En Bloc Resection of Vertebral Tumors of Thoracic and Lumbar Spine

✓ The authors describe a technique for total en bloc spondylectomy that can be used for lesions involving the lumbar spine. The technique involves a combined anterior—posterior approach and takes into account the unique anatomy of the lumbar spine. This technique allows for the en bloc resection of lumbar vertebral tumors, thus optimizing outcome while minimizing the risk of neurological injury. The technique is described in detail with the aid of neuroimaging studies, photographs of gross pathological specimens, and illustrations, and a discussion of other authors' experiences is provided for comparison.

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Lumbopelvic Reconstruction After Combined L5 Spondylectomy and Total Sacrectomy for En Bloc Resection of a Malignant Fibrous Histiocytoma

Neurosurgery ◽

10.1227/01.neu.0000382972.15422.10 ◽

2010 ◽

Vol 67 (2) ◽

pp. E498-E502 ◽

Cited By ~ 19

Author(s):

Gary L. Gallia ◽

Ian Suk ◽

Timothy F. Witham ◽

Susan L. Gearhart ◽

James H. Black ◽

...

Keyword(s):

Lumbar Spine ◽

Myocutaneous Flap ◽

Treatment Options ◽

En Bloc Resection ◽

Bloc Resection ◽

Reconstruction Technique ◽

Intractable Pain ◽

En Bloc ◽

Total Sacrectomy ◽

Vertebral Segment

Abstract BACKGROUND Primary sacral neoplasms that extend superiorly to involve the distal lumbar spine represent complex surgical problems. Treatment options for these patients are often limited to hemicorporectomy. OBJECTIVE To detail our surgical technique for en bloc resection of a sarcoma involving the L5 vertebral segment and sacrum and the reconstruction of the lumbopelvic junction. METHODS A 52-year-old woman presented with intractable pain secondary to a sarcoma involving the L5 vertebral segment and sacrum. She underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of her neoplasm. A novel lumbopelvic reconstruction technique was used to establish a liaison between the lumbar spine and pelvis. RESULTS Operative complications included a venous vascular injury and a nonviable myocutaneous flap. Postoperatively, the patient had complete resolution of her pain. Unfortunately, the patient developed metastatic disease and died 5 months after her initial surgical procedure. CONCLUSION We describe a patient who underwent a combined L5 spondylectomy and total sacrectomy for en bloc resection of a lumbosacral sarcoma. Additionally, we report a novel technique to reconstruct the lumbopelvic junction. The operative procedures are detailed with the aid of radiographs, intraoperative photographs, and illustrations.

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Total cervical spondylectomy for primary osteogenic sarcoma

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.3.0386 ◽

2002 ◽

Vol 97 (3) ◽

pp. 386-392 ◽

Cited By ~ 21

Author(s):

Zvi R. Cohen ◽

Daryl R. Fourney ◽

Rex A. Marco ◽

Laurence D. Rhines ◽

Ziya L. Gokaslan

Keyword(s):

Cervical Spine ◽

Osteogenic Sarcoma ◽

En Bloc Resection ◽

Bloc Resection ◽

Nerve Roots ◽

En Bloc ◽

Total En Bloc Spondylectomy ◽

Content Type ◽

Bloc Spondylectomy ◽

Thoracic And Lumbar Spine

✓ The authors describe a technique for total spondylectomy for lesions involving the cervical spine. The method involves separately staged anterior and posterior approaches and befits the unique anatomy of the cervical spine. The procedure is described in detail, with the aid of radiographs, intraoperative photographs, and illustrations. Unlike in the thoracic and lumbar spine—for which methods of total en bloc spondylectomy have previously been described—a strictly en bloc resection is not possible in the cervical spine because of the need to preserve the vertebral arteries and the nerve roots supplying the upper limbs. Although the resection described in this case is by definition intralesional, it is oncologically sound, given the development of effective neoadjuvent chemotherapeutic regimens for osteosarcoma.

