Outcome and complications of reconstruction of the thoracolumbar spine for vertebral tumours

Forty-six patients with progressive neurological deficits or severe pain underwent subtotal vertebrectomy and resection of thoracic and lumbar vertebral tumours. Following subtotal vertebrectomy, 22 spinal segments were reconstructed with titanium mesh cylinders, 13 with allograft struts, 7 with methyl methacrylate, one with autograft bone, and 2 patients underwent spinal reconstruction with miscellaneous materials, In one:patient, 40 mm cancellous screws and a titanium mesh cylinder filled with methyl methacrylate were used. Following the reconstruction, 34 patients underwent stabilisation with anterior plates, and 5 patients with posterior rods and pedicle screws. No instrumental fixation was used in 7 patients. Postoperatively, 9 patients who had severe pain but no preoperative neurological deficits remained neurologically intact. Of 33 patients with preoperative incomplete deficit (Frankel grades C and D), 14 improved, 18 were unchanged, and one was worse. Of 3 patients in Frankel grade B, 2 improved to grade C but did not recover ambulation and the third patient remained at Frankel grade B. Other complications included 2 perioperative deaths due to respiratory failure and coagulopathy, one postoperative deterioration, and optic neuropathy in one patient. Backed out screws were seen in 2 patients. Although spinal reconstruction and instrumentation systems allow for immediate stability and mobilisation, a significant perioperative morbidity warrants a careful patient selection. (C) 1999 Harcourt Publishers Ltd.