Total En Bloc Spondylectomy for Lumbar Spinal Tumors by Paraspinal Approach

World Neurosurg. (2018)120:28-35

OBJECTIVE: To report and describe a modified posterioronly
approach (paraspinal approach) for total en bloc
spondylectomy (TES) of lumbar spinal tumors.

METHODS: From February 2013 to June 2014, 5 patients
with lumbar spinal tumors who underwent TES through a
posterior-only paraspinal approach were studied retrospectively;
operative time, blood loss, complications,
neurologic outcomes, and degree of resection were
recorded to evaluate the efficacy of this surgical method.

RESULTS: Patients included 3 men and 2 women with a
mean age of 48.4 years (range, 46e52 years). Two lesions
were located in L2, 2 lesions were located in L3, and 1
lesion was located in L4. Three patients had solitary
metastatic tumors (lung cancer in 2 cases, breast cancer
in 1 case), and 2 patients had primary tumors (osteosarcoma
and plasma cell tumor). According to the surgical
classification of spinal tumors by Tomita et al., 4 cases
were type 4 and 1 case was type 1. Mean operative time
was 464 minutes (range, 420-510 minutes), and mean
blood loss was 1280 mL (range, 1000-1500 mL). One
patient had cerebrospinal fluid leakage, and 1 had transient
motor weakness because of nerve root traction.
Mean follow-up time was 20.6 months (range, 12e30
months), and all patients had improved or stable neurologic
function. No local recurrence was observed at last
follow-up.

CONCLUSIONS: The posterior-only paraspinal approach
is a valid alternative for TES of lumbar spinal tumors,
especially for overweight or muscular patients.