Malignant Primary Spinal Neoplasms: Total En Bloc Spondylectomy

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.