Surgical Outcomes and Risk Factors for Surgical Complications After En Bloc Resection Following Reconstruction with 3D-printed Artificial Vertebral Body for Thoracolumbar Tumors

Overview

Journal World J Surg Oncol

Publisher Biomed Central

Specialties General Surgery
Oncology

Date 2023 Dec 15

PMID 38097982

Authors

Jinxin Hu

Guohui Song

Hongmin Chen

Huaiyuan Xu

Anqi Wang

Xiangqin Wang

Bingbing Hou

Jinchang Lu

Qinglian Tang

Jin Wang

Xiaojun Zhu

Affiliations

Soon will be listed here.

Abstract

Background: The outcomes of patients with tumors of the thoracolumbar spine treated with en bloc resection (EBR) using three-dimensional (3D)-printed endoprostheses are underreported.

Methods: We retrospectively evaluated patients with thoracolumbar tumors who underwent surgery at our institution. Logistic regression analysis was performed to identify the potential risk factors for surgical complications. Nomograms to predict complications were constructed and validated.

Results: A total of 53 patients with spinal tumors underwent EBR at our hospital; of these, 2 were lost to follow-up, 45 underwent total en bloc spondylectomy, and 6 were treated with sagittal en bloc spondylectomy. The anterior reconstruction materials included a customized 3D-printed artificial vertebral body (AVB) in 10 cases and an off-the-shelf 3D-printed AVB in 41 cases, and prosthesis mismatch occurred in 2 patients reconstructed with the off-the-shelf 3D-printed AVB. The median follow-up period was 21 months (range, 7-57 months). Three patients experienced local recurrence, and 5 patients died at the final follow-up. A total of 50 perioperative complications were encountered in 29 patients, including 25 major and 25 minor complications. Instrumentation failure occurred in 1 patient, and no prosthesis subsidence was observed. Using a combined surgical approach was a dependent predictor of overall complications, while Karnofsky performance status score, lumbar spine lesion, and intraoperative blood loss ≥ 2000 mL were predictors of major complications. Nomograms for the overall and major complications were constructed using these factors, with C-indices of 0.850 and 0.891, respectively.

Conclusions: EBR is essential for the management of thoracolumbar tumors; however, EBR has a steep learning curve and a high complication rate. A 3D-printed AVB is an effective and feasible reconstruction option for patients treated with EBR.

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References

Matsumoto M, Watanabe K, Tsuji T, Ishii K, Nakamura M, Chiba K . Late instrumentation failure after total en bloc spondylectomy. J Neurosurg Spine. 2011; 15(3):320-7. DOI: 10.3171/2011.5.SPINE10813. View

Li Z, Wei F, Liu Z, Liu X, Jiang L, Yu M . Risk Factors for Instrumentation Failure After Total En Bloc Spondylectomy of Thoracic and Lumbar Spine Tumors Using Titanium Mesh Cage for Anterior Reconstruction. World Neurosurg. 2019; 135:e106-e115. DOI: 10.1016/j.wneu.2019.11.057. View

Demura S, Kato S, Shinmura K, Yokogawa N, Shimizu T, Handa M . Perioperative complications of total en bloc spondylectomy for spinal tumours. Bone Joint J. 2021; 103-B(5):976-983. DOI: 10.1302/0301-620X.103B5.BJJ-2020-1777.R1. View

Melcher I, Disch A, Khodadadyan-Klostermann C, Tohtz S, Smolny M, Stockle U . Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy. Eur Spine J. 2007; 16(8):1193-202. PMC: 2200785. DOI: 10.1007/s00586-006-0295-5. View

Yang W, Jiang L, Liu X, Wei F, Yu M, Wu F . Surgical complications of extraspinal tumors in the cervical spine: a report of 110 cases and literature review. Eur Spine J. 2017; 27(4):882-890. DOI: 10.1007/s00586-017-5259-4. View

Li Z, Guo L, Zhang P, Wang J, Wang X, Yao W . A Systematic Review of Perioperative Complications in en Bloc Resection for Spinal Tumors. Global Spine J. 2022; 13(3):812-822. PMC: 10240596. DOI: 10.1177/21925682221120644. View

