BACKGROUND Solitary spinal metastasis (SM) is one of the indications for total en bloc spondylectomy (TES). Conventional TES carries the risk of damage to the great vessels anterior to the vertebral column, mainly because of a lack of visualization of the anterior structures. In this study, we devised a modified standard TES technique to achieve direct visualization in a 1-stage posterior approach. METHODS Included in this study were patients ≥18 years old with solitary thoracic or lumbar SM who underwent the modified standard TES at our institution between January 2017 and October 2022. Patient data were retrospectively sourced from medical records, and patients had a minimum of 3 months of postoperative follow-up. RESULTS This study involved 71 East Asian patients (median age, 57 years; 34 males), comprising 38 patients with thoracic SM and 33 with lumbar SM. Lung cancer was the most common tumor histology. Fourteen patients (19.7%) experienced intraoperative complications; pleural rupture was the predominant complication, and there were no cases of injury to the spinal cord or great vessels. The median operative time was 305 minutes (range, 203 to 660 minutes). The median intraoperative blood loss was 1,000 mL (range, 400 to 4,000 mL). The median perioperative blood transfusion was 4 units (range, 0 to 12 units), and the median hospitalization duration was 17 days (range, 14 to 29 days). Additionally, 27 patients (38.0%) had acute (perioperative) complications. Seven patients were lost to follow-up. Significant clinical improvement was achieved 3 months postoperatively. Postoperative early and late complications were observed in 5 patients. Of the 64 patients with completed follow-up, 47 (73.4%) had negative surgical margins, and none received postoperative radiation therapy. Revision surgery for local tumor recurrence was performed in 4.7% of patients. The median follow-up was 31.5 months (range, 3 to 81 months). CONCLUSIONS Our modified standard TES was demonstrated to be a safe and effective surgical technique for solitary thoracolumbar SM. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

---

改良标准全整块脊椎切除术治疗孤立性胸椎或腰椎转移瘤：直接可视化下的一阶段后路手术。


背景孤立性脊柱转移瘤（SM）是全整块脊柱切除术（TES）的适应症之一。传统 TES 存在脊柱前大血管损伤的风险，主要是因为缺乏前部结构的可视化。在本研究中，我们设计了一种改进的标准 TES 技术，以在一阶段后路方法中实现直接可视化。方法 本研究纳入 2017 年 1 月至 2022 年 10 月期间在本机构接受改良标准 TES 的年龄≥18 岁的孤立性胸椎或腰椎 SM 患者。患者数据回顾性来源于医疗记录，患者至少接受了 3 个月的治疗的术后随访。结果 本研究涉及 71 名东亚患者（中位年龄 57 岁；34 名男性），其中 38 名胸部 SM 患者，33 名腰椎 SM 患者。肺癌是最常见的肿瘤组织学。 14 名患者（19.7%）出现术中并发症；胸膜破裂是主要并发症，无脊髓或大血管损伤病例。中位手术时间为 305 分钟（范围为 203 至 660 分钟）。术中失血量中位数为 1,000 mL（范围为 400 至 4,000 mL）。围手术期中位输血量为 4 单位（范围为 0 至 12 单位），中位住院时间为 17 天（范围为 14 至 29 天）。此外，27 名患者 (38.0%) 出现急性（围手术期）并发症。七名患者失访。术后3个月，临床效果显着改善。 5例患者出现术后早期和晚期并发症。在完成随访的 64 名患者中，有 47 名（73.4%）的手术切缘为阴性，并且没有人接受术后放射治疗。 4.7% 的患者因局部肿瘤复发而进行了修复手术。中位随访时间为 31.5 个月（范围为 3 至 81 个月）。结论 我们的改良标准 TES 被证明是治疗孤立性胸腰椎 SM 的一种安全有效的手术技术。证据级别 治疗级别 IV。有关证据级别的完整描述，请参阅作者须知。