En-bloc spondylectomy in the lumbar spine: indications, results and complications in a series of 47 patients affected by primary malignant bone tumors

Alessandro Luzzati; Stefano Conti; Isabella Sperduti; Alessandra Scotto Di Uccio; Simone Mazzoli; Luca Cannavò; Gennaro Scotto; Carmine Zoccali

doi:10.1007/s00402-024-05274-w

En-bloc spondylectomy in the lumbar spine: indications, results and complications in a series of 47 patients affected by primary malignant bone tumors

Arch Orthop Trauma Surg. 2024 Apr 8. doi: 10.1007/s00402-024-05274-w. Online ahead of print.

Authors

Alessandro Luzzati¹, Stefano Conti², Isabella Sperduti³, Alessandra Scotto Di Uccio⁴, Simone Mazzoli¹, Luca Cannavò¹, Gennaro Scotto¹, Carmine Zoccali^{5

6}

Affiliations

¹ Oncological and Reconstructive Surgery Unit, IRCCS-Galeazzi Orthopedic Institute, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
² Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
³ Statistical Department, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
⁴ General Surgery and Organ Transplantation Unit, School of General Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Rome, Italy.
⁵ Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy. carminezoccali@libero.it.
⁶ Oncological Orthopedics Department, IRCCS-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. carminezoccali@libero.it.

PMID: 38589502
DOI: 10.1007/s00402-024-05274-w

Abstract

Introduction: Wide Surgery is the reference treatment for malignant and aggressive benign primary bone tumors in the spine. When located in the lumbar spine, En-Bloc Spondylectomy (EBS) remains a complex challenge. Moreover, surgery is complicated by the presence of the diaphragm in the thoracolumbar junction and the hinderance of the iliac wings at the lumbosacral levels. Therefore, EBS in the lumbar spine frequently requires combined approaches. The purpose of this study is to describe clinical presentation, tumor characteristics and results of a series of 47 consecutive patients affected by malignant primary bone tumors of the lumbar spine who underwent EBS.

Materials and methods: 47 patients were reviewed. Complications were distinguished in early and late whether they occurred before or after 30 days from surgery. Overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS) were calculated by the Kaplan-Meier product-limit method from surgery until relapse or death.

Results: 27 patients presented to observation after a first intralesional approach in a non-specialized center. Chordoma was the most represented histotype. Vertebrectomies were: 23 one-level, 10 two-level, 12 three-level and 2 four-level. Reconstructions were always carried out with screws and rods. The main postoperative complication was blood loss, while hardware failure was the main long-term complication. The 5-year LRFS was 75.5%, the 5-year DFS was 54.3%, and 5-year OS was 63.6%.

Conclusions: The surgical margin obtained during the index surgery was statistically associated with Local Recurrence, DFS and OS, underlining the importance of treating patients in reference centers.

Keywords: Bone tumors; En-bloc spondylectomy; Lumbar spine; Spine surgery; Wide margin; Wide surgery.