Hybrid Therapy Versus Total En Bloc Spondyectomy in the Treatment of Solitary Radioresistant Spinal Metastases

✓Leiomyosarcoma is a rare malignant smooth-muscle tumor that rarely metastasizes to bone. It is extremely uncommon for osseous metastasis to be the initial presentation of leiomyosarcoma or to be the initial manifestation of recurrence in patients with a history of leiomyosarcoma. The authors have treated four cases of metastatic leiomyosarcoma with the lesion initially presenting in the spine, and a fifth case of disseminated leiomyosarcoma that involved the spine. In their report, they highlight the cases of two of these patients and provide tabular data for the remaining three. The authors performed a comprehensive review of the literature on spinal leiomyosarcomas and retrospective chart reviews of five surgically treated patients in whom a spinal metastatic leiomyosarcoma was diagnosed. Their series consists of five women who ranged in age from 36 to 47 years (mean age 43.2 years). Four patients had known, or presumed, uterine primary lesions, whereas one harbored a retroperitoneal primary tumor. These lesions generally appear as lytic foci on imaging studies, but variable imaging characteristics were observed. All cases were managed aggressively: four patients underwent posterior/posterolateral decompression and fusion, and one underwent anterior–posterior en bloc resection and fusion. In all cases preoperative symptoms resolved. Two patients died 9 and 13 years after initial presentation. The remaining patients are alive and neurologically intact. Metastatic spinal leiomyosarcomas tend to symptomatically involve only one spinal level at the time of diagnosis and are known to recur locally. These lesions commonly affect women in early middle age, and long-term survival, even in those with systemic metastatic lesions, is better than that seen in individuals with more aggressive spinal metastases. Attempted gross-total resection with fusion, as opposed to minimal palliative decompression, is recommended.

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Repeated total en bloc spondylectomy for spinal metastases at different sites in one patient

European Spine Journal ◽

10.1007/s00586-015-4091-y ◽

2015 ◽

Vol 24 (10) ◽

pp. 2196-2200 ◽

Cited By ~ 6

Author(s):

Shurei Sugita ◽

Hideki Murakami ◽

Satoru Demura ◽

Satoshi Kato ◽

Katsuhito Yoshioka ◽

...

Keyword(s):

Spinal Metastases ◽

En Bloc ◽

Total En Bloc Spondylectomy ◽

En Bloc Spondylectomy ◽

Bloc Spondylectomy

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Total en bloc spondylectomy for solitary spinal metastases

International Orthopaedics ◽

10.1007/bf00180229 ◽

1994 ◽

Vol 18 (5) ◽

Cited By ~ 241

Author(s):

K. Tomita ◽

N. Kawahara ◽

H. Baba ◽

H. Tsuchiya ◽

S. Nagata ◽

...

Keyword(s):

Spinal Metastases ◽

En Bloc ◽

Total En Bloc Spondylectomy ◽

En Bloc Spondylectomy ◽

Bloc Spondylectomy

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En bloc spondylectomy for spinal metastases: a review of techniques

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.5.6 ◽

2003 ◽

Vol 15 (5) ◽

pp. 1-6 ◽

Cited By ~ 61

Author(s):

Kevin C. Yao ◽

Stefano Boriani ◽

Ziya L. Gokaslan ◽

Narayan Sundaresan

Keyword(s):

Treatment Strategies ◽

Spinal Metastases ◽

Staging System ◽

Surgical Staging ◽

Spinal Tumors ◽

Surgical Approaches ◽

En Bloc ◽

En Bloc Spondylectomy ◽

Effective Treatment Modality ◽

Bloc Spondylectomy

Object Spinal metastases are prevalent in the population of patients with cancer. Effective cancer therapy must incorporate treatment strategies for these lesions. Increasingly, surgery is being recognized as an effective treatment modality both for the patient's quality of life and potential oncological cure. En bloc spondylectomy is the surgical procedure of choice to obtain these goals. The purpose of this study was to examine critically the rationale, indications, and outcomes of en bloc spondylectomy for spinal metastases. Methods Outcomes in the authors' series of patients who underwent en bloc spondylectomy for spinal metastases are critically analyzed. The rationale and indications for this procedure are discussed. The Weinstein, Boriani, and Biagini surgical staging system for spinal tumors is described. A review of the literature is performed to examine further the rationale underlying this aggressive surgical approach to metastatic spinal disease. Conclusions En bloc spondylectomy is the treatment of choice for solitary and oligometastatic spinal metastases with biologically favorable histological findings. In appropriately selected patients, neurological outcome, pain control, and oncological control are significantly better after en bloc spondylectomy compared with radiation therapy. Oncological outcomes also exceed those of intralesional techniques. The Weinstein, Boriani, and Biagini surgical staging system provides a standard with which to plan surgical approaches and to compare surgical outcomes.

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Total en bloc spondylectomy for solitary spinal metastases

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto64216 ◽

1996 ◽

Vol 3 (2) ◽

pp. 11-18

Author(s):

K. Tomita ◽

N. Kawahara ◽

H. Baba ◽

H. Tsuchiya ◽

S. Nagata ◽

...

