Systematic Analysis for the Reason of Revision-Surgery After Non-Total En Bloc Spondylectomy Open Surgery Among Spinal Metastatic Tumor Cases: A Retrospective Study.

Objective: This study examines patients with metastatic spinal disease undergoing non-total en bloc spondylectomy, focusing on revision surgery reasons and its effectiveness in treating spinal instability, neurological issues, and pain.

Methods: This study conducted a retrospective case series in a single center and included 344 patients with metastatic spinal tumor who underwent non-total en bloc spondylectomy open surgery between 2013 and 2021 and were followed up for ＞2 years.

Results: Of 344 patients, 20 (7.1%) had revision surgery due to delayed infection (n = 1), fixation loosening (n = 2), and tumor recurrence (n = 17). The revision group had lower rates of radiotherapy (35%) and long-segment fixation (45%) than the unrevised group (60.2%, 74%; P < 0.001). Decompression surgery had the highest revision rate (15.8%), followed by vertebrectomy (8.9%), separation surgery (4.7%), and hybrid surgery (2.3%). Postoperative scores and survival rates were improved in the revision group (median survival 32 vs. 11 months; P < 0.05).

Conclusions: Long-segment fixation with radiotherapy may reduce revision surgery need and extend the time between surgeries. Hybrid or separation surgeries lower the likelihood of revision. Revision surgery can relieve pain and improve neurological function. Patients in the revision group have longer survival times.