ROLE OF TOTAL EN BLOC SPONDYLECTOMY (TES) IN SOLITARY METASTASIS OF THORACO-LUMBAR SPINE SECONDARY TO RENAL CELL CARCINOMA

Abstract

Introduction: The conventional approach to spinal malignancy is via intralesional piecemeal resection but the incidence of local recurrence after surgery has been increasing as survival of patients getting prolonged due to advance adjuvant treatment TES is devised to minimize the incidence of local recurrence in malignant spinal tumours. The purpose of this study is to analyse whether the radical procedure like TES is justifiable in solitary metastasis or not

Material & Methods: We analysed 6 patients who undergone surgery for metastases of spine secondary to renal cell carcinoma between1996 and 2005 out of which 4 had TES for solitary intraosseous thoracolumbar lesion. They include three men and one woman ranging an age from 51 to 64 years. Common presenting complaints were intractable back pain dependent on opiates and progressive neural deficit. Four patients had localised intraosseous thoraco-lumbar lesion. The extent of spinal lesion was assessed with X-rays, CT scans and MRI for all patients. All patient’s prognosis was analysed by Tokuhasi Scoring System.3 patients had pre-op embolisation.4 patients with solitary intra-osseous metastasis underwent radical surgery in the form of total vertebrectomy and 3- column stabilisation of spine. Total surgical time was between 9–13 hrs and total blood loss between 4–11 Litres.

Results: None of the patients had surgery related major complication. No external brace used for mobilisation. The surgical outcome assessed by the pain, severity of paresis and the ability to walk before and after surgery. All patients followed up regularly to detect local tumour recurrences and position of implant. None of the patients with TES shown signs of local recurrence The follow up period for the surviving patients ranged from 9 to 32 months after TES. One patient died 9 month post-op due to widespread metastasis.

Conclusion: TES offers the most aggressive mode of treatment for the solitary metastasis of Thoraco-Lumbar spine secondary to Renal Cell Carcinoma. Considering the technical demands and potential risks of TES, the indication for TES with spinal metastasis should be limited to the cases with solitary intra-osseous lesions in malignancies with good prognosis.