Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background

Tomita, Katsuro; Kawahara, Norio; Murakami, Hideki; Demura, Satoru

doi:10.1007/s00776-005-0964-y

Cited by 252 publications

(221 citation statements)

References 37 publications

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“…Because SFT/ HPCs, especially grade III, have the character of local infiltration, the local recurrence rate will be high if surgery is inadequate [4,8,10]. The surgical procedures applicable to the spinal column include the simplest subtotal resection, piecemeal total spondylectomy, and the most complex TES [17,[24][25][26]. In our retrospective review of these cases, it appeared that subtotal resection led to a high rate of tumor recurrence.…”

Section: Discussionmentioning

confidence: 98%

Surgical management of spinal solitary fibrous tumor/hemangiopericytoma: a case series of 20 patients

et al. 2017

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recurrence being 36.6 (median 28, range 12-73) months. Our results indicate that grade III is an adverse prognostic factor for both recurrence and over survival (OS) for spinal osseous SFT/HPC, while total resection, especially TES, is a positive prognostic factor. Conclusions Spinal osseous SFT/HPC is a challenging clinical entity given its high local recurrence rate. Surgical management plays a crucial role in the whole treatment of spinal SFT/HPCs and total excision, especially TES, should be strived for whenever possible. Postoperative radiotherapy is recommended to lower the recurrent rate. This study also confirms that pathology grade III is an adverse prognostic factor for spinal osseous SFT/HPCs.

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Section: Discussionmentioning

confidence: 98%

Surgical management of spinal solitary fibrous tumor/hemangiopericytoma: a case series of 20 patients

et al. 2017

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“…Since then, an increasing number of surgeons have performed and modified this procedure in order to apply the principles of tumor surgery [8] to the spine: attain wide resections, achieve long term local and systemic tumor control. 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].…”

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%

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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“…2,12 In the case of a solitary vertebral metastasis, this can be achieved through total or subtotal spondylectomy. 13 Palliation is also an important role for the surgical management of spinal metastases. Improvements in approaches and anesthesia management have resulted in reduced morbidity.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Surgical Treatment of Metastatic Spinal Tumors

Meyer¹,

Singh²,

Jenkins³

2010

Mount Sinai J Medicine

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Spinal metastases represent a significant cause of morbidity in patients diagnosed with malignancies. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. The treatment paradigm for spinal metastases involves a cohesive multidisciplinary approach that allows treatment plans to be made in the context of a patient's overall condition. There have been significant advances in the surgical treatment of spinal metastases that can significantly improve a patient's quality of life. demonstrated that vertebral metastases are found in as many as 30% of patients with malignancies. 2 Spinal metastases are most commonly seen, in decreasing order of incidence, from primary lung, prostate, kidney, liver, gastric, and colon cancers in males and primary breast, lung, uterine, thyroid, and gastric cancers in females. 3 In addition, there is a significant contribution from hematogenous disorders such as lymphoma and multiple myeloma. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. 4 Magnetic resonance imaging is the diagnostic modality of choice in the diagnosis of spinal metastases, with a sensitivity of 93% and a specificity of 97%. 5 Additional information regarding the extent of bone destruction and alignment can be obtained with computed tomography of the spine.We have found that a cohesive multidisciplinary approach to the treatment of metastases to the spine can improve outcomes as it brings the treating physicians together and allows plans to be made in the context of the patient's overall condition. The initial evaluation should involve a thorough history, including any prior history of malignancy. In some cases, symptoms related to spinal metastases are the first signs of malignancy, and a thorough metastatic workup, including standard X-rays, computed tomography of the chest, abdomen, and pelvis, positron emission tomography, and bone scans, is often necessary to identify the primary tumor. In addition, blood dyscrasias such as multiple myeloma and lymphoma need to be considered, and this requires further laboratory studies of the blood and possibly cerebrospinal fluid. Treatment paradigms involve close collaboration between the medical oncologist, radiation oncologist, and spine surgeon. The pathology of the primary tumor is important in determining the patient's life expectancy, sensitivity to adjuvant treatments, and likelihood of achieving systemic control.

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Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background

Cited by 252 publications

References 37 publications

Surgical management of spinal solitary fibrous tumor/hemangiopericytoma: a case series of 20 patients

Surgical management of spinal solitary fibrous tumor/hemangiopericytoma: a case series of 20 patients

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Surgical Treatment of Metastatic Spinal Tumors

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