Stability reconstruction after resections of primary malignant tumors

杜 開 利(Du Kaili，ept Spine Surg，Sun Yat-sen Memo Hosp，Sun Yat-sen Univ，Guangzhou 510120)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－212～217

Stability reconstruction after resections of primary malignant tumors

杜 開 利(Du Kaili，ept Spine Surg，Sun Yat-sen Memo Hosp，Sun Yat-sen Univ，Guangzhou 510120)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－212～217

ObjectiveTo review the methods of the stability reconstruction after resections of primary malignant spinal tumors.MethodsFrom January 1999 to January 2009，38 cases of primary malignant spinal turmors underwent tumor removal including vertebrectomies in 16 segments of 13 cases，posterior arch resections in 8 segments of 7 cases，total spondylectomies in 12 segments of 11 cases and other types of resections in 7 cases.According to the different tumor excisions，various stability reconstructions were chosen such as veterbral body reconstruction，anterior vertebral body replacement with internal fixation，posterior pedicle screw fixation with bone grafting，or combinaion surgery.Bone graft for fusion，distance upper to lower endplate，failure of internal fixation were observed.Preoperative visual analogue scale(VAS)，Frankel neural function scores and SF-36 scores were compared between the last follow-up and preoperation/ResultsPatients were follwed up from 12 to 89 months with average 29.7 months.Six cases died during the follow-up period and 5 cases relapsed and performed sugery again.At the last follow up，VAS improved from 6.2 ± 2.2 to 1.8 ± 1.3(t= －17.080，P 0.000)，with excellent-to-good rate of pain relief 86.8%;Frankel neural function scores improved by one level in 21 cases，two levels in 8 cases，and one case had no improvement;SF-36 scores improved from 30.7 ± 7.2 to 58.3 ± 16.5(t=19.037，P=0.000).All of grafts were fused without graft fractures.Bone absorption happened in 5 cases.The endplate subsidence varied in different reconstructions.There was no serious neural impairment after operation.ConclusionReconstruction following excision of primary malignant spinal tumors based on WBB staging system and threecolumn theory，shows good fusion and stability，and then achieves satisfactory short-term and mid-term therapeutic effects.The location of tumors，prognosis and bone strength should be considered.15 refs，2 figs.

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