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Malignant Primary Spinal Neoplasms: Total En Bloc Spondylectomy

  • Patrick C. Hsieh
  • Alexander TaghvaEmail author
Chapter
  • 1.1k Downloads
Part of the Tumors of the Central Nervous System book series (TCNS, volume 6)

Abstract

Malignant primary spinal tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. Total en bloc spondylectomy (TES) involves removal of vertebral segment(s) in whole to achieve wide en bloc tumor excision (Fig. 25.5). Total en bloc spondylectomy can be performed through staged or combined anterior and posterior approaches, or from an all posterior approach. Although one can occasionally diagnose a lesion based on the combination of clinical history, physical examination, and imaging findings, an absolute tissue diagnosis is important and can only be obtained through histopathological examination on a biopsied specimen. With tissue diagnosis, one can properly elucidate the aggressiveness and the natural history of the disease and its likelihood to respond to chemotherapy and/or radiation therapy. It also allows the surgeons to decide on the appropriate surgical strategy to treat the lesion. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.

Keywords

Vertebral Body Posterior Approach Bloc Resection Giant Cell Tumor Osteoid Osteoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abdel-Wanis Mel S, Tsuchiya H, Kawahara N, Tomita K (2001) Tumor growth potential after tumoral and instrumental contamination: an in-vivo comparative study of T-saw, Gigli saw, and scalpel. J Orthop Sci 6(5):424–429CrossRefGoogle Scholar
  2. Bacci G, Forni C, Longhi A, Ferrari S, Donati D, De Paolis M, Barbieri E, Pignotti E, Rosito P, Versari M (2004) Long-term outcome for patients with non-metastatic Ewing’s sarcoma treated with adjuvant and neoadjuvant chemotherapies. 402 patients treated at Rizzoli between 1972 and 1992. Eur J Cancer 40(1):73–83PubMedCrossRefGoogle Scholar
  3. Bacci G, Balladelli A, Forni C, Ferrari S, Longhi A, Bacchini P, Alberghini M, Fabbri N, Benassi M, Briccoli A, Picci P (2007) Adjuvant and neoadjuvant chemotherapy for Ewing sarcoma family tumors in patients aged between 40 and 60: report of 35 cases and comparison of results with 586 younger patients treated with the same protocols in the same years. Cancer 109(4):780–786PubMedCrossRefGoogle Scholar
  4. Boriani S, Biagini R, De Iure F, Di Fiore M, Gamberini G, Zanoni A (1994) Lumbar vertebrectomy for the treatment of bone tumors: surgical technique. Chir Organi Mov 79(2):163–173PubMedGoogle Scholar
  5. Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22(9):1036–1044PubMedCrossRefGoogle Scholar
  6. Boriani S, Saravanja D, Yamada Y, Varga PP, Biagini R, Fisher CG (2009) Challenges of local recurrence and cure in low grade malignant tumors of the spine. Spine 34(22 Suppl):S48–S57PubMedCrossRefGoogle Scholar
  7. Brown AP, Fixsen JA, Plowman PN (1987) Local control of Ewing’s sarcoma: an analysis of 67 patients. Br J Radiol 60(711):261–268PubMedCrossRefGoogle Scholar
  8. Cloyd JM, Acosta FL Jr, Polley MY, Ames CP (2010) En bloc resection for primary and metastatic tumors of the spine: a systematic review of the literature. Neurosurgery 67(2):435–444, discussion 444-5PubMedCrossRefGoogle Scholar
  9. Eilber FR, Grant T, Morton DL (1978) Adjuvant therapy for osteosarcoma: preoperative and postoperative treatment. Cancer Treat Rep 62(2):213–216PubMedGoogle Scholar
  10. Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24PubMedGoogle Scholar
  11. Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120PubMedGoogle Scholar
  12. Fayette J, Blay JY (2006) Adjuvant chemotherapy in the treatment of sarcomas. Bull Cancer 93(3):257–261PubMedGoogle Scholar
  13. Ferguson WS, Goorin AM (2001) Current treatment of osteosarcoma. Cancer Invest 19(3):292–315PubMedCrossRefGoogle Scholar
  14. Fujita T, Ueda Y, Kawahara N, Baba H, Tomita K (1997) Local spread of metastatic vertebral tumors. A histologic study. Spine 22(16):1905–1912PubMedCrossRefGoogle Scholar
