article = {JSO-2020-6-104}
title = {Spondylectomy in the Treatment of Neoplastic Spinal Lesions – A Retrospective Outcome Analysis of 582 Patients Using a Patient-Level Meta-Analysis}
journal = {Journal of Surgical Oncology}
year = {2020}
issn = {2674-3000}
doi = {http://dx.doi.org/10.31487/j.JSO.2020.06.04}
url = {https://www.sciencerepository.org/spondylectomy-in-the-treatment-of-neoplastic-spinal-lesions_JSO-2020-6-104 
author = {Alexander Spiessberger,Varun  Arvind, Mansoor  Nasim,Basil  Grueter,Edin  Nevzati,Silvia  Hofer,Samuel  K Cho,}
keywords = {Spondylectomy, spinal chordoma, spinal sarcoma, spinal metastasis}
abstract ={Background: En-bloc spondylectomy in the treatment of spinal tumors is a complex procedure with
potential complications. This study aims at identifying predictors of postoperative complications, lesion
recurrence and overall survival.
Methods: A systematic review of the literature was conducted, and patient-level data extracted from the
included studies. Multiple linear-regression models were calculated to predict the occurrence of
postoperative complications, lesion recurrence and overall survival based on age, tumor etiology, surgical
approach, mode of resection (en-bloc versus intralesional), tumor extension based on Weinstein-BorianiBiagini classification system and number of levels treated.
Results: Data of 582 individual adult and pediatric patients were extracted from the literature; Patient
characteristics are: 45% female, median age of 46 years (range 5-78); most common etiologies were:
sarcoma (46%), metastases (31%) and chordoma (11%). The surgical technique was: anterior (2.5%),
combined (45%) and posterior approach (52.4%); 68.5% underwent en-bloc spondylectomy; average levels
resected were 1.6 (1-6); 65% of patients had neurologic deficits at presentation, average survival was 2.6
years; Direct procedure-related complications were observed in 17.7%, with the most prevalent being CSF
leaks, wound infections and neural injury. For postoperative complications, recurrence and 5-year survival
significant regression equations were found (F(7,90)=2.57, p=0.018) with an R2 of 0.1; (F(5,147)=2.35,
p=0.044) with an R2 of 0.07 and (F(4,101)=7.2, p=0.01) with an R2 of 0.38. Odds ratio for predicted
complications was 1.35 for en-bloc resection and 1.25 for more than one level treated. The odds ratio for
tumor recurrence was 0.78 for en-bloc resection; odds ratio for 5-year survival were 0.79 for increased
patient age, 0.65 for increasing tumor grade, 0.79 for tumor dissemination at diagnosis and 1.68 for en-bloc
resection.
Conclusion: En-bloc spondylectomy provides improved survival and lower recurrence rates but also higher
operative complication rates when compared to intralesional resections. Interestingly the complication rate
was not influenced by tumor stage (WBB scale) and tumor etiology.
}