Sub-Total and Total Vertebrectomy for Tumours

Abstract

En bloc resections in the spine involve sub-total and total vertebral body excision depending on the location of the tumour. The goal of these procedures is to obtain tumour-free margins and conform surgical planning to the oncological indications proposed by Enneking and validated later in the treatment of primary tumours. The spine imposes significant anatomical constraints which make wide margins more difficult to achieve when compared to extremity surgery.

There are three techniques one can use:

• The first is a combination of anterior and posterior approaches to perform the en bloc resection of the vertebral body/ies In selected cases -when the tumour is not expanding anteriorly- this procedure can be performed by posterior-only approach.

• The second is an anterior and posterior approach (or posterior approach alone if feasible) to perform a sagittal resection of the vertebrae.

• The third is the resection of posterior elements by posterior approach alone. All three are technically challenging and complications should be anticipated.

The Weinstein, Boriani, Biagini staging system can be used to help assess spine tumours as well as to plan the resection.

The epidural extension of a tumour may prevent the obtaining of negative margins. A very morbid choice like dura resection and inclusion in the specimen can be considered and weighed against the risks.

The risks of surgery must always be balanced against the risks of avoiding surgery. When non-oncologically appropriate treatment is performed most of these patients will experience local recurrences and undergo further surgery and possibly die of the disease.