Abstract
En bloc spondylectomy is a technique that enables wide or marginal resection of malignant lesions of the spine. Both all posterior techniques as well as combined approaches are reported. Aim of the present study was to analyse the results of 21 patients with malignant lesions of the spine, all treated with en bloc excision in a combined posteroanterior (n = 19) or all posterior approach (n = 2). Twenty-one consecutive patients, operated between 1997 and 2005, were included into this retrospective study. Thirteen patients had primary malignant lesions, eight patients had solitary metastases, all located in the thoracolumbar spine. There were 16 single level, three two-level, one three-level and one four-level spondylectomy. The patients were followed clinically and radiographically (including CT studies) with an average follow-up of 4 years. Out of 11 patients with primary Ewing or osteosarcoma seven patients are alive without any evidence of disease. One patient died after 5 years from other causes and three are alive with evidence of disease. Latter had either a poor histologic response to the preoperative chemotherapy (n = 2) or an intralesional resection (n = 1). All three patients with solitary spinal metastases of Ewing or osteosarcoma died of the disease. Five patients with solitary metastases of mainly hypernephroma are alive. In total, six resections were intralesional, mainly due to large intraspinal tumor masses, with two patients having had previous surgery. In the remaining cases, wide (n = 10) or marginal (n = 5) resection was accomplished. There were one pseudarthrosis requiring extension of the fusion and two cases with local recurrences and repeated excisional surgery. At follow-up CT studies, all cages were fused. Health related quality of life analysis (SF-36) revealed only slightly decreased physical component and normal mental component scores compared to normals in those patients with no evidence of disease. En bloc spondylectomy enables wide or marginal resection of malignant lesions of the spine in most cases with acceptable morbidity. Intralesional resection, poor histologic response, and solitary spinal metastases of Ewing and osteosarcoma are associated with a poor prognosis.
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References
Bielack SS, Kempf-Bielack B, Delling G, Exner G, Flege S et al (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 1:776–790
Boriani S, Biagini R, DeLure F (1996) En bloc resections of bone tumors of the thoracolumbar spine. Spine 21:1927–1931
Boriani S, Chevally F, Weinstein J (1996) Chordoma of the spine above the sacrum. Spine 21:1569–1577
Boriani S, Weinstein J, Biagini R (1997) Primary bone tumors of the spine. Spine 22:1036–1044
Ellert U, Bellach B (1999) German national health survey 1998—description of an update random sampling test. Gesundheitswesen 61:S184–S190
Enneking WF (1980) A system of staging musculoskeletal neoplasms. Clin Orthop 204:9–24
Fidler MW (1994) Radical resection of vertebral body tumours. J Bone Joint Surg 76-B:765–772
Fisher C, Keynan O, Boyd M et al (2005) The surgical management of primary tumors of the spine. Spine 30:1899–1908
Juergens C, Weston C, Lewis I, Whelan J, Paulussen M et al (2006) Safety assessment of intensive induction with vincristine, ifosfamide, doxorubicin, and etoposide in the treatment of Ewing tumors in the EURO-Ewing 99 clinical trial. Pediatr blood cancer 47:22–29
Krepler P, Windhager R, Bretschneider W et al (2002) Total vertebrectomy for primary malignant tumours of the spine. J Bone Joint Surg 84-B:712–715
Mazel Ch, Grunenwald D, Laudrin P, Marmorat J (2003) Radical excision in the management of thoracic and cervicothoracic tumors involving the spine: results in a series of 36 cases. Spine 28:782–792
Oda I, Cunningham B, Abumi K et al (1999) The stability of reconstruction methods after thoracolumbar total spondylectomy. Spine 24:1634–1638
Ozaki T, Flege S, Liljenqvist U et al (2002) Osteosarcoma of the spine: experience of the cooperative osteosarcoma study group. Cancer 15:1069–1077
Roy-Camille R, Mazel Ch, Sailant G, Lapresle Ph (1990) Treatment of malignant tumors of the spine with posterior instrumentation. In: Sundaresan N, Schmidek HH, Schiller AL et al (eds).Tumors of the spine: diagnosis and clinical management. Saunders, Philadelphia, pp 473–487
Roy-Camille R, Mazel Ch (1991) Vertebrectomy through an enlarged posterior approach for tumors and malunions. In: Bridwell KH, De Wald RL (eds) The text book of spinal surgery. Lippincott, Philadelphia, pp 1245–1256
Roy-Camille R, Saillant G, Bisserie M, Judet T, Hautefort E, Mamoudy P (1981) Total excision of thoracic vertebrae. Rev Chir Orthop Reparatrice Appar Mot 67:421–430
Roy-Camille R, Saillant G, Mazel Ch, Monpierre H (1990) Total vertebrectomy as treatment of malignant tumors of the spine. Chir Organi Mov 75:94–96
Salzer-Kuntschik M, Brand G, Delling G (1983) Determination of the degree of morphological regression following chemotherapy in malignant bone tumors. Pathologe 4:135–141
Schuck A, Ahrens S, von Schorlemer I, Kuhlen M, Paulussen M et al (2005) Radiotherapy in Ewing tumors of the vertebrae: treatment results and local relapse analysis of the CESS and EICESS trials. Int J Radiat Oncol Biol Phys 63:1562–1567
Stener B (1971) Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg 53-B:288–295
Talac R, Yaszemski M, Currier B et al (2002) Relationship between surgical margins and local recurence in sarcomas of the spine. Clin Orthop 397:127–132
Tomita K, Kawahara N, Baba H et al (1994) Total en bloc spondylectomy for solitary spinal metatases. Int Orthop 18:291–298
Tomita K, Kawahara N, Baba H et al (1997) Total en bloc spondylectomy. Spine 22:324–333
Tomita K, Kawahara N, Kobayashi T (2001) Surgical strategy for spinal metastases. Spine 26:298–306
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Liljenqvist, U., Lerner, T., Halm, H. et al. En bloc spondylectomy in malignant tumors of the spine. Eur Spine J 17, 600–609 (2008). https://doi.org/10.1007/s00586-008-0599-8
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DOI: https://doi.org/10.1007/s00586-008-0599-8