Multilevel En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine Is Challenging But Rewarding

Abstract

Background Over the years, en bloc spondylectomy has proven its efficacy in controlling spinal tumors and improving survival rates. However, there are few reports of large series that critically evaluate the results of multilevel en bloc spondylectomies for spinal neoplasms. Questions/purposes Using data from a large spine tumor center, we answered the following questions: (1) Does multilevel total en bloc spondylectomy result in acceptable function, survival rates, and local control in spinal neoplasms? (2) Is reconstruction after this procedure feasible? (3) What complications are associated with this procedure? (4) is it possible to achieve adequate surgical margins with this procedure? Methods We retrospectively investigated 38 patients undergoing multilevel total en bloc spondylectomy by a single surgeon (AL) from 1994 to 2011. Indications for this procedure were primary spinal sarcomas, solitary metastases, and aggressive primary benign tumors involving multiple segments of the thoracic or lumbar spine. Patients had to be medically fit and have no visceral metastases. Analysis was by chart and radiographic review. Margin quality was classified into intralesional, marginal, and wide. Radiographs, MR images, and CT scans were studied for local recurrence. Graft healing and instrumentation failures at subsequent followup were assessed. Complications were divided into major or minor and further classified as intraoperative and early and late postoperative. We evaluated the oncologic status using cumulative disease-specific and metastases-free survival analysis. Minimum followup was 24 months (mean, 39 months; range, 24-124 months).

Primary vascular bone tumors in the spine: a challenge for pathologists and spine oncology surgeons

“…A second example of Epithelioid Hemangioendothelioma (arising in T12) that showed mature vessel lumen formation, in addition to intracytoplasmic vacuoles on hematoxylin and eosin (c ×200 of magnification) associated with a strong nuclear reactivity for TFE3 antibody (d ×200 of magnification). TFE3 and CAMTA1 markers are specific of Epithelioid Hemangioendothelioma and are mutually exclusive need of relevant anatomical structures sacrifice to achieve appropriate oncological margins [14,15].…”

Three Level Thoracolumbar Spondylectomy for Recurrent Giant Cell Tumour of the Spine: A Case Report

“…Luzzati reported a series of 13 out of 38 cases operated for spondylectomy which had intra-operative dura tear with three requiring revision surgery for the leak. He had 14 major complications and 22 minor complication in his series 3 . Post-operative complications following dura tear include postural headache, nausea, vomiting, pain or tightness in the neck or back, dizziness, diplopia due to VI cranial nerve paresis and tinnitus.…”

Loss of Local Tumor Control After Index Surgery for Spinal Metastases: A Prospective Cohort Study

“…27 In another study from the group of Tomita, 10 patients with spinal metastases for which en bloc spondylectomy was performed, had no recurrences after 10 years of follow up. 28 Complication rates for en bloc spondylectomy vary widely 14,24,29,30 and partially depends on surgeons' caseload and expertise. Whether more radical surgical removal of metastatic spinal lesions affects survival is unclear; a different question is whether en bloc resection might lower the rate of LLC.…”