Clinical Outcome of Spinal Reconstruction After Total En Bloc Spondylectomy at 3 or More Levels

Retrospective clinical study.To assess the clinical and radiological outcome of spinal reconstruction after total en bloc spondylectomy (TES) at 3 or more levels.There have been few reports of multilevel spondylectomy for spinal tumor. This is the first case series on the clinical outcome for reconstructions after 3 or more levels of TES.Twenty-six patients treated by 3 or more levels of TES at Kanazawa University Hospital were included in this analysis. Reconstruction was performed with pedicle screw fixation and a titanium mesh cage filled with autograft in all cases. To increase spinal stability in reconstruction, spinal shortening was performed. Instrument failure and radiological findings were evaluated using radiograph and computed tomographical scan with multiplanar reconstructions. The length of spinal shortening was also measured.Excluding 4 patients with deteriorating general condition, radiological evaluation was performed for more than 1 year in 22 patients. All 22 patients had no evidence of local recurrence at the surgical site of the spine during the follow-up period. Cage subsidence was seen in 11 patients (50%). Eight of the 11 patients showed the appearance of subsidence 1 month after the surgery. There was one instrument failure that required revision surgery 8 months after TES surgery. One other patient showed bone resorption on the contact surfaces of the cage at 24 months after the surgery. The mean length of the resection vertebrae was 84.6 mm (52-124 mm), while the length of the shortening was 10.4 mm (3-22 mm).No local recurrence was observed after TES at 3 or more levels. Cage subsidence was a common phenomenon (50%) and already observed 1 month after surgery in 8 of the 11 cases. Spinal shortening has the potential to provide good stability for multilevel TES.4.