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Chirurgisches Management von Sarkomen der thorakolumbalen Wirbelsäule

Surgical management of thoracolumbar spinal sarcoma

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Zusammenfassung

Primäre maligne Tumoren der thorakolumbalen Wirbelsäule sind sehr selten. Die häufigsten Entitäten sind das Chordom, gefolgt vom Osteo-, Ewing- und Chondrosarkom. Eine detaillierte Bildgebung gefolgt von einer Biopsie sind die entscheidenden diagnostischen Schritte. Das chirurgische Stagingsystem von Weinstein und Boriani erlaubt eine genaue Analyse der Tumorausbreitung. Die Therapie in einem multimodalen Konzept besteht aus (neo-)adjuvanter Polychemotherapie und wahlweise Radiatio. Die chirurgische Therapie sollte in einer En-bloc-Exzision mit suffizienten Resektionsgrenzen erfolgen. Die Defektrekonstruktion muss über Wirbelkörperersatzverfahren und langstreckige Instrumentierungen vorgenommen werden. Die En-bloc-Spondylektomie ist ein sehr anspruchsvolles Verfahren und erfordert eine strenge Indikationsstellung, eine enge Kooperation mit benachbarten Fachabteilungen und exakte Operationsplanung. Nur so ist der Eingriff realisierbar und stellt die einzige suffiziente Resektionsform dar. Die Durchführung der En-bloc-Spondylektomie an sich sollte Wirbelsäulenzentren mit großer Erfahrung vorbehalten bleiben, die dann auch ein entsprechendes Komplikationsmanagement sicherstellen können.

Abstract

Primary malignant tumors of the thoracolumbar spine are very rare. The most common entities are chordoma, followed by osteosarcoma, Ewing’s sarcoma and chondrosarcoma. Detailed imaging and a sequential biopsy are the most important diagnostic steps. The surgical staging system of Weinstein and Boriani permits a precise analysis of tumor expansion. Therapy under a multimodal concept consists of (neo-) adjuvant therapy and possible radiation. The surgical therapy should be performed as an en bloc excision with sufficient resection borders. The reconstruction of the defects must include methods of vertebral body replacement and long posterior instrumentation. En bloc spondylectomy is a very demanding technique and demands strict indications, close cooperation with adjacent specialties and exact planning of the operation. Only in this manner is the operation possible and offers the only sufficient form of resection. The execution of the en bloc spondylectomy should be left to spine centers with great experience, as they could also guarantee the respective complication management.

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Authors and Affiliations

  1. Sektion für Muskuloskeletale Tumorchirurgie und Sektion für Wirbelsäulenchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    K.-D. Schaser, I. Melcher, C. Druschel, S. Tsitsilonis & A.C. Disch

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  1. K.-D. Schaser
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  2. I. Melcher
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  3. C. Druschel
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  5. A.C. Disch
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Correspondence to K.-D. Schaser.

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Schaser, KD., Melcher, I., Druschel, C. et al. Chirurgisches Management von Sarkomen der thorakolumbalen Wirbelsäule. Orthopäde 41, 659–673 (2012). https://doi