Outcome and complications of reconstruction of the thoracolumbar spine forvertebral tumours

Forty-six patients with progressive neurological deficits or severe pain un derwent subtotal vertebrectomy and resection of thoracic and lumbar vertebr al tumours. Following subtotal vertebrectomy, 22 spinal segments were recon structed with titanium mesh cylinders, 13 with allograft struts, 7 with met hyl methacrylate, one with autograft bone, and 2 patients underwent spinal reconstruction with miscellaneous materials, In one:patient, 40 mm cancello us screws and a titanium mesh cylinder filled with methyl methacrylate were used. Following the reconstruction, 34 patients underwent stabilisation wi th anterior plates, and 5 patients with posterior rods and pedicle screws. No instrumental fixation was used in 7 patients. Postoperatively, 9 patient s who had severe pain but no preoperative neurological deficits remained ne urologically intact. Of 33 patients with preoperative incomplete deficit (F rankel grades C and D), 14 improved, 18 were unchanged, and one was worse. Of 3 patients in Frankel grade B, 2 improved to grade C but did not recover ambulation and the third patient remained at Frankel grade B. Other compli cations included 2 perioperative deaths due to respiratory failure and coag ulopathy, one postoperative deterioration, and optic neuropathy in one pati ent. Backed out screws were seen in 2 patients. Although spinal reconstruct ion and instrumentation systems allow for immediate stability and mobilisat ion, a significant perioperative morbidity warrants a careful patient selec tion. (C) 1999 Harcourt Publishers Ltd.