Keyword(s):

Spinal Metastases ◽

Lumbar Vertebrae ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Wide Margin ◽

Total En Bloc Spondylectomy ◽

En Bloc Spondylectomy ◽

Bloc Spondylectomy

We have developed a technique for total en bloc spondylectomy through a posterior approch and now report our experience of 20 patients with a solitary or localised metastasis in the thoracic or lumbar vertebrae. There are two steps: an en bloc laminectomy, followed by en bloc resection of the vertebral body with an oncological wide margin and the insertion of a vertebral prosthesis. Pain was relieved in the 17 patients who could be assessed; 11 of the 15 patients with a neurological deficit were much improved, impending paralysis being prevented in 5 patients. There have been no local recurrences. Nine patients are at present alive with a mean follow up of 17,4 months.

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Quantification of Vertebral Involvement in Metastatic Spinal Disease

The Open Orthopaedics Journal ◽

10.2174/1874325001307010286 ◽

2013 ◽

Vol 7 (1) ◽

pp. 286-291 ◽

Cited By ~ 3

Author(s):

Ricardo Vieira Botelho ◽

Matheus Fernandes de Oliveira ◽

Jose Marcus Rotta

Keyword(s):

Radical Surgery ◽

Spinal Metastasis ◽

Spinal Metastases ◽

Spinal Disease ◽

Vertebral Metastasis ◽

En Bloc ◽

En Bloc Spondylectomy ◽

Good General Health ◽

Bloc Spondylectomy ◽

Vertebral Involvement

Introduction: For patients with a solitary and well-delimitated spinal metastasis that resides inside the vertebral body, without vertebral canal invasion, and who are in good general health with a long life expectancy, en bloc spondylectomy/total vertebrectomy combined with the use of primary stabilizing instrumentation has been advocated. However, clinical experience suggests that these qualifying conditions occur very rarely. Objective: The purpose of this paper is to quantify the distribution of vertebral involvement in spinal metastases and determine the frequency with which patients can be considered candidates for radical surgery (en bloc spondylectomy). Methods: Consecutive patients were classified accordingly to Enneking’s and Tomita’s schemes for grading vertebral involvement of metastases. Results: Fifty-one (51) consecutive patients were evaluated. Eighty-three percent of patients presented with the involvement of multiple vertebral levels and/or spinal canal invasion. Conclusion: Because of diffuse vertebral involvement of metastases, no patients in this sample were considered to be candidates for radical spondylectomy of vertebral metastasis.

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Total en bloc spondylectomy for spinal metastases in thyroid carcinoma

Journal of Neurosurgery Spine ◽

10.3171/2010.9.spine09878 ◽

2011 ◽

Vol 14 (2) ◽

pp. 172-176 ◽

Cited By ~ 52

Author(s):

Satoru Demura ◽

Norio Kawahara ◽

Hideki Murakami ◽

Mohamed E. Abdel-Wanis ◽

Satoshi Kato ◽

...

Keyword(s):

Survival Rate ◽

Local Recurrence ◽

Thyroid Carcinoma ◽

Spinal Metastases ◽

Debulking Surgery ◽

En Bloc ◽

Total En Bloc Spondylectomy ◽

En Bloc Spondylectomy ◽

Bloc Spondylectomy ◽

The Impact

Object Thyroid carcinoma generally has a favorable prognosis, and patients rarely present with distant metastases. Authors of several studies have proposed piecemeal resection for spinal metastases in thyroid carcinoma; however, few have analyzed the impact of local curative surgery such as total en bloc spondylectomy (TES) for thyroid carcinoma. The purposes of the present study are to determine the strategy of surgical treatment for spinal metastases of thyroid carcinoma and to evaluate the surgical results of and the prognosis associated with TES. Methods Twenty-four cases of spinal metastases were retrospectively reviewed. The patients included 16 women and 8 men, with a mean age of 60.7 years. Histological examination showed follicular carcinoma in 15 cases, papillary carcinoma in 8, and medullary carcinoma in 1. Total en bloc spondylectomy was performed in 10 cases; debulking surgery, such as piecemeal excision or eggshell curettage, was performed in 14. The average follow-up time was 55 months (12–180 months). Results Four patients had no evidence of disease, 8 were alive with the disease, and 12 had died of the disease. The overall survival rate from the time of surgery was 74% at 5 years. Patients with visceral metastases had a significant, higher risk of death. The survival rate of patients following TES was 90% at 5 years, which was higher than the rate in patients who underwent debulking surgery (63%). However, no significant difference was observed between the 2 types of surgery. There was a local recurrence after debulking surgery in 8 (57%) of 14 cases. Because of the recurrences, reoperation was required after a mean of 41 months. In contrast, there was a local recurrence after TES in only 1 (10%) of 10 cases. The difference between debulking surgery and TES regarding local recurrence was statistically significant. Conclusions Total en bloc spondylectomy with enough of a margin provided favorable local control of spinal metastases of thyroid carcinoma during a patient's lifetime.

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