Surgery for Solitary Metastases of the Spine

Sundaresan, Narayan; Rothman, Arthur I.; Manhart, Karen; Kelliher, Kevin

doi:10.1097/00007632-200208150-00021

Cited by 228 publications

(130 citation statements)

References 27 publications

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“…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%

“…Surgical treatment had been prevented by the thoracolumbar spine's close proximity to the surrounding neurovascular structures, i.e., the aorta, caval vein, myelon and nerve roots. Therefore, an intralesional corpectomy by piecemeal resection was considered as the only feasible surgery [12,22,23,26,33,54,64,68] followed by anterior-posterior stabilization of the resulting segmental spinal defect. However, the overwhelming majority of these intralesional resection patients have shown a poor oncological outcome [17,44,64].…”

Section: Introductionmentioning

confidence: 99%

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En bloc spondylectomy reconstructions in a biomechanical in-vitro study

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

et al. 2008

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“…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

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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.

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“…A more aggressive approach has been taken by the oncologists and surgeons managing patients with spine metastases, and especially for solitary metastases has shown a favorable outcome [6]. These are due to improvement in the pain, maintenance of function, decrease in the recurrence and potential for improvement in the neurological status [7].…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic assisted en bloc resection of a spine tumor

et al. 2010

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Spine tumors are fairly common and the management is through a multimodality approach. Lesions of the thoracic and lumbar vertebrae have been treated with such extensive anterior and/or posterior approaches. The authors present a case of a 56-year-old lady with solitary T11 metastases from colonic carcinoma and a case of a 43-year-old lady with T5-T6 high-grade osteogenic sarcoma. The treatment consists of a wide vertebrectomy by posterior approach, after anterior release and sub-pleural dissection using a thoracoscopic approach. A thoracoscopic assisted anterior approach could reduce the duration and the morbidity of a vertebrectomy without affecting oncological management.

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Surgery for Solitary Metastases of the Spine

Cited by 228 publications

References 27 publications

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

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

Thoracoscopic assisted en bloc resection of a spine tumor

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