Motor function of the upper-extremity after transection of the second thoracic nerve root during total en bloc spondylectomy

Background: In total en bloc spondylectomy (TES) of upper thoracic spine including the second thoracic (T2) vertebra, T2 nerve roots are usually transected. In this study, we examined the association between transection of the T2 nerve roots and upper-extremity motor function in patients with upper thoracic TES. Copyright:Methods: We assessed 16 patients who underwent upper thoracic TES with bilateral transection of the T2 nerve roots. Patients were divided into three groups: 3 patients without any processing of T1 and upper nerve roots (T2 group), 7 with extensive dissection of T1 nerve roots (T1-2 group), and 6 with extensive dissection of T1 and upper nerve roots (C-T2 group). Postoperative upper-extremity motor function was compared between the groups.Results: Postoperative deterioration of upper-extremity motor function was observed in 9 of the 16 patients (56.3%). Three of the 7 patients in the T1-2 group and all 6 patients in the C-T2 group showed deterioration of upper-extremity motor function, but there was no deterioration in the T2 group. In the T1-2 group, 3 patients showed mild deterioration that did not affect their activities of daily living and they achieved complete recovery at the latest follow-up examination. In contrast, severe dysfunction occurred frequently in the C-T2 group, without recovery at the latest follow-up.Conclusions: The transection of the T2 nerve roots alone did not result in upper-extremity motor dysfunction; rather, the dysfunction is caused by the extensive dissection of the T1 and upper nerve roots. Therefore, transection of the T2 nerve roots in upper thoracic TES seems to be an acceptable procedure with satisfactory outcomes

Implantation of Liquid Nitrogen Frozen Tumor Tissue after Posterior Decompression and Stabilization for Metastatic Spinal Tumors

Study DesignA retrospective study.PurposeTo evaluate the immunity-enhancing effect of implantation of a liquid nitrogen-treated tumor.Overview of LiteratureWe have developed a new technique of implanting a tumor frozen in liquid nitrogen after posterior decompression and stabilization, with the aim of enhancing antitumor immunity in order to prolong the survival period of the patient. In the current study, the immunity-enhancing effect of this new technique has been evaluated.MethodsThe subjects were 19 patients in whom we had earlier performed decompression and stabilization between April 2011 and September 2013. The 19 subjects were divided into two groups, namely a frozen autologous tumor tissue implantation group (n=15; "implantation group"), which consisted of patients, who underwent implantation with autologous tumor tissue frozen in liquid nitrogen, and a control group (n=4), which consisted of patients, who did not undergo autologous cancer transplantation. To evaluate the immunity-enhancing effect of the protocol, plasma cytokines (interferon [IFN]-γ and interleukin [IL]-12) were analyzed before surgery and a month after surgery.ResultsThe mean rate of increase in IFN-γ was significantly higher in the implantation group (p=0.03). Regarding IL-12, no significant difference was observed between the groups, although the implantation group exhibited increased levels of IL-12 (p=0.22).ConclusionsDecompression and stabilization combined with autologous frozen tumor cell implantation can enhance cancer immunity in metastatic spinal tumor patients. It is hypothesized that this procedure might prevent local recurrence and prolong survival period

Invasiveness Reduction of Recent Total Spondylectomy: Assessment of the Learning Curve

Study DesignCase-control study.PurposeTo evaluate the surgical magnitude and learning curve of "second-generation" total en bloc spondylectomy (TES).Overview of LiteratureIn June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting.MethodsTES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups.ResultsMean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p<0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p<0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p<0.05). Postoperative creatine phosphokinase levels did not differ among the groups.ConclusionsTES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive

Motor function of the upper-extremity after transection of the second thoracic nerve root during total en bloc spondylectomy.

BACKGROUND: In total en bloc spondylectomy (TES) of upper thoracic spine including the second thoracic (T2) vertebra, T2 nerve roots are usually transected. In this study, we examined the association between transection of the T2 nerve roots and upper-extremity motor function in patients with upper thoracic TES. METHODS: We assessed 16 patients who underwent upper thoracic TES with bilateral transection of the T2 nerve roots. Patients were divided into three groups: 3 patients without any processing of T1 and upper nerve roots (T2 group), 7 with extensive dissection of T1 nerve roots (T1-2 group), and 6 with extensive dissection of T1 and upper nerve roots (C-T2 group). Postoperative upper-extremity motor function was compared between the groups. RESULTS: Postoperative deterioration of upper-extremity motor function was observed in 9 of the 16 patients (56.3%). Three of the 7 patients in the T1-2 group and all 6 patients in the C-T2 group showed deterioration of upper-extremity motor function, but there was no deterioration in the T2 group. In the T1-2 group, 3 patients showed mild deterioration that did not affect their activities of daily living and they achieved complete recovery at the latest follow-up examination. In contrast, severe dysfunction occurred frequently in the C-T2 group, without recovery at the latest follow-up. CONCLUSIONS: The transection of the T2 nerve roots alone did not result in upper-extremity motor dysfunction; rather, the dysfunction is caused by the extensive dissection of the T1 and upper nerve roots. Therefore, transection of the T2 nerve roots in upper thoracic TES seems to be an acceptable procedure with satisfactory outcomes

Case 1: A 49-year-old man with primary spinal tumor (angiosarcoma) at T2–4.

<p>A: Total en bloc spondylectomy (TES) was performed using a posterior-only approach. B: Bilateral T2–4 nerve roots were transected. C: No deterioration of upper-extremity motor function occurred after surgery.</p

Case 2: A 71-year-old man with metastatic renal cell carcinoma at C7–T2.

<p>A: Total en bloc spondylectomy (TES) was performed using a combined anterior and posterior approach. B: Bilateral T2 nerve roots ware transected and bilateral C8–T1 nerve roots ware circumferentially dissected to the extraforamen. C: Severe upper-extremity motor dysfunction persisted even 3 years after surgery.</p

Postoperative mean Japanese Orthopaedic Association (JOA) scores (+ <i>SD</i>) 4 weeks after surgery (A) and at the latest follow up (B).

<p>Patients who underwent upper thoracic TES with bilateral transection of the T2 nerve roots were divided into three groups: no processing of T1 and upper nerve roots (T2 group, <i>n</i> = 3), extensive dissection of T1 nerve roots (T1–2 group, <i>n</i> = 7), and extensive dissection of T1 and upper nerve roots (C–T2 group, <i>n</i> = 6). The C–T2 group showed significantly more severe deterioration than the other two groups, both 4 weeks after surgery and at the latest follow up (P = 0.001).</p

A schema of upper thoracic total en bloc spondylectomy; the T1 nerve roots are circumferentially dissected to the extraforamen and the T2 nerve roots are transected.

<p>A schema of upper thoracic total en bloc spondylectomy; the T1 nerve roots are circumferentially dissected to the extraforamen and the T2 nerve roots are transected.</p

Japanese Orthopaedic Association (JOA) scoring system for the evaluation of cervical myelopathy.

<p>Japanese Orthopaedic Association (JOA) scoring system for the evaluation of cervical myelopathy.</p