En Bloc Resection of Thoracic and Upper Lumbar Spinal Tumors Using a Novel Rotation-Reversion Technique through Posterior-Only Approach.

Abstract

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy.

Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed.

Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6-74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm. The mean operation time and blood loss were 458.5 minutes (range, 220-880 minutes) and 3,146.2 mL (range, 1,000-6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery.

Conclusions: The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.