En Bloc Resection of Tumors of the Lumbar Spine: A Systematic Review of Outcomes and Complications.

Autor:	Jones M; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK., Alshameeri Z; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK zeiad@doctors.org.uk., Uhiara O; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK., Rehousek P; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK., Grainger M; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK., Hughes S; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK., Czyz M; Spinal Surgery Department, Royal Orthopaedic Hospital, Birmingham, UK.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2021 Dec; Vol. 15 (6), pp. 1223-1233.
DOI:	10.14444/8155
Abstrakt:	Background: The literature on total en bloc spondylectomy (TES) of bone tumors of the lumbar spine is sparse and heterogeneous. Therefore, the aim was to systematically pool the data from the published studies to quantitatively summarize the morbidity and mortality and to identify factors associated with favorable outcomes and complications. Method: A systematic literature search for studies with individual patient-level data was conducted using specific medical subject heading(MeSH) terms. The outcome measures assessed included complications, tumor recurrence, survival, and function. Individual patient data were pooled from all the studies and quantitatively analyzed to assess the association of different factors with outcomes and complications. Results: Twelve studies were included in this review with a total of 145 TES cases. Of all patients, 50% had at least 1 reported complication post surgery and this was associated with advancing age (OR 1.04, P < 0.001), metastatic disease (OR 5.61, P < 0.001), and adjuvant chemo and/or radiotherapy (OR 20.3, P = 0.001). Intralesional excision (OR 5.2, P = 0.01) and primary malignant tumors (OR 3.3, P = 0.02) were associated with a high recurrence rate. However, the surgical approach was not associated with differences in survival ( P = 0.874) or recurrence ( P = 0.525) rates. L5 tumor resection was associated with excessive bleeding. Postoperatively, there was an overall improvement in the Frankel grades in most patients. Conclusion: TES is associated with high rates of complications especially in association with primary malignant and metastatic diseases. However, the number of publications on this topic remain scarce and heterogeneous. Hence, there is a need for standardization in the reporting of the outcomes and complications to help with decision-making and consenting for this procedure. Competing Interests: Declaration of Conflicting Interests: The author(s) report no conflicts of interest or financial disclosures with respect to the research, authorship, and/or publication of this article. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)
Databáze:	MEDLINE
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