic disease (OR 5.61, P < 0.001), and adjuvant chemo and/or radiotherapy (OR 20.3, P = 0.001). Intralesional excision (OR 5.2, P = 0.01) and primary malignant tumors (OR 3.3, P = 0.02) were associated with a high recurrence rate. However, the surgical approach was not associated with differences in survival (P = 0.874) or recurrence (P = 0.525) rates. L5 tumor resection was associated with excessive bleeding. Postoperatively, there was an overall improvement in the Frankel grades in most patients.

Conclusion: TES is associated with high rates of complications especially in association with primary malignant and metastatic diseases. However, the number of publications on this topic remain scarce and heterogeneous. Hence, there is a need for standardization in the reporting of the outcomes and complications to help with decision-making and consenting for this procedure.

Keywords: complications; en bloc; lumbar; malignant; outcome; primary en bloc resection; spine; spondylectomy; thoracolumbar; tumor.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) report no conflicts of interest or financial disclosures with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Flow chart of systematic search and review process conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement criteria.
Figure 2
Figure 2
The mean volume of blood loss associated with the primary diagnosis. The number of cases for each diagnosis is reported. There were single cases for some tumors and for these the actual volume of blood loss (not the mean) is depicted. Aneurysmal bone cyst (ABC), chondrosarcoma, and renal cancer were associated with the largest blood loss. GCT, giant cell tumor.
Figure 3
Figure 3
Cases with reported blood loss and operative time are demonstrated. There is a general decrease in trend from T12 to L4 in blood loss. However, L5 is associated with the highest blood loss and operative time.
Figure 4
Figure 4
Survival Kaplan-Meier graphs from the 3 types of tumors. Malignant primary and metastasis had the worst survival.
Figure 5
Figure 5
Kaplan-Meier graph showing survival rates for malignant primary and metastatic tumors based on the excision margin. As expected, wide excision margin was associated with better survival.
Figure 6
Figure 6
Comparing Frankel grade before and after surgery for a total of 83 cases. The neurological status of patients was generally better postoperatively.
See this image and copyright information in PMC

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