Malignant Primary Spinal Neoplasms: Total En Bloc Spondylectomy
- 1.1k Downloads
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.
KeywordsVertebral Body Posterior Approach Bloc Resection Giant Cell Tumor Osteoid Osteoma
- 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
- 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