Total spondylectomy for primary tumor of the thoracolumbar spine

Abstract

Study Design: Six patients with primary malignant tumor of the thoracolumbar spine who underwent total spondylectomy (TS) by en bloc resection were reviewed retrospectively. Objectives: To report surgical technique and preliminary results of TS and to evaluate its oncological curability. Setting: Japan. Methods: Six patients were treated by TS by en bloc resection of the vertebral tumor. TS through a posterior approach was performed in three cases (T1 osteosarcoma, L1 osteosarcoma and L1 chordoma) and in the others through a single stage anterior and posterior combined approach (T6 ± 8 recurrent giant cell tumor, L4 chordoma and L5 giant cell tumor). Surgical margins of the specimens were evaluated histologically. All patients were followed, and their status was evaluated by clinical and imaging studies. Results: There were no complications related to surgery. Programmed sacri®ce of nerve roots were performed in three cases for oncologic excision. A wide surgical margin was achieved in one case, a marginal one in four, and an intralesional margin in one. Five patients were alive without evidence of tumor and one was alive with disease at follow-up evaluation after 2.0 ± 4.8 years. Local recurrence was found in one case of T1 osteosarcoma with an intralesional margin. Conclusions: These preliminary results suggested that TS is an eective procedure in control of local recurrence with acceptable complications. Spinal Cord (2000) 38, 146 ± 152

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

“…This study agrees with previous investigations [2,6,18,21,24,32,34,38] supporting en bloc spondylectomy for treatment of primary malignant vertebral bone tumors and solitary spinal metastasis of certain tumor entities. En bloc spondylectomy followed by dorsoventral reconstruction allowed radical resections with negative margins in all patients.…”

“…At a mean follow-up of 32 months, we had no local recurrence. In the series by Abe et al, local recurrence was found in three cases with a mean follow-up of 38 months [2]. The low recurrence rate in our study, with no reoperation required for local relapse, may be due to both, the consequent multimodality treatment concept and the negative resection margins in all patients.…”

Two-stage multilevel en bloc spondylectomy with resection and replacement of the aorta

“…Over the decades, this technique has been considered as a risky and technically highly demanding procedure that was reserved for limited indications in some specialized centers [5,10]. In 1994, Tomita, one of the pioneers in en bloc resection of the spine, published his series of 20 spondylectomies for solitary spinal metastases [11].…”

Total spondylectomy and circular reconstruction for L5 vertebral body chordoma using a telescopic lordotic cage

“…In recent years the following have been used: bicortical iliac crest grafts (Benoit et al 1990), allograft and anterior Goutallier plate (Boriani et al 1996), fibular allograft (Tomita et al 1997), tricortical iliac crest grafts (Bosma et al 2001), chest tube filled with methylmethacrylate (Marmor et al 2001) or an apatite-wollastonite glass ceramic vertebral prosthesis or a titanium mesh cage filled with iliac bone chips and augmented with Zielke or Kaneda instrumentation (Abe et al 2000(Abe et al , 2001, and mesh cages which have to be cut to obtain physiological regional lordosis. These devices are mostly not designed for L5 reconstruction and do not provide reliable primary stability.…”

“…After complete exposure of neural structures, the epidural part of the chordoma was removed. Its surface within the vertebral body was continuously covered with bone wax to prevent dissemination of tumor cells (Abe et al 2000). Finally, the posterior longitudinal ligament was horizontally transsected twice.…”