En Bloc Resection of Primary Spinal Tumors

2009 ◽  
Vol 21 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Jason C. Eck ◽  
Mark B. Dekutoski
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc

En Bloc Resection for Primary and Metastatic Tumors of the Spine

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 435-445 ◽  
Author(s):  
Jordan M. Cloyd ◽  
Frank L. Acosta ◽  
Mei-Yin Polley ◽  
Christopher P. Ames
Keyword(s):  
Disease Free Survival ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
Primary Group ◽  
Metastatic Tumors ◽  
En Bloc ◽  
Primary Tumors ◽  
Free Survival ◽  
Disease Free

Abstract BACKGROUND The efficacy of en bloc resection for spinal tumors is unknown because most of the current evidence is provided by small, single-institution clinical series or case reports. OBJECTIVE To combine all previously published reports of en bloc resection for primary and metastatic spinal tumors, to describe the overall pattern of disease-free survival, and to investigate potentially prognostic factors for recurrence. METHODS A complete MEDLINE search for all articles reporting survival data for en bloc resection of spinal tumors was undertaken; 44 articles met inclusion criteria from which 306 eligible patients were identified. RESULTS There were 229 cases of primary tumors with a mean follow-up of 65.0 months and 77 cases of solitary metastatic tumors with a mean follow-up of 26.5 months. Median time to recurrence was 113 months for the primary group and 24 months for the metastatic group. Disease-free survival rates at 1, 5, and 10 years were 92.6%, 63.2%, and 43.9%, respectively, for the primary group and 61.8%, 37.5%, and 0%, respectively, for the metastatic group; 5-year disease-free survival rates were 58.4% for chordoma and 62.9% for chondrosarcoma. After adjusting for covariates, age, male sex, metastatic tumors, and osteosarcomas were significantly associated with a tumor recurrence. CONCLUSION This study provides the largest published series of patients undergoing en bloc resection for spinal tumors. Median time to recurrence reached almost 10 years in patients with primary tumors; however, it was only 2 years in those with isolated metastatic tumors.

scholarly journals Spondylectomy in the Treatment of Neoplastic Spinal Lesions – A Retrospective Outcome Analysis of 582 Patients Using a Patient-Level Meta-Analysis

2020 ◽  
pp. 1-8
Author(s):  
Alexander Spiessberger ◽  
Alexander Spiessberger ◽  
Varun Arvind ◽  
Mansoor Nasim ◽  
Basil Grueter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Odds Ratio ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Patient Level ◽  
Bloc Spondylectomy

Background: En-bloc spondylectomy in the treatment of spinal tumors is a complex procedure with potential complications. This study aims at identifying predictors of postoperative complications, lesion recurrence and overall survival. Methods: A systematic review of the literature was conducted, and patient-level data extracted from the included studies. Multiple linear-regression models were calculated to predict the occurrence of postoperative complications, lesion recurrence and overall survival based on age, tumor etiology, surgical approach, mode of resection (en-bloc versus intralesional), tumor extension based on Weinstein-BorianiBiagini classification system and number of levels treated. Results: Data of 582 individual adult and pediatric patients were extracted from the literature; Patient characteristics are: 45% female, median age of 46 years (range 5-78); most common etiologies were: sarcoma (46%), metastases (31%) and chordoma (11%). The surgical technique was: anterior (2.5%), combined (45%) and posterior approach (52.4%); 68.5% underwent en-bloc spondylectomy; average levels resected were 1.6 (1-6); 65% of patients had neurologic deficits at presentation, average survival was 2.6 years; Direct procedure-related complications were observed in 17.7%, with the most prevalent being CSF leaks, wound infections and neural injury. For postoperative complications, recurrence and 5-year survival significant regression equations were found (F(7,90)=2.57, p=0.018) with an R2 of 0.1; (F(5,147)=2.35, p=0.044) with an R2 of 0.07 and (F(4,101)=7.2, p=0.01) with an R2 of 0.38. Odds ratio for predicted complications was 1.35 for en-bloc resection and 1.25 for more than one level treated. The odds ratio for tumor recurrence was 0.78 for en-bloc resection; odds ratio for 5-year survival were 0.79 for increased patient age, 0.65 for increasing tumor grade, 0.79 for tumor dissemination at diagnosis and 1.68 for en-bloc resection. Conclusion: En-bloc spondylectomy provides improved survival and lower recurrence rates but also higher operative complication rates when compared to intralesional resections. Interestingly the complication rate was not influenced by tumor stage (WBB scale) and tumor etiology.

Biomimetic 3D-printed custom-made prosthesis for anterior column reconstruction in the thoracolumbar spine: a tailored option following en bloc resection for spinal tumors

2018 ◽  
Vol 27 (12) ◽  
pp. 3073-3083 ◽  
Author(s):  
Marco Girolami ◽  
Stefano Boriani ◽  
Stefano Bandiera ◽  
Giovanni Barbanti-Bródano ◽  
Riccardo Ghermandi ◽  
...  
Keyword(s):  
Thoracolumbar Spine ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anterior Column ◽  
Spinal Tumors ◽  
En Bloc ◽  
Custom Made ◽  
3D Printed ◽  
Anterior Column Reconstruction

scholarly journals Contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection: a technique for oncological resection of posterolateral spinal tumors