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Primary osseous chondrosarcoma in the lumbar spine: case report and literature review with analysis

Journal of International Medical Research ◽

10.1177/03000605211058890 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110588

Author(s):

Chih-Hisu Tu ◽

You-Pen Chiu ◽

Hui-Ru Ji ◽

Cheng-Di Chiu

Keyword(s):

Lumbar Spine ◽

Vertebral Body ◽

Case Reports ◽

En Bloc Resection ◽

Bloc Resection ◽

Two Stage ◽

En Bloc ◽

Limb Weakness ◽

One Stage ◽

Anterior Corpectomy

Primary spinal chondrosarcoma (CS) is rare. Only a few previous case reports have included a detailed description of the surgical process used to treat the CS. In addition, a paucity of documentation exists comparing differences in the outcomes between the approaches in en bloc resection. Here, we present a case of CS in the lumbar (L) spine treated with two-stage (anterior and posterior approach) en bloc surgery and analyze the differences between one-stage and two-stage approaches in the treatment of primary lumbar CS. A 30-year-old male patient with an L3 vertebral body CS presented with back pain and lower limb weakness. Lumbar spine magnetic resonance imaging (MRI) showed an L3 vertebral body tumor with cord and root compression. Two-stage surgery comprising posterior total laminectomy and transpedicular screw fixation over L2–L4 in the first stage, with subsequent anterior corpectomy, cage implantation, and anterior lumbar interbody fusion was performed to achieve total tumor removal and stabilization. The patient’s symptoms improved postoperatively, with no recurrence as of the 2-year follow-up. The analysis of previous similar cases showed that two-stage surgery, compared with one-stage surgery, appears to be beneficial in lumbar spine multisegment disease, providing a lower recurrence rate.

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Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension

Journal of Neurosurgery Spine ◽

10.3171/2013.11.spine13211 ◽

2014 ◽

Vol 20 (3) ◽

pp. 327-334 ◽

Cited By ~ 3

Author(s):

Ehud Mendel ◽

Narendra Nathoo ◽

Thomas Scharschmidt ◽

Carl Schmidt ◽

James Boehmler ◽

...

Keyword(s):

Lumbar Spine ◽

Pelvic Ring ◽

Early Mobilization ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

The Creation ◽

Negative Tumor ◽

Lumbar Extension ◽

Transpedicular Screw Fixation

En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging. A patient with an iliosacral chondrosarcoma with lumbar spine extension is presented in this report to illustrate a novel lumbopelvic spinal construct. Following combined external pelvectomy and hemisacrectomy with contralateral L3–5 hemilaminectomy and ipsilateral pediculotomy, bicortical transvertebral body screws were substituted for the missing pedicles, resulting in the creation of “false pedicles,” which were further supplemented with an autologous vascularized fibular strut graft from the amputated lower limb and applied to the lateral aspect of the vertebral bodies. The creation of false pedicles allowed for a robust reconstruction of the lumbopelvic junction, including maintaining pelvic ring integrity with a “neo-pelvis”, creating a functional load-bearing construct adequate for early mobilization and ambulation. The biomechanical dynamics of this unique construct are also discussed.

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Pelvic reconstruction after subtotal sacrectomy for sacral chondrosarcoma using cadaveric and vascularized fibula autograft

Journal of Neurosurgery Spine ◽

10.3171/2014.6.spine13657 ◽

2014 ◽

Vol 21 (4) ◽

pp. 623-627 ◽

Cited By ~ 9

Author(s):

Christopher C. Gillis ◽

John T. Street ◽

Michael C. Boyd ◽

Charles G. Fisher

Keyword(s):

Lumbar Spine ◽

Pelvic Ring ◽

Neurological Status ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Fibula Graft ◽

Vascularized Fibula ◽

Independent Ambulation ◽

Vascularized Fibula Graft

A novel method of spinopelvic ring reconstruction after partial sacrectomy for a chondrosarcoma is described. Chondrosarcoma is one of the most common primary malignant bone tumors, and en bloc resection is the mainstay of treatment. Involvement of the pelvis as well as the sacrum and lumbar spine can result in a technically difficult challenge for en bloc resection and for achievement of appropriate load-bearing reconstruction. After en bloc resection in their patient, the authors achieved reconstruction with a rod and screw construct including vascularized fibula graft as the main strut from the lumbar spine to the pelvis. Additionally, a cadaveric allograft strut was used as an adjunct for the pelvic ring. This is similar to a modified Galveston technique with vascularized fibula in place of the Galveston rods. The vascularized fibula provided appropriate biomechanical support, allowing the patient to return to independent ambulation. There was no tumor recurrence; neurological status remained stable; and the allograft construct integrated well and even increased in size on CT scans and radiographs in the course of a follow-up longer than 7 years.

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