Complications of En Bloc Resections in the Spine

Bandiera, Stefano; Boriani, Stefano; Donthineni, Rakesh; Amendola, Luca; Cappuccio, Michele; Gasbarrini, A.

doi:10.1016/j.ocl.2008.10.002

Cited by 39 publications

(22 citation statements)

References 14 publications

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“…Anatomical complexity of the spine makes it technically demanding, and careful surgical planning according to the Enneking stage, and WBB system is of great importance [20]. Total en bloc spondylectomy is also considered to cause more complications than the other two surgical procedures in the spine, which have been widely discussed in the literature [33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Treatment and outcome of malignant giant cell tumor in the spine

Yin

Cheng

et al. 2015

J Neurooncol

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Malignant giant cell tumor (MGCT) in the spine is extremely rare and there is little published information regarding this subject in the literature. We attempted to correlate different treatment options and outcomes over time. A retrospective study of patients with spinal MGCT who were surgically treated in our center between 2006 and 2012 was performed. Overall, three surgical management strategies, including subtotal resection, piecemeal total resection, and total en bloc spondylectomy were applied. Postoperative radiotherapy was carried out in 4 cases. Clinical data and efficacy of surgical treatment strategy were analyzed via chart review. A total of 14 patients with spinal MGCT were included in the study. Three cases were diagnosed as primary MGCT (PMGCT), while the other 11 patients were secondary MGCT (SMGCT). The mean follow-up period was 41 (range 3-75) months. Recurrence was found in 7 patients after surgery in our center, while distant metastasis and death occurred in 4 and 6 cases, respectively. MGCT of bone is always a high-grade sarcoma with a poor prognosis and complete excision, while also preserving neural function, is recommended. In our study, patients who underwent total en bloc spondylectomy had significantly lower local recurrence rate for MGCT in the spine.

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Section: Discussionmentioning

confidence: 99%

Treatment and outcome of malignant giant cell tumor in the spine

Yin

Cheng

et al. 2015

J Neurooncol

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“…Bandiera et al reported complications for 72 of 134 patients who underwent en bloc resections for spinal tumors from 1990 through 2007. 4 Some of these complications were immediate, some were delayed, and some included death. Thus, although en bloc resection of primary spinal tumors might be the ideal treatment goal, it must be weighed against the associated complications from these radical procedures, especially for children.…”

Section: Discussionmentioning

confidence: 99%

Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up

Menezes¹,

Ahmed²

2014

PED

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Object Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. Methods: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010. Results Pathological lesions among the 23 patients were 4 aneurysmal bone cysts, 2 osteochondromas, 5 chordomas, 4 osteoblastomas, 3 fibrous dysplasias, 4 eosinophilic granulomas, and 1 Ewing's sarcoma. Clinical presentation consisted of neck pain (n = 23), headaches and occipital pain (n = 16), myelopathy (n = 8), and torticollis (n = 4). Selective angiography and coil embolization were undertaken for all patients with aneurysmal bone cysts and osteoblastomas, 2 patients with chordomas, 1 patient with fibrous dysplasia, and 1 patient with Ewing's sarcoma. Primary embolization treatment of radiation-induced aneurysmal bone cyst of the atlas showed complete reossification. Results of CT-guided needle biopsy were diagnostic for 1 patient with eosinophilic granuloma and 1 with Ewing's sarcoma. Needle biopsies performed before referral were associated with extreme blood loss for 1 patient and misdiagnosis for 2 patients. Surgery involved lateral extrapharyngeal, transoral, posterior, and posterolateral approaches with vertebral artery rerouting. Complete resection was possible for 9 patients (2 with osteochondroma, 3 with fibrous dysplasia, 2 with chordoma, and 2 with osteoblastoma). Decompression and internal fusion were performed for 3 patients with aneurysmal bone cysts. Of the 23 patients, 7 underwent dorsal fusion and 4 underwent ventral fusion of the axis body. Chemotherapy was necessary for the patients with eosinophilic granuloma with multifocal disease and for the patient with Ewing's sarcoma. There was no morbidity, and there were no deaths. All patients with benign lesions were free of disease at the time of the follow-up visit (mean ± SD follow-up 8.8 ± 1.1 years; range 2–18 years). Chordomas received proton or LINAC irradiation, and as of 4–15 years of follow-up, no recurrence has been noted. Conclusions Because most atlantoaxial tumors in children are benign, an intralesional procedure could suffice. Vascular control and staged resection are critical. Ventral transoral fusion or lateral extrapharyngeal fusion has been successful. Resection with ventral fusion and reconstruction are essential for vertebral body collapse. Management of eosinophilic granulomas must be individualized and might require diagnosis through needle biopsy.

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“…Definitive tumor resection for chordomas is limited by proximity to critical structures, technical constraints due to the pattern of local tumor growth morbidity associated with extensive en bloc resections and need for secondary reconstructive procedures [1,13,[15][16][17][18]. Local recurrence is recognized as the most important prognostic factor for long-term disease survival following initial resection [19].…”

Section: Clinical Outcome By Treatment Modalitymentioning

confidence: 99%

“…Although they can metastasize, their long-term outcomes are most dependent on the pattern of local recurrences that often require repeated surgical debulking and/or radiation therapy. Due to their poor ultimate prognosis and the potential for significant surgical morbidity especially at recurrence, most chordomas are treated by initial near total resection followed by post-operative radiation therapy [1][2][3][4]. Treatment failure following radiation therapy is often attributed to sub-optimal dosing due to adjacent critical neural structures like the optic chiasm or the brain stem [5].…”

Section: Introductionmentioning

confidence: 99%