Surgical management of recurrent thoracolumbar spinal sarcoma with 4-level total en bloc spondylectomy: description of technique and report of two cases

Druschel, Claudia; Disch, Alexander C.; Melcher, I.; Engelhardt, Timm Oliver; Luzzati, Alessandro; Haas, Norbert; Schaser, K.-D.

doi:10.1007/s00586-011-1859-6

Cited by 32 publications

(23 citation statements)

References 15 publications

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“…Thirty-one patients (81%) were alive without any evidence of disease. Other case series and case reports in the literature have also shown total en bloc spondylectomy to be effective in increasing patient survival and preventing local recurrences [1,3,5,6,8,9,13,14,20] (Table 2). Boriani et al [1], in their study of 33 patients undergoing multilevel en bloc spondylectomy, had a disease-free survival rate of more than 50%.…”

Section: Discussionmentioning

confidence: 93%

“…All living patients recovered from their complications at final followup. In the literature, the majority of patients treated with multilevel en bloc spondylectomy recover from their complications [3,6,8,9,14,20]. Multilevel en bloc resections are technically more demanding and morbid, owing to the proximity of neurovascular structures, visceral organs, need for an anterior and posterior approach, and increased blood loss and surgical time, thus increasing the risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…It becomes further challenging when the tumor involves multiple levels and visceral structures. There are a few reports in the literature on multilevel en bloc procedures, although most are case reports and small series [1,3,5,6,8,9,13,14,20].…”

Section: Introductionmentioning

confidence: 99%

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

Luzzati

Shah

Gagliano

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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).

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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

Luzzati

Shah

Gagliano

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Combined, single-stage anterior-posterior approaches are associated with an increase of perioperative morbidity, especially in patients with poor medical conditions due to cardiopulmonary diseases [20]. However, spinal cord decompression and fusion in these patients is increasingly performed [5] to improve or retain neurological function, improve quality of life and to reduce pain, preferably by minimizing surgical invasiveness.…”

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confidence: 99%

360-degree osteosynthesis via a posterolateral transpedicular approach in high-risk patients

et al. 2012

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Purpose Patients requiring anterior-posterior thoracic spine stabilization and suffering from concomitant cardiopulmonary disease are at increased risk to develop procedure-related complications. In order to reduce cardiopulmonary complications, the efficacy of a posterolateral transpedicular approach for 360-degree fusion was investigated. Methods Fourteen consecutive patients presenting with spinal cord compression from osteoporotic, metastatic and tuberculotic fractures were treated. Spinal cord decompression was achieved by laminectomy, facetectomy and corpectomy with subsequent posterior instrumented fusion using a screw-rod system. Results The procedure was successfully performed in 14 high-risk patients. Preoperatively, all patients presented with thoracic and lower back pain and nine patients with a paraparesis (Frankel grade C). The implants were introduced monoportally or biportally. In all cases, neurological symptoms moderately improved. Conclusion The posterolateral transpedicular approach might be a safe, less-invasive and efficient alternative to anterior-posterior fusion. However, biomechanic efficacy and long-term outcome as compared to the transthoracic technique remains to be studied in a larger patient cohort.

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“…All these lead to surgical management of recurrent spinal tumours difficult. As described by Boriani et al, local recurrence is the worst complication in the management of spine tumours because this significantly affects quality of life and prognosis (15,16). Multilevel en bloc spondylectomy up to 4 levels have been described with good functional outcome and low recurrence rates for primary malignant and benign aggressive tumours and recurrent tumours of these.…”

mentioning

confidence: 99%

Solitary vertebral metastasis of primary clear cell carcinoma of the liver: a case report and review of literature

Maharajan¹,

Hey²,

Tham³

et al. 2017

J. Spine Surg.

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Primary clear cell carcinoma of liver (PCCCL) is an uncommon variant of primary hepatocellular carcinoma.Though the literature describes a better prognosis in relation to the proportion of clear cells in the tumour when compared to the other variants, there is no general consensus in the management due to its rarity and unclear clinicopathological and prognostic factors. There is dearth of evidence with regard to the metastasizing nature of PCCCL and its management. In addition, the management of recurrent spinal tumours both primary and metastatic is not clear as the available evidence is mostly based on case reports.We describe an unusual presentation of PCCCL with solitary spinal metastasis and further complicated by tumour recurrence in a 71-year-old male. Such presentation has never been described before. He presented with low back pain and incomplete neurological deficits involving both lower limbs. On detailed evaluation, he was found to have a solitary metastasis at L3 vertebra secondary to PCCCL. He underwent radical excision of tumour and reconstruction for the solitary metastasis at L3 vertebral body and trans arterial chemo embolisation (TACE) for the hepatic lesion. Pt was asymptomatic until 9 months post operatively when he developed tumour recurrence at L3 vertebra. Patient subsequently underwent 2 stage palliative surgery followed by radiotherapy and chemotherapy. At his latest follow-up (1 year), the patient's overall general condition has improved with residual neurological deficits in the lower limb. PCCCL is a rare type of hepatocellular carcinoma which can present as "solitary metastasis" to the spine. Although the literature suggests a good prognosis for this histological type, this case did not have a good outcome. In addition to providing information for the management of similar cases in the future, this case report highlights that every patient has to be managed on a case-by-case basis.

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Surgical management of recurrent thoracolumbar spinal sarcoma with 4-level total en bloc spondylectomy: description of technique and report of two cases

Cited by 32 publications

References 15 publications

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

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

360-degree osteosynthesis via a posterolateral transpedicular approach in high-risk patients

Solitary vertebral metastasis of primary clear cell carcinoma of the liver: a case report and review of literature

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