  15. Gokaslan ZL (1996) Spine surgery for cancer. Curr Opin Oncol 8(3):178–181PubMedCrossRefGoogle Scholar
  16. Goto T, Okuma T, Nakada I, Hozumi T, Kondo T (2007) Preoperative adjuvant therapy for primary malignant bone tumors. Gan To Kagaku Ryoho 34(11):1750–1754PubMedGoogle Scholar
  17. Heslin MJ, Lewis JJ, Nadler E, Newman E, Woodruff JM, Casper ES, Leung D, Brennan MF (1997) Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 15(8):2832–2839PubMedGoogle Scholar
  18. Hess T, Kramann B, Schmidt E, Rupp S (1997) Use of preoperative vascular embolisation in spinal metastasis resection. Arch Orthop Trauma Surg 116(5):279–282PubMedCrossRefGoogle Scholar
  19. Hsieh PC, Li KW, Sciubba DM, Suk I, Wolinsky JP, Gokaslan ZL (2009) Posterior-only approach for total en bloc spondylectomy for malignant primary spinal neoplasms: anatomic considerations and operative nuances. Neurosurgery 65(6 Suppl)):173–181, discussion 181PubMedGoogle Scholar
  20. Kawahara N, Tomita K, Baba H, Toribatake Y, Fujita T, Mizuno K, Tanaka S (1996) Cadaveric vascular anatomy for total en bloc spondylectomy in malignant vertebral tumors. Spine 21(12):1401–1407PubMedCrossRefGoogle Scholar
  21. Kraus DH, Dubner S, Harrison LB, Strong EW, Hajdu SI, Kher U, Begg C, Brennan MF (1994) Prognostic factors for recurrence and survival in head and neck soft tissue sarcomas. Cancer 74(2):697–702PubMedCrossRefGoogle Scholar
  22. O’Mara RE (1974) Bone scanning in osseous metastatic disease. JAMA 229(14):1915–1917PubMedCrossRefGoogle Scholar
  23. Rosen G (1978) Primary Ewing’s sarcoma: the multidisciplinary lesion. Int J Radiat Oncol Biol Phys 4(5–6):527–532PubMedGoogle Scholar
  24. Roy-Camille R, Saillant G, Bisserie M, Judet T, Hautefort E, Mamoudy P (1981) Total excision of thoracic vertebrae (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 67(3):421–430PubMedGoogle Scholar
  25. Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME (2007) Part II: spinal-cord neoplasms–primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol 8(2):137–147PubMedCrossRefGoogle Scholar
  26. Schirmer CM, Malek AM, Kwan ES, Hoit DA, Weller SJ (2006) Preoperative embolization of hypervascular spinal metastases using percutaneous direct injection with n-butyl cyanoacrylate: technical case report. Neurosurgery 59(2):E431–E432, author reply E431-2PubMedCrossRefGoogle Scholar
  27. Schirrmeister H, Guhlmann A, Elsner K, Kotzerke J, Glatting G, Rentschler M, Neumaier B, Trager H, Nussle K, Reske SN (1999) Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET. J Nucl Med 40(10):1623–1629PubMedGoogle Scholar
  28. Stener B (1971) Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg Br 53(2):288–295PubMedGoogle Scholar
  29. Tomita K, Kawahara N, Baba H, Tsuchiya H, Nagata S, Toribatake Y (1994a) Total en bloc spondylectomy for solitary spinal metastases. Int Orthop 18(5):291–298PubMedCrossRefGoogle Scholar
  30. Tomita K, Toribatake Y, Kawahara N, Ohnari H, Kose H (1994b) Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis. Paraplegia 32(1):36–46PubMedCrossRefGoogle Scholar
  31. Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y (1997) Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine 22(3):324–333PubMedCrossRefGoogle Scholar
  32. Tomita K, Kawahara N, Murakami H, Demura S (2006) Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci 11(1):3–12PubMedCrossRefGoogle Scholar
  33. Trubenbach J, Nagele T, Bauer T, Ernemann U (2006) Preoperative embolization of cervical spine osteoblastomas: report of three cases. AJNR Am J Neuroradiol 27(9):1910–1912PubMedGoogle Scholar
  34. Yamazaki T, McLoughlin GS, Patel S, Rhines LD, Fourney DR (2009) Feasibility and safety of en bloc resection for primary spine tumors: a systematic review by the spine oncology study group. Spine 34(22 Suppl):S31–S38PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of Southern California Keck School of MedicineLos AngelesUSA

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