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.

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.

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.

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.

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.

scholarly journals Endoscopic submucosal dissection of malignant non-pedunculated colorectal lesions

2018 ◽  
Vol 06 (08) ◽  
pp. E961-E968 ◽  
Author(s):  
Carl-Fredrik Rönnow ◽  
Jacob Elebro ◽  
Ervin Toth ◽  
Henrik Thorlacius
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
Residual Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Procedural Time

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is an established method for en bloc resection of large non-pedunculated colorectal lesions in Asia but dissemination of ESD in Western countries is limited. The aim of this study was to evaluate the role of ESD in the management of malignant non-pedunculated colorectal lesions in a European center. Patients and methods Among 255 patients undergoing colorectal ESD between 2014 and 2016, 29 cases were identified as submucosal invasive cancers and included in this study. The main outcomes were en bloc, R0 and curative resection as well as procedural time, complications and recurrence. Results Median tumor size was 40 mm (range 20 – 70 mm). Thirteen cancers were located in the colon and 16 were located in the rectum. Procedural time was 89 minutes (range 18 – 594 minutes). Complete resection was achieved in 28 cases, en bloc and R0 resection rates were 83 % and 69 %, respectively. Curative resection rate was 38 %. One case had a perforation in the sigmoid colon requiring emergency surgery. No significant bleeding occurred. Six patients underwent additional surgery after ESD, one of whom had residual tumor. One recurrence was detected in 20 patients that were followed-up endoscopically, median follow-up time was 13 months (range 2 – 30 months). Conclusion ESD seems to be a safe and effective method for treating non-pedunculated malignant colorectal lesions after careful patient selection and proper endoscopic training.

Total cervical spondylectomy for primary osteogenic sarcoma

2002 ◽  
Vol 97 (3) ◽  
pp. 386-392 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document