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Indications for En Bloc Spondylectomy for Metastatic Spine Disease

  • Raphaële Charest-Morin
  • Charles G. Fisher
Chapter

Abstract

In the metastatic spine population, treatment is generally palliative, with invasive surgical interventions such as an en bloc resection having limited indications. En bloc resection can be considered for patients with good performance status, favorable life expectancy, and harboring a solitary spinal metastasis from a favorable histology such as renal cell carcinoma and thyroid cancer. In this subgroup of patients, local control is of paramount importance as prolonged survival is anticipated; therefore, an oncologic resection might be considered. Recent advances in radiation oncology, specifically stereotactic body radiotherapy (SBRT), have demonstrated excellent control rates without the morbidity of invasive resections and have generally become the first line of treatment for an isolated spinal metastasis without spinal cord compression. Consultation through a multidisciplinary group of spine surgeons and medical and radiation oncologists is strongly encouraged for these challenging cases. When indicated, en bloc resection carries a high risk of complications, both intraoperative and postoperative. However, in properly selected patients, acceptable outcomes and perhaps better long-term local control rate can be obtained and should be considered especially when SBRT is not possible due to spinal cord compression and in patients with good prognosis who failed SBRT.

Keywords

En bloc resection En bloc spondylectomy Oncologic resection Renal cell carcinoma Thyroid cancer Solitary metastasis Isolated metastasis Indications Outcomes Complications Morbidity 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicCentre Hospitalier Universitaire de QuébecQCCanada
  2. 2.Division of Spine, Department of OrthopaedicsThe Combined Neurosurgical and Orthopaedic Spine Program at Vancouver Coastal HealthVancouverCanada

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