Oncosurgical Results of Multilevel Thoracolumbar En-bloc Spondylectomy and Reconstruction with a Carbon Composite Vertebral Body Replacement System

Study Design. Retrospective clinical study for patients receiving multilevel en-bloc spondylectomy resection for sarcomas and solitary metastases of the thoracolumbar spine. Objective. Assess the clinical and radiologic outcome after multilevel en-bloc spondylectomy and reconstruction. Summary of Background Data. Monolevel en-bloc spondylectomies have proven their oncosurgical effectiveness while reports on multilevel resections for extracompartmental tumor localizations are rare. Methods. Patients treated by multilevel en-bloc spondylectomy and restoration with a carbon composite vertebral body replacement system were investigated. Patient charts, and clinical follow-up investigations were analyzed for histopathological tumor origin, preoperative symptoms, surgical peri-and postoperative data, applied adjuvant therapies, as well as the course of disease. Solitary metastases time until occurrence and prognostic scores were evaluated (Tomita/Tokuhashi Score). CT-scans were performed and analyzed at follow up. Oncological status was evaluated including local recurrence rates, cumulative disease specific, and metastases-free survival. Results. Multilevel (2-5 segments) en-bloc spondylectomy of the thoracolumbar spine was performed in 20 patients (15 sarcomas and 5 solitary spinal metastases 9 male/11 female, mean age at surgery: 54 +/- 15 years.). Wide and marginal surgical margins were achieved in 7 and 13 patients, respectively. Mean follow-up period was 25.0 (9-53) months. Thirteen patients received adjuvant therapy. No implant breakage or loosening was observed. Local recurrence occurred in one patient. Thirteen of the 18 surviving patients showed no evidence of the disease, two died of systemic disease. Conclusion. Multilevel en-bloc spondylectomy offers a radical resection option for extracompartmental tumor involvement. It provides oncologically adequate resection margins with low local recurrence. However, the procedures are complex; the patient's stress is high and metastatic disease developed in one-third of patients. A judicious patient selection and a realistic feasibility evaluation must precede the decision for surgery. Reconstruction using a carbon composite cage system showed low complication rates and offers advantages for oncosurgical procedures.