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Perioperative complications of total en bloc spondylectomy: adverse effects of preoperative irradiation.

Yokogawa N, Murakami H, Demura S, Kato S, Yoshioka K, Hayashi H, Ishii T, Igarashi T, Fang X, Tsuchiya H - PLoS ONE (2014)

Bottom Line: Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer.The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits.The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

ABSTRACT

Background: Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. We examined the perioperative complications associated with TES in patients receiving preoperative irradiation.

Methods: Seventy-seven patients underwent TES between May 2010 and April 2013. We performed a retrospective review of prospectively collected data for 50 patients with metastatic tumors of the thoracic spine, excluding patients with primary spinal tumors, lumbar spinal metastasis, and combined anterior and posterior approach TES. Patients were divided into 2 groups: those with preoperative irradiation (RT-TES group, 18 patients) and those without preoperative irradiation (TES group, 32 patients). The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits.

Results: Significant differences in patient characteristics were not observed between the RT-TES and TES groups. Perioperative TES complications occurred in 20/50 patients (40.0%). The complication rate in the RT-TES group was 77.8% (14 out of 18), threefold higher than the 18.8% (6 out of 32) in the TES group (P<0.01). The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01).

Conclusion: The perioperative complication rate associated with TES for spinal metastasis was significantly higher among patients receiving preoperative irradiation than among those not receiving preoperative irradiation.

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Related in: MedlinePlus

Operative schema for total en bloc spondylectomy.(A) Pediculotomy using a T-saw and en bloc resection of the posterior element; (B) Anterior column osteotomy and removal of the tumor-affected vertebral body.
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pone-0098797-g001: Operative schema for total en bloc spondylectomy.(A) Pediculotomy using a T-saw and en bloc resection of the posterior element; (B) Anterior column osteotomy and removal of the tumor-affected vertebral body.

Mentions: Total en bloc spondylectomy (TES, Figure 1) is used for complete resection of spinal tumors, including primary malignant, aggressive benign, and metastatic tumors [1], [2]. Intervention with TES reduces local tumor recurrence and improves patient prognosis [3], [4], [5]. However, because of its technically demanding procedures and use in patients who often have complicated medical backgrounds, such as cancer, the rate of perioperative complications is high compared with that associated with other spinal surgeries [6]. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. To our knowledge, the rate of perioperative complications in TES, with a focus on the adverse effects of preoperative irradiation, has not been previously reported. In the present study, we examined the rate of perioperative complications associated with TES in a single-center, retrospective study.


Perioperative complications of total en bloc spondylectomy: adverse effects of preoperative irradiation.

Yokogawa N, Murakami H, Demura S, Kato S, Yoshioka K, Hayashi H, Ishii T, Igarashi T, Fang X, Tsuchiya H - PLoS ONE (2014)

Operative schema for total en bloc spondylectomy.(A) Pediculotomy using a T-saw and en bloc resection of the posterior element; (B) Anterior column osteotomy and removal of the tumor-affected vertebral body.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043789&req=5

pone-0098797-g001: Operative schema for total en bloc spondylectomy.(A) Pediculotomy using a T-saw and en bloc resection of the posterior element; (B) Anterior column osteotomy and removal of the tumor-affected vertebral body.
Mentions: Total en bloc spondylectomy (TES, Figure 1) is used for complete resection of spinal tumors, including primary malignant, aggressive benign, and metastatic tumors [1], [2]. Intervention with TES reduces local tumor recurrence and improves patient prognosis [3], [4], [5]. However, because of its technically demanding procedures and use in patients who often have complicated medical backgrounds, such as cancer, the rate of perioperative complications is high compared with that associated with other spinal surgeries [6]. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. To our knowledge, the rate of perioperative complications in TES, with a focus on the adverse effects of preoperative irradiation, has not been previously reported. In the present study, we examined the rate of perioperative complications associated with TES in a single-center, retrospective study.

Bottom Line: Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer.The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits.The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

ABSTRACT

Background: Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. We examined the perioperative complications associated with TES in patients receiving preoperative irradiation.

Methods: Seventy-seven patients underwent TES between May 2010 and April 2013. We performed a retrospective review of prospectively collected data for 50 patients with metastatic tumors of the thoracic spine, excluding patients with primary spinal tumors, lumbar spinal metastasis, and combined anterior and posterior approach TES. Patients were divided into 2 groups: those with preoperative irradiation (RT-TES group, 18 patients) and those without preoperative irradiation (TES group, 32 patients). The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits.

Results: Significant differences in patient characteristics were not observed between the RT-TES and TES groups. Perioperative TES complications occurred in 20/50 patients (40.0%). The complication rate in the RT-TES group was 77.8% (14 out of 18), threefold higher than the 18.8% (6 out of 32) in the TES group (P<0.01). The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01).

Conclusion: The perioperative complication rate associated with TES for spinal metastasis was significantly higher among patients receiving preoperative irradiation than among those not receiving preoperative irradiation.

Show MeSH
Related in: MedlinePlus