Reoperation for spinal tumors at the cervicothoracic junction

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Objective To investigate the causes and operative technique of reoperation for spinal tumors at cervicothoracic junction.Methods The records of 14 consecutive patients underwent reoperation between July 2000 and January 2008 were retrospectively studied.Pathological types included chondrosarco-ma in 5 cases,giant cell tumor in 5,and hemangiosarcoma,invasive osteoblastoma,chromaffinoma,aneurys-mal bone cyst in 1 case,respectively.There were mono-segment spondylectomy in 6 cases,di-segments in 2and tri-segments in 3 cases.Eleven patients underwent tumor resection through combined anterior and poste-rior approach,while 1 case had mono-segment spondylectomy and 2 cases had di-segments spondylectomy through a posterolateral approach.Tumor resections had accomplished in one stage for all cases exeept that 2cases of tri-segments spondylectomy were performed in two-stage.Anterior reconstruction was achieved by titanium mesh filled with bone graft or bone cement plus locking screw-plate system or single rod fixation while screw-rod system was used for posterior reconstruction.The patient with hemangiosarcoma accepted chemotherapy and local radiotherapy,while other patients received local radiotherapy as adjuvant therapy af-ter reoperation.Results Local pain relieved and neurofunction improved in all patients in various degrees.Postoperative complications included leakage of cerebral spinal fluid in 3 cases healed by drainage and dressing,Horner syndrome in 2 cases and transient hoarse voice in 1 case recovered 2 to 5 weeks after op-eration.All patients were followed up from 18 months to 9 years.Seven cases developed local recurrence 12to 22 months after reoperation.Among them,5 cases died 30-38 months after reoperation while 2 cases were alive with tumor lesion.Conclusion The influencing factor of local recurrence includes pathological type of tumor,resection fashion and relative adjuvant therapy.Operative rationale and resection fashion are crucial for surgical therapy.The opportunity of first operation should be cherished.Gross radical resection and post-operative adjuvant therapy according to pathology is necessary.Reoperation has higher risk and is more dif-ficult.Care should be taken to protect anatomical structures to prevent the occurrence of complications. Key words: Cervical vertebrae; Thoracic vertebrae; Spinal neoplasms; Reoperation