Major complications after total en bloc spondylectomy with high-dose radiation therapy for spinal metastasis: A case report and review of literature

Abstract

Background: Radiation therapy is indicated for spinal metastasis of renal cell carcinoma. However, High-dose radiation therapy can increase the complication rates after spinal metastasectomy. The complications after spinal metastasectomy with high-dose radiation therapy are difficult to manage.Case description: A 60-year-old man was diagnosed with renal cell carcinoma and treated with chemotherapy and nephrectomy. For solitary metastasis from T12 to L1, two courses of radiation therapy comprising a total of 70-Gy was performed, however the treatment was ineffective at his previous hospital. He was referred to our institute, we performed total en bloc spondylectomy for spinal metastasis. After the surgery, delayed wound healing occurred associated with radiation therapy and was treated with Prostaglandin E1 administration. Pain relief and neurologic recovery was achieved after the surgery. However, cage subsidence and rod breakage, subsequent pin-hole skin defect were observed three years after surgery. We performed anterior-posterior spinal reconstruction and latissimus dorsi muscle flap. The patient was pain-free with normal neurologic function, and no evidence of recurrence at 13-year follow-up. For the instrumentation failure and skin problems associated with radiation therapy, we carried out salvage surgery with additional spinal reconstruction and muscle flap. Conclusions: Even after high-dose radiation therapy, curative resection of solitary metastasis might be managed for selective RCC patients because long term survival is expected.

Keywords

• High dose radiation therapy
• Total en bloc spondylectomy
• Instrumentation failure
• Skin problems
• Latissimus dorsi muscle flap