En bloc spondylectomy for spinal metastases: a review of techniques

Yao, Kevin C.; Boriani, Stefano; Gokaslan, Ziya L.; Sundaresan, Narayan

doi:10.3171/foc.2003.15.5.6

Cited by 92 publications

(38 citation statements)

References 22 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the indication of TES for spinal metastasis still remained controversial [18,19]. Interestingly, there were more cases with metastasis underwent TES than that with primary tumors in literature [1,2,4,5,8,17,18,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

Huang

Chen

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

Purpose The objectives of this study were to describe our surgical management with a modified total en bloc spondylectomy (TES) and to evaluate the clinical effects in patients with thoracolumbar tumors. Methods Sixteen consecutive patients with thoracolumbar neoplasms underwent a modified TES via single posterior approach followed by dorsoventral reconstruction from December 2008 to July 2011. Details of the modified technique were described and the patients' clinical information was retrospectively reviewed and analyzed. Results Significant improvements in neurological function were achieved in most of the patients. Local pain or radicular leg pain was relieved postoperatively. The mean operation time was 7.2 h, with an average blood loss of 2,300 ml. No major complications, instrumentation failure or local recurrence was found at the final follow-up. Five patients died of the disease during mean 14-month (3.0-23) follow-up. Conclusions The modified TES with a single posterior approach is feasible, safe and effective for thoracolumbar spine tumors.

show abstract

Section: Discussionmentioning

confidence: 99%

Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

Huang

Chen

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…The previously described techniques were modified [7,32,37,58,59], prognostic surgical scores [56,57,60,61] were established considering the underlying tumor biology, the number/presence of extraspinal metastases and an estimation of life expectancy. With the results of these scores and the tremendous advance in spine surgery technique the indication from primary spinal tumors is now extended to selected cases of solitary spinal metastases with biologically favorable tumor entities [1,54,62,70]. Thanks to advances in tumor screening and diagnostics, the number of patients who may benefit from this extensive surgical treatment continues to increase.…”

Section: Discussionmentioning

confidence: 99%

“…Thanks to advances in tumor screening and diagnostics, the number of patients who may benefit from this extensive surgical treatment continues to increase. Various authors have shown that en bloc spondylectomy, combined with multimodal therapies, can effectively reduce local recurrency rates and markedly prolong overall long-term survival [37,53,54,61,70]. However, to provide an acceptable patient outcome and quality of life, the basic knowledge of short-and long-term postoperative implant stability is a mandatory tool to carry into surgery.…”

Section: Discussionmentioning

confidence: 99%

“…As an alternative treatment, en bloc spondylectomy of spinal malignancies has attracted growing interest. It circumvents direct exposure of the tumor tissue and enables the surgeon to reach wide resection margins of the spine [8,18,20,32,35,46,48,51,52,[58][59][60]70]. For selected patients, the en bloc resection is expected to decrease local recurrence rates and improve the patient's chances of overall survival.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

et al. 2008

View full text Add to dashboard Cite

Wide surgical margins make en bloc spondylectomy and stabilization a referred treatment for certain tumoral lesions. With a total resection of a vertebra, the removal of the segment's stabilizing structures is complete and the instrumentation guidelines derived from a thoracolumbar corpectomy may not apply. The influence of one or two adjacent segment instrumentation, adjunct anterior plate stabilization and vertebral body replacement (VBR) designs on post-implantational stability was investigated in an in-vitro en bloc spondylectomy model. Biomechanical in-vitro testing was performed in a six degrees of freedom spine simulator using six human thoracolumbar spinal specimens with an age at death of 64 (±20) years. Following en bloc spondylectomy eight stabilization techniques were performed using long and short posterior instrumentation, two VBR systems [(1) an expandable titanium cage; (2) a connected long carbon fiber reinforced composite VBR pedicle screw system)] and an adjunct anterior plate. Testsequences were loaded with pure moments (±7.5 Nm) in the three planes of motion. Intersegmental motion was measured between Th12 and L2, using an ultrasound based analysis system. In flexion/extension, long posterior fixations showed significantly less range of motion (ROM) than the short posterior fixations. In axial rotation and extension, the ROM of short posterior fixation was equivalent or higher when compared to the intact state. There were only small, nonsignificant ROM differences between the long carbon fiber VBR and the expandable system. Antero-lateral plating stabilized short posterior fixations, but did not markedly effect long construct stability. Following thoracolumbar en bloc spondylectomy, it is the posterior fixation of more than one adjacent segment that determines stability. In contrast, short posterior fixation does not sufficiently restore stability, even with an antero-lateral plate. Expandable verses nonexpandable VBR system design does not markedly affect stability.

show abstract

“…Interpretation of these striking differences included less violation of the tumor border, minimized tumor cell contamination and decreased tumor tissue derived blood loss. Application of these principles on solitary spinal metastatic disease have reinforced the concept of aggressive surgical treatment in selected patients, with biologically favorable cancers, who have the potential of long-term survival [3,28,39]. Despite conclusive evidence for significantly improved survival is missing to date, Sundaresan et al have shown that among 80 patients with solitary spinal metastases who underwent gross resection of tumor by various techniques, the rate of locoregional recurrences for the entire series was 32%, whereas only 17% of the patients who underwent en bloc resection experienced local recurrence [28].…”

Section: Discussionmentioning

confidence: 99%

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

Melcher

Disch

Khodadadyan-Klostermann

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

Primary malignant spinal tumors and solitary vertebral metastases of selected tumor entities in the thoracolumbar spine are indications for total en bloc spondylectomy (TES). This study aimed to describe our oncological and surgical management and to analyze the treatment results by management with TES for extra-and intracompartmental solitary spinal metastases and primary malignant vertebral bone tumors. In 15 patients (3 malignant bone tumors and 12 solitary metastases), tumors were distributed in the thoracic (n = 8) and lumbar (n = 7) spine. Tumors were classified as intra-(n = 8) and extracompartmental (n = 7). All patients underwent TES via a laterally extended posterior approach followed by dorsoventral reconstruction. Function and quality of life were assessed by Oswestry disability index (ODI) and SF-36 score. At follow-up (100%; mean: 33 ± 22 months), 11 patients had no evidence of disease. Two patients were alive with the disease and two were dead of the disease (no primary bone tumors). Histology revealed negative margins (R0) in all patients with wide (n = 11) and marginal (n = 4) resections. Two patients developed pulmonal metastases of which they died at 4 and 16 months of survival. No local recurrence was observed. Major complications did not occur. TES resulted in an acceptable outcome in the quality of life and function. TES is a demanding procedure reaching wide to marginal resections in a curative approach. In conjunction with multimodal therapies, local recurrences can effectively be prevented while control of distant disease needs to be improved. Proper selection of adequate patients combined with careful surgical planning are prerequisites for low complication rates, acceptable function and improved overall prognosis.

show abstract

En bloc spondylectomy for spinal metastases: a review of techniques

Cited by 92 publications

References 22 publications

Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

Contact Info

Product

Resources

About