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.

En bloc spondylectomy for treatment of tumor-induced osteomalacia

2009 ◽  
Vol 11 (5) ◽  
pp. 600-604 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Rory J. Petteys ◽  
Sophia F. Shakur ◽  
Ziya L. Gokaslan ◽  
Edward F. McCarthy ◽  
...  
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
Radical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Phosphaturic Mesenchymal Tumor ◽  
Spinal Segment ◽  
Spine Tumor ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy

En bloc spondylectomy represents a radical resection of a spinal segment most often reserved for patients presenting with a primary extradural spine tumor or a solitary metastasis in the setting of an indolent, well-controlled systemic malignancy. The authors report a case in which en bloc spondylectomy was conducted to control a metabolically active spine tumor. A 56-year-old woman, who suffered from severe tumor-induced osteomalacia, was found to have a fibroblast growth factor-23–secreting phosphaturic mesenchymal tumor in the T-8 vertebral body. En bloc resection was conducted, leading to resolution of her tumor-induced osteomalacia. This case suggests that radical spondylectomy may be beneficial in the management of metabolically or endocrinologically active tumors of the spine.

scholarly journals Total en bloc spondylectomy for solitary spinal metastases

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.

Three-Level En Bloc Spondylectomy for Chordoma

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons325-ons333 ◽  
Author(s):  
Michelle J. Clarke ◽  
Wesley Hsu ◽  
Ian Suk ◽  
Edward McCarthy ◽  
James H. Black ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Tumor Margins ◽  
Bloc Spondylectomy ◽  
Negative Tumor ◽  
Neurologically Intact ◽  
Neurovascular Structures

Abstract Background: En bloc resection of spinal and sacral chordomas may convey a survival benefit. However, these procedures often are complex and require the surgeon to plan a procedure that results in negative tumor margins, protects vital neurovascular structures, and concludes with a viable biomechanical reconstruction. Objective: We present a case of a 3-level en bloc lumbar spondylectomy and reconstruction. Methods: A case of a 45-year-old woman with biopsy-proven exophytic L4 chordoma is presented. The patient underwent successful L3-L5 en bloc spondylectomy and reconstruction over 3 stages. Results: The patient did well following the procedure, and was neurologically intact at 6-week follow-up. Conclusion: Three-level en bloc spondylectomy with lumbopelvic reconstruction is a challenging yet feasible procedure.

scholarly journals Surgical treatment of aggressive vertebral hemangiomas

2016 ◽  
Vol 41 (2) ◽  
pp. E7 ◽  
Author(s):  
Viren S. Vasudeva ◽  
John H. Chi ◽  
Michael W. Groff
Keyword(s):  
Residual Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Gross Total Resection ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Vertebral Hemangiomas

OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of “hemangioma” between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3–65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the patient who underwent en bloc resection who continued to have back pain. CONCLUSIONS Gross-total resection or subtotal resection in combination with vertebroplasty or adjuvant radiation therapy to treat residual tumor seems sufficient in the treatment of aggressive vertebral hemangiomas. En bloc resection appears to provide a similar oncological benefit, but it carries higher morbidity to the patient.

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.

Total en bloc lumbar spondylectomy

2001 ◽  
Vol 95 (2) ◽  
pp. 264-269 ◽  
Author(s):  
Eric Marmor ◽  
Laurence D. Rhines ◽  
Jeffrey S. Weinberg ◽  
Ziya L. Gokaslan
Keyword(s):  
Lumbar Spine ◽  
Posterior Approach ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Neurological Injury ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Content Type ◽  
Bloc Spondylectomy ◽  
Anterior Posterior

✓ 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.

Risk factors for local recurrence after total en bloc spondylectomy for metastatic spinal tumors: A retrospective study

2018 ◽  
Vol 23 (3) ◽  
pp. 459-463 ◽  
Author(s):  
Takashi Igarashi ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Katsuhito Yoshioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Local Recurrence ◽  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy

More than 10-year follow-up after total en bloc spondylectomy for spinal tumors.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e21503-e21503
Author(s):  
Satoshi Kato ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Katsuhito Yoshioka ◽  
Hiroyuki Hayashi ◽  
...  
Keyword(s):  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy

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 Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

2012 ◽  
Vol 22 (3) ◽  
pp. 556-564 ◽  
Author(s):  
Lin Huang ◽  
Keng Chen ◽  
Ji-chao Ye ◽  
Yong Tang ◽  
Rui Yang ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Single Posterior Approach
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