Risk factors for instrumentation failure after total en bloc spondylectomy of thoracic and lumbar spine tumors using titanium mesh cage for anterior reconstruction.

November 25, 2019

OBJECTIVE:

This study aimed to investigate the risk factors for instrumentation failure (IF) after total en bloc spondylectomy (TES) of thoracic and lumbar spine tumors using titanium mesh cage (TMC) for anterior reconstruction.

METHODS:

Data of patients who underwent TES for thoracic and lumbar spine tumors in our institution were retrospectively reviewed. Anterior reconstruction was performed using TMC filled with morcelized allograft or morcelized autograft. Posterior reconstruction was performed using pedicle fixation. Survival analysis of the time from TES to IF was conducted. Kaplan-Meier method was used for univariate analysis. Factors of statistical significance were subjected to multivariate analysis by Cox regression analysis.

RESULTS:

In total, 30 patients (20 men and 10 women), with a mean age of 37.1±14.3 (range, 14-65) years were included. The mean follow-up period was 41.8±21.3 (range, 13-120) months. Bone fusion was achieved in 23 (76.7%) cases. IF occurred in 8 cases. The mean time from TES to the first IF was 31.8±15.1 (range, 13-64) months. On univariable analysis, body mass index (BMI) >28, perioperative radiotherapy, and TMC in oblique position were found to be associated with IF. On multivariable analysis, these three factors entered into the Cox regression model were also significant.

CONCLUSION:

Total en bloc spondylectomy is able to achieve durable oncological control. However, instrumentation failure, a not uncommon late complication that leads to reoperation should be caused concern. Perioperative radiotherapy, titanium mesh cage in the oblique position, and BMI>28 are significant predictive factors.