En-bloc spondylectomy at the thoracolumbar junction for primary and metastatic spinal tumors: indications, outcomes and complications in a consecutive series of 22 patients.

PURPOSE: En bloc spondylectomy at the thoracolumbar junction represents one of the most demanding procedures in oncological spine surgery, with significant morbidity. The present study aims to evaluate clinical and oncological results of a series of patients who underwent en-bloc spondylectomy at the thoracolumbar junction.

METHODS: A retrospective review was conducted on 22 patients at a single referral center. Demographic, clinical, surgical, pathological, and outcome data were collected. Survival analyses were performed using the Kaplan-Meier method.

RESULTS: The cohort included 22 patients, mean age 49 years. Pain was the predominant symptom (95.5%), and 7 patients (31.8%) presented with pathological fractures. Neurological function was preserved in most cases (ASIA E, 77.3%). A posterior-only approach was used in 15 cases (68.2%), while combined approaches were required in the remainder. Mean operative time was 499 min, and mean blood loss 2,198 mL, both correlating with the number of levels resected. Margins were intralesional in 10 cases (45.5%), marginal in 6 (27.3%), and wide in 6 (27.3%). Early complications occurred in 12 patients (54.5%), late complications in 3 patients (13.6%). Local recurrence developed in 2 patients (9.1%), one with intralesional margins and one with wide resection. At median follow-up of 26 months, 5-year local recurrence-free survival was 88.1%, metastasis-free survival 81.9%, disease-free survival 81.9%, and overall survival 64.1%.

CONCLUSION: En bloc resection at the thoracolumbar junction achieves satisfactory oncological control but carries high morbidity. Marginal margins, particularly at the dural interface, appear oncologically adequate, whereas intralesional resections remain strongly associated with recurrence.