2017 ◽  
Vol 26 (3) ◽  
pp. 275-281 ◽  
Author(s):  
Viren S. Vasudeva ◽  
Alexander E. Ropper ◽  
Samuel Rodriguez ◽  
Kyle C. Wu ◽  
John H. Chi
Keyword(s):  
Spinal Column ◽  
Progression Free Survival ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
High Morbidity ◽  
Low Grade ◽  
En Bloc ◽  
Bloc Spondylectomy ◽  
Pars Interarticularis

En bloc resection of tumors involving the spinal column is technically challenging and is associated with high morbidity to the patient due to the proximity of critical neurological and vascular structures and the destabilizing nature of this surgery. Nevertheless, evidence has shown improved progression-free survival with en bloc resection for certain low-grade malignant and aggressive benign musculoskeletal tumors. To avoid the morbidity of en bloc spondylectomy in patients with tumors localized to the lateral and posterolateral spinal column, the authors have found that the goals of surgery can be accomplished through a contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER). They reviewed their series of 5 patients who underwent successful tumor removal through a COPPER approach. These patients were all found to harbor spinal column tumors involving the posterolateral elements that, based on pathology, would benefit from en bloc resection. Tumor pathology included chondrosarcoma, leiomyosarcoma, osteoblastoma, and liposarcoma. Resections were performed by completing ipsilateral facetectomies above and below the lesion and ipsilateral pedicle osteotomies from a contralateral approach following hemilaminectomy. By disarticulating the posterolateral elements while carefully protecting the thecal sac, the tumors were removed en bloc along with the affected lamina, pedicles, pars interarticularis, and spinous processes, allowing tumor-free margins. This technical report suggests that the COPPER approach is safe and effective for en bloc resection of tumors involving the posterolateral aspect of the spinal column with tumor-free margins and that it eliminates the need for anterior column reconstruction.

scholarly journals Clamshell thoracotomy for en bloc resection of a 3-level thoracic chordoma: technical note and operative video

2020 ◽  
Vol 49 (3) ◽  
pp. E16
Author(s):  
John F. Burke ◽  
Andrew K. Chan ◽  
Rory R. Mayer ◽  
Joseph H. Garcia ◽  
Brenton Pennicooke ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Posterior Spinal Fusion ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Technical Note ◽  
Spinal Tumors ◽  
En Bloc ◽  
Clamshell Thoracotomy ◽  
Bloc Excision ◽  
Upper Thoracic

The clamshell thoracotomy is often used to access both hemithoraxes and the mediastinum simultaneously for cardiothoracic pathology, but this technique is rarely used for the excision of spinal tumors. We describe the use of a clamshell thoracotomy for en bloc excision of a 3-level upper thoracic chordoma in a 20-year-old patient. The lesion involved T2, T3, and T4, and it invaded both chest cavities and indented the mediastinum. After 2 biopsies to confirm the diagnosis, the patient underwent a posterior spinal fusion followed by bilateral clamshell thoracotomy for 3-level en bloc resection with simultaneous access to both chest cavities and the mediastinum. To demonstrate how the clamshell thoracotomy was used to facilitate the tumor resection, an operative video and illustrations are provided, which show in detail how the clamshell thoracotomy can be used to access both hemithoraxes and the mediastinum.

Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases

2019 ◽  
Vol 30 (4) ◽  
pp. 424-431 ◽  
Author(s):  
A. Karim Ahmed ◽  
Zachary Pennington ◽  
Camilo A. Molina ◽  
Yuanxuan Xia ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Planning ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Careful Consideration ◽  
Spinal Tumors ◽  
Surgical Morbidity ◽  
En Bloc ◽  
Spine Tumors ◽  
3D Printed

Effective en bloc resection of primary spinal tumors necessitates careful consideration of adjacent anatomical structures in order to achieve negative margins and reduce surgical morbidity. This can be particularly challenging in the cervical spine, where vital neurovascular and connective tissues are present in the region. Early multidisciplinary surgical planning that includes clinicians and engineers can both optimize surgical planning and enable a more feasible resection with oncological margins. The aim of the current work was to demonstrate two cases that involved multidisciplinary surgical planning for en bloc resection of primary cervical spine tumors, successfully utilizing 3D-printed patient models and neoadjuvant therapies.

scholarly journals Oncological principles in spinal tumor surgery

2021 ◽  
Vol 18 (2) ◽  
pp. 64-72
Author(s):  
N. S. Zaborovskii ◽  
D. A. Ptashnikov ◽  
D. A. Mikhaylov ◽  
O. A. Smekalenkov ◽  
S. V. Masevnin
Keyword(s):  
Personal Experience ◽  
Resection Margin ◽  
Complete Removal ◽  
Spinal Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Single Block ◽  
The Sacrifice

Surgical intervention remains the cornerstone of the treatment of patients with spinal tumors. The presented literature review includes also the authors’ personal experience in the treatment of tumors. Pain relief, local control of a neoplasm growth and preservation of body functions are the main goals of this pathology treatment.Treatment of spinal tumors is based on the biology, location and extent of the neoplasm. If surgical treatment is indicated, en-bloc resection is the preferred method. This operation is based on the complete removal of the tumor in a single block entirely covered by a shell of healthy tissue. This surgical procedure can be challenging due to the proximity of the neural structures. Moreover, achieving clean resection margin around the tumor often requires the sacrifice of adjacent anatomic structures. A more comprehensive approach requires a combination of surgery, systemic therapy and radiotherapy to improve outcomes in patients with advanced spinal tumors.The fulfillment of oncological principles is fundamental to achieving best treatment outcomes for spinal tumors.

Sign in / Sign up

Export Citation Format

Share Document