Indications and Technique of Thoracic En Bloc Resections

Abstract

En-bloc resections in the thoracic spine are mostly reserved for primary tumors of the spine. Rarely, en-bloc resections are considered for spinal metastases if the metastasis is solitary and can be removed en-bloc without a high likelihood of breaching the margins during the resection. Traditionally, it has been considered difficult to perform en-bloc resections in the thoracic spine due to the anatomic proximity of the major blood vessels and thus intralesional resections with curettage were preferred. This, however, resulted in a high risk of local recurrence and, in the case of a primary tumor, metastasis with poor survival. En bloc resection has the primary goals of gaining local control of the tumor by removing it as a whole and thereby reducing the rate of local recurrence and in primary tumors avoid tumor spread and improve survival [1, 4, 5].