Spondylectomy for malignant tumors of the spine.

Sundaresan, Narayan; DiGiacinto, George V.; Krol, George; Hughes, James E. O.

doi:10.1200/jco.1989.7.10.1485

Cited by 105 publications

(47 citation statements)

References 9 publications

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“…14 The first attempts at total vertebrectomy consisted of peacemeal resection, often with a combined anterior and posterior approach. 2,5,15,17 An intralesional procedure was used to decompress the cord and stabilise the spine in order to regain function and quality of life while minimising the tumour mass. This met the criteria of a palliative procedure and would nowadays be accepted for the treatment of spinal metastases.…”

Section: Discussionmentioning

confidence: 99%

“…2 Of the 4767 lesions listed in the Vienna Bone Tumour Registry, 1715 were primary malignant tumours of which 44 were in the spine, 2.5% of all primary malignancies of bone.…”

mentioning

confidence: 99%

“…1 In contrast to metastases, primary malignant tumours affect the spine in only 1% to 2% of patients. 2 Of the 4767 lesions listed in the Vienna Bone Tumour Registry, 1715 were primary malignant tumours of which 44 were in the spine, 2.5% of all primary malignancies of bone.…”

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confidence: 99%

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Total vertebrectomy for primary malignant tumours of the spine

Krepler

Windhager

Bretschneider

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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Primary malignant tumours should be resected with wide margins. This may be difficult to apply to lesions of the spine. We undertook total vertebrectomy on seven patients, four males and three females with a mean age at operation of 26.5 years (6.3 to 45.8). The mean follow-up was 52.3 months. Histological examination revealed a Ewing's sarcoma in two patients and osteosarcoma, leiomyosarcoma, spindle-cell sarcoma, chondrosarcoma and malignant schwannoma in one each. In five patients, histological examination showed that a wide resection had been achieved. At follow-up there was no infection and a permanent neurological deficit was only seen in those patients in whom the surgical procedure had required resection of nerve roots. Despite the high demands placed on the surgeon and anaesthetist and the length of postoperative care we consider total vertebrectomy to be an appropriate procedure for the operative treatment of primary malignant lesions of the spine. Metastases in the spine are common and account for 40% to 60% of secondary osseous lesions. Surgical treatment involves intralesional or marginal resection and stabilisation in order to release the neural structures, provide relief from pain and allow walking.1 In contrast to metastases, primary malignant tumours affect the spine in only 1% to 2% of patients. 2 Of the 4767 lesions listed in the Vienna Bone Tumour Registry, 1715 were primary malignant tumours of which 44 were in the spine, 2.5% of all primary malignancies of bone.Adequate surgical treatment of primary malignant bone tumours of the limbs involves wide or radical resection in combination with neoadjuvant chemotherapy and, if responsive, radiotherapy. The aim of preoperative chemotherapy is to reduce the viable tumour mass and to prevent further dissemination. The combination of systemic and surgical treatment offers the patient a good chance of survival with a satisfactory quality of life.

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Section: Discussionmentioning

confidence: 99%

“…2 Of the 4767 lesions listed in the Vienna Bone Tumour Registry, 1715 were primary malignant tumours of which 44 were in the spine, 2.5% of all primary malignancies of bone.…”

mentioning

confidence: 99%

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Total vertebrectomy for primary malignant tumours of the spine

Krepler

Windhager

Bretschneider

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…Furthermore, we believe that the neurological morbidity associated with resection of spine tumors is minimal, apart from those instances in which a nerve root or dura mater has to be included as part of the resection for oncological purposes. [1][2][3][4][5]7,8,10,[12][13][14][16][17][18]20,22,23 Although the majority of spinal tumors involve the VB, other tumor patterns may also be observed. Purely posteriorly located lesions or those located laterally are candidates for en bloc resection.…”

Section: Rationale For the Proceduresmentioning

confidence: 99%

En bloc spondylectomy for spinal metastases: a review of techniques

Yao

Boriani

Gokaslan

et al. 2003

FOC

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Object Spinal metastases are prevalent in the population of patients with cancer. Effective cancer therapy must incorporate treatment strategies for these lesions. Increasingly, surgery is being recognized as an effective treatment modality both for the patient's quality of life and potential oncological cure. En bloc spondylectomy is the surgical procedure of choice to obtain these goals. The purpose of this study was to examine critically the rationale, indications, and outcomes of en bloc spondylectomy for spinal metastases. Methods Outcomes in the authors' series of patients who underwent en bloc spondylectomy for spinal metastases are critically analyzed. The rationale and indications for this procedure are discussed. The Weinstein, Boriani, and Biagini surgical staging system for spinal tumors is described. A review of the literature is performed to examine further the rationale underlying this aggressive surgical approach to metastatic spinal disease. Conclusions En bloc spondylectomy is the treatment of choice for solitary and oligometastatic spinal metastases with biologically favorable histological findings. In appropriately selected patients, neurological outcome, pain control, and oncological control are significantly better after en bloc spondylectomy compared with radiation therapy. Oncological outcomes also exceed those of intralesional techniques. The Weinstein, Boriani, and Biagini surgical staging system provides a standard with which to plan surgical approaches and to compare surgical outcomes.

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“…Fourteen were classified as possible for inclusion, but only five fully satisfied the two inclusion criteria (7)(8)(9)(10)(11). An additional 61 studies that met inclusion criteria were identified by a bibliography search.…”

Section: Evaluation Of the Datamentioning

confidence: 99%

Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review

Fisher¹

2010

Int J Oncol

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Abstract. The last decade has witnessed a dramatic change in management of metastatic spine disease, with an increased role for surgery and emerging use of stereotactic radiotherapy, often in combination. Patients may be treated with radiotherapy followed by surgery, or have surgery and then adjuvant radiotherapy. In both cases, the surgeon and oncologist need to select the optimal timing for surgery and radiotherapy to minimize wound complications while obtaining maximum oncolytic effects. The purpose of this review was to determine the optimal timing of surgery and radiotherapy in patients surgically treated for spinal metastases. A systematic review utilizing Medline, Embase, Paper First, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews was performed. References were screened to further identify relevant studies and basic science literature reviewed. A total of 46 reports discussing the timing of surgery after radiotherapy, describing experience in 5836 patients, were identified. Only one retrospective study addressed the research question and suggested that surgery within seven days of radiation increases the rate of postoperative wound complications. Timing of adjuvant radiotherapy following surgery was addressed in 51 reports describing 7090 patients. None of the studies specifically answered the research question. The time interval between radiotherapy and surgery was reported as 5-21 days in nine studies. Based on this systematic review together with the understanding of general principles of wound healing and effects of radiation on wound healing, the optimal radiotherapy-surgery/surgery-radiotherapy time interval should be at least one week to minimize wound complications.

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Spondylectomy for malignant tumors of the spine.

Cited by 105 publications

References 9 publications

Total vertebrectomy for primary malignant tumours of the spine

Total vertebrectomy for primary malignant tumours of the spine

En bloc spondylectomy for spinal metastases: a review of techniques

Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review

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