Perioperative complications of en bloc resection and anterior column reconstruction for thoracic and lumbar spinal tumors

PURPOSE

To evaluate the perioperative clinical outcomes of en bloc resection and anterior column reconstruction for thoracolumbar spinal tumors.

METHODS

This study conducted a retrospective analysis of prospective data collection of 86 consecutive patients, including 40 males and 46 females, with an average age of 39 years (ranged from 10 to 71 years). There were 35 cases of a malignant primary tumor,42 cases of an aggressive benign tumor, and nine cases of metastases. The main lesions were located in 65 cases of thoracic spine, 17 cases of lumbar spine, and 4 cases of thoracolumbar spine. Tumors involved one level in 45 patients, two levels in 12 patients, three levels in 21 patients, four levels in five patients, five levels in two patients, and six levels in one patient.

RESULTS

According to the Weinstein-Boriani-Biagini surgical staging system, all patients achieved en bloc resections, including 74 cases of total en bloc spondylectomy and 12 cases of sagittal resections. The mean surgical time was 559 min (210-1208 min), and the mean total blood loss was 1528 ml (260-5500 ml). A total of 122 complications were observed in 62(72.1%) patients, of which 18(20.9%) patients had 25 major complications and one patient (1.2%) died of complications. The combined approach (P = 0.002), total blood loss (P = 0.003), staged surgery (P = 0.004), previous surgical history (P = 0.045), the number of involved vertebrae (P = 0.021) and lumbar location (P = 0.012) were statistically significant risk factors for major complication. When all above risk factors were incorporated in multivariate analysis, only the combined approach (P = 0.052) still remained significant.

CONCLUSIONS

En bloc resection and anterior column reconstruction is accompanied by a high incidence of complications, especially when a combined approach is necessary.

Delayed Presentation of Thoracic Aortic Pseudoaneurysm Following Pedicle Screw Implantation: A Case Report

Background

Pedicle screw insertion has been known to have several complications even in the most skilled surgical hands. However, injury to the thoracic aorta during pedicle screw insertion is rare, delayed presentation secondary to pseudoaneurysm is even rarer, the pseudoaneurysm formation caused by a series of malpositioned pedicle screws has perhaps not been reported so far.

Case presentation

In this paper, we report here a case in which inadvertent injury to the thoracic aorta resulted in pseudoaneurysm, its manifestation was initially vague, resulting in a delayed diagnosis. Delayed aortic pseudoaneurysm or injury can be asymptomatic for a long time. Patients with renewed or continued back pain should alert orthopaedic surgeons regarding the possibility of pseudoaneurysms, regardless of the period that has elapsed after pedicle screw implantation.

[Radiological outcomes of unstable thoraco-lumbar fractures without neurological deficit treated through percutaneous surgery]

OBJECTIVE

To analyse the radiological outcomes in the long term of unstable thoracic and lumbar fractures treated through percutaneous surgery.

MATERIAL AND METHODS

Retrospective review of a series of patients with unstable thoracic and lumbar fractures treated with percutaneous minimally invasive surgery between 2010 and 2015 in three different hospital centres. Six radiological parameters were measured annually during a 2-year period: Fracture angle, kyphotic deformity, sagittal index, percentage of compression, degree of displacement and deformation angle.

RESULTS

A total of 37 patients were included with a median age of 41.3 years and a median follow-up period of 2.2 years. Fracture angle rose from 14.8° to 17.1° (increase of 15.54%), kyphotic deformity from 15.9° to 17.7° (increase of 11.32%), sagittal index from 10.1 to 12.3 (increase of 21.78%), percentage of compression from 32.7% to 36.8% (increase of 12.53%), degree of displacement from 3.0mm to 4.4mm (increase of 50%) and deformation angle from 20.7° to 22.9° (increase of 10.62%).

CONCLUSIONS

All the radiological parameters studied lost correction throughout the 24 months of follow-up; the degree of displacement and the sagittal index were the most marked. Nevertheless, the greatest loss of correction occurred in the first postoperative year, the parameters then stabilised over the 24 months of follow up. We routinely recommend the measurement of all previous parameters for the follow up of unstable thoracic and lumbar fractures treated through percutaneous surgery.