Total spondylectomy for solitary spinal metastasis of the thoracolumbar spine: A preliminary report

Eight cases of solitary spinal metastasis with neurological deficit in thor acolumbar spine in which total en bloc spondylectomy (TS) was performed by bisecting the affected vertebra through both pedicles using fine thread wir e saws mere reviewed. Patient age ranged from 40 to 78 (mean, 62) years. Pr imary lesions were in the lung (2), kidney (2), thyroid (3) and prostate (1 ). TX was performed through a posterior approach in 5 cases (T6-7, T12, L2, L2 and L2-3) and through a one-stage anterior and posterior combined appro ach in the others (L2, L3 and L4). The spine was reconstructed with a ceram ic vertebral prosthesis and a pedicle screw fixation system in 5 cases, and with augmented anterior spinal instruments in 3 cases. There were neither surgical complications nor surgical mortality. All patients became ambulato ry and pain-free after surgery. Histologically, a marginal surgical margin was achieved in only one case. The other 7 cases had intralesional margin a t the osteotomized pedicles. Four patients died from causes unrelated to lo cal recurrence 4 to 44 (mean, 19) months after surgery. Effectiveness of su rgery was maintained until death in all 4 of these patients. Asymptomatic l ocal recurrence occurred in 2 patients with renal cancer at 10 and 33 month s after surgery. These preliminary results suggest that TS for solitary spi nal metastasis can achieve good control of local recurrence without major c omplications and is clinically acceptable surgery.