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05.02.2018 | Original Paper | Ausgabe 3/2018

International Orthopaedics 3/2018

Single-stage multi-level construct design incorporating ribs and chest wall reconstruction after en bloc resection of spinal tumour

Zeitschrift:
International Orthopaedics > Ausgabe 3/2018
Autoren:
Jianru Xiao, Shaohui He, Jian Jiao, Wei Wan, Wei Xu, Dan Zhang, Weibo Liu, Nanzhe Zhong, Tielong Liu, Haifeng Wei, Xinghai Yang
Wichtige Hinweise
Jianru Xiao, Shaohui He and Jian Jiao contributed equally to this work, and all should be considered first authors.

Abstract

Purpose

Multi-level reconstruction incorporating the chest wall and ribs is technically demanding after multi-segmental total en bloc spondylectomy (TES) of thoracic spinal tumours. Few surgical techniques are reported for effective reconstruction. A novel and straightforward technical reconstruction through posterior-lateral approach was presented to solve the extensive chest wall defect and prevent occurrences of severe respiratory dysfunctions after performing TES. The preliminary outcomes of surgery were reviewed.

Methods

Multi-level TES was performed for five patients with primary or recurrent thoracic spinal malignancies through posterior-lateral approach. The involved ribs and chest wall were removed to achieve tumour-free margin. Then titanium mesh with allograft bone and pedicle screw-rod system were adopted for the circumferential spinal reconstruction routinely. Titanium rods were modified accordingly to attach to the screw-rod system proximally, and the distal end of rods was dynamically inserted into the ribs.

Results

The mean surgery time was 6.7 hours (range 5–8), with the average blood loss of 3260 ml (range 2300–4500). No severe neurological complications were reported while three patients had complaints of slight numbness of chest skin (no. 1, 3, and 5). No severe respiratory complications occurred during peri-operative period. No implant failure and no local recurrence or distant metastases were observed with an average follow-up of 12.5 months.

Conclusions

The single-stage reconstructions incorporating spine and chest wall are straightforward and easy to perform. The preliminary outcomes of co-reconstructions are promising and favourable. More studies and longer follow-up are required to validate this technique.

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