Dang L, Liu Z, Liu X, Jiang L, Yu M, Wu F . Sagittal en bloc resection of primary tumors in the thoracic and lumbar spine: feasibility, safety and outcome. Sci Rep. 2020; 10(1):9108. PMC: 7272461. DOI: 10.1038/s41598-020-65326-0. View

McDonnell M, Glassman S, Dimar 2nd J, Puno R, Johnson J . Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am. 1996; 78(6):839-47. DOI: 10.2106/00004623-199606000-00006. View

Yoshioka K, Murakami H, Demura S, Kato S, Kawahara N, Tomita K . Clinical outcome of spinal reconstruction after total en bloc spondylectomy at 3 or more levels. Spine (Phila Pa 1976). 2013; 38(24):E1511-6. DOI: 10.1097/BRS.0b013e3182a6427a. View

10.

Fang T, Zhang M, Yan J, Zhao J, Pan W, Wang X . Comparative Analysis of 3D-Printed Artificial Vertebral Body Versus Titanium Mesh Cage in Repairing Bone Defects Following Single-Level Anterior Cervical Corpectomy and Fusion. Med Sci Monit. 2021; 27:e928022. PMC: 7876950. DOI: 10.12659/MSM.928022. View

11.

He S, Bi Y, Ye C, Peng D, Xiao J, Wei H . Interdisciplinary Surgical Treatments and Long-Term Outcomes of Lumbar Spinal Tumors With Retroperitoneal Involvements: A Retrospective Case Series Study. Front Oncol. 2022; 11:720432. PMC: 8733943. DOI: 10.3389/fonc.2021.720432. View

12.

Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R . Predictors for surgical complications of en bloc resections in the spine: review of 220 cases treated by the same team. Eur Spine J. 2016; 25(12):3932-3941. DOI: 10.1007/s00586-016-4463-y. View

13.

Sciubba D, De La Garza Ramos R, Goodwin C, Xu R, Bydon A, Witham T . Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine. Eur Spine J. 2016; 25(12):4080-4087. DOI: 10.1007/s00586-016-4641-y. View

14.

Costanzo R, Ferini G, Brunasso L, Bonosi L, Porzio M, Benigno U . The Role of 3D-Printed Custom-Made Vertebral Body Implants in the Treatment of Spinal Tumors: A Systematic Review. Life (Basel). 2022; 12(4). PMC: 9030237. DOI: 10.3390/life12040489. View

15.

Schilling A, Ehresman J, Huq S, Ahmed A, Lubelski D, Cottrill E . Risk Factors for Wound-Related Complications After Surgery for Primary and Metastatic Spine Tumors: A Systematic Review and Meta-Analysis. World Neurosurg. 2020; 141:467-478.e3. DOI: 10.1016/j.wneu.2020.03.210. View

16.

Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y . Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976). 1997; 22(3):324-33. DOI: 10.1097/00007632-199702010-00018. View

17.

Amendola L, Cappuccio M, De Iure F, Bandiera S, Gasbarrini A, Boriani S . En bloc resections for primary spinal tumors in 20 years of experience: effectiveness and safety. Spine J. 2014; 14(11):2608-17. DOI: 10.1016/j.spinee.2014.02.030. View

18.

Wang T, Jia Q, Fan R, Qian M, Yang C, Wei H . Multi-level En Bloc Resection as a Preferred Salvage Therapy for Recurrent Thoracolumbar Chondrosarcoma: A Comparative Study With Piecemeal Resection. Spine (Phila Pa 1976). 2020; 45(12):789-797. DOI: 10.1097/BRS.0000000000003403. View

19.

Xu H, Wang X, Han Y, Jiang Y, Wang J, Zhang X . Biomechanical comparison of different prosthetic reconstructions in total en bloc spondylectomy: a finite element study. BMC Musculoskelet Disord. 2022; 23(1):955. PMC: 9635202. DOI: 10.1186/s12891-022-05919-0. View

20.

Zhou H, Liu S, Li Z, Liu X, Dang L, Li Y . 3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors. J Neurosurg Spine. 2022; 37(2):274-282. DOI: 10.3171/2022.1.SPINE21900. View