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Paholpak P, Sangsin A, Sirichativapee W, Wisanuyotin T, Kosuwon W, Sumnanoont C, Thammaroj P, Ungarreevittaya P, Kasai Y, Murakami H, Tsuchiya H. Total en bloc spondylectomy is worth doing in complete paralysis spinal giant cell tumor, a minimum 1-year follow-up. J Orthop Surg (Hong Kong) 2021; 29:23094990211005900. [PMID: 33910414 DOI: 10.1177/23094990211005900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the neurological recovery of Frankel A spinal giant cell tumor (GCT) patients after they had received a Total En Bloc Spondylectomy (TES). MATERIALS AND METHODS We retrospectively recorded data of three patients (two females) with mobile spine GCT (T6, T10, and L2) Enneking stage III with complete paralysis before surgery, who had undergone TES in our institute from January 2018 to September 2020. The duration of neurologic recovery to Frankel E was the primary outcome. The intra-operative blood loss, operative time, operative-related complications, and the local recurrence were the secondary outcomes. RESULTS The duration of suffering from Frankel A to TES surgery was 2 months for the T6 patient, 3 weeks for the T10 patient, and 1 month for the L2 patient. Three patients had achieved full neurological recovery to Frankel E within 6 months after TES (T6 for 5 months, T10 for 3 months, and L2 for 3 months). The average blood loss was 2833.33 ml and the mean operative time was 400 min. Up until the last follow-up (13-25 months), no evidence of local recurrences had been found in any of the three patients. CONCLUSION Frankel A spinal GCT patients can achieve full neurological recovery after TES, if the procedure is performed within 3 months after complete paraplegia. TES can effectively control any local recurrences.
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Affiliation(s)
- Permsak Paholpak
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Musculoskeletal Oncology and Spinal Disorder Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Apiruk Sangsin
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - Winai Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Musculoskeletal Oncology and Spinal Disorder Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Taweechok Wisanuyotin
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Musculoskeletal Oncology and Spinal Disorder Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Weerachai Kosuwon
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Musculoskeletal Oncology and Spinal Disorder Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Chat Sumnanoont
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Musculoskeletal Oncology and Spinal Disorder Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Puntip Thammaroj
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piti Ungarreevittaya
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yuichi Kasai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Musculoskeletal Oncology and Spinal Disorder Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Multi-level En Bloc Resection as a Preferred Salvage Therapy for Recurrent Thoracolumbar Chondrosarcoma: A Comparative Study With Piecemeal Resection. Spine (Phila Pa 1976) 2020; 45:789-797. [PMID: 32058425 DOI: 10.1097/brs.0000000000003403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis was performed. OBJECTIVE The aim of this study was to evaluate the feasibility and effectiveness of multilevel en bloc resection versus piecemeal resection for recurrent thoracolumbar chondrosarcoma (CHS). SUMMARY OF BACKGROUND DATA Multilevel en bloc resection for recurrent thoracolumbar CHS is rarely performed. METHODS Included in this retrospective study were 27 patients with recurrent thoracolumbar CHS who received either multilevel en bloc resection or piecemeal resection as a salvage revision procedure in our center between 2010 and 2018. Relevant data between the two methods were compared. Relapse-free survival (RFS) and overall survival (OS) were analyzed by log-rank analysis. RESULTS Our series comprised 16 males and 11 females with a mean age of 40.7 years. Multilevel en bloc resection was performed in 17 patients, and piecemeal resection in 10 patients. Of the 17 patients receiving multilevel en bloc resection, five patients experienced recurrence, of whom three died, whereas in the 10 patients receiving piecemeal resection, seven experienced recurrence and all of them died, showing a significant difference between the two groups (P = 0.04 for recurrence, P = 0.007 for death). Complications occurred more frequently in the patients receiving multilevel en bloc resection (P = 0.04), but RFS and OS were prolonged significantly in this group of patients as compared with piecemeal resection group (56.8 ± 9.7 vs. 17.2 ± 4.2, P = 0.016; 67.3 ± 8.4 vs. 21.4 ± 3.5, P = 0.002). CONCLUSION Multilevel en bloc resection as a salvage therapy for recurrent thoracolumbar CHS is technically challenging with high risk of complications, but it can significantly prolong RFS and OS of such patients as compared with piecemeal resection. LEVEL OF EVIDENCE 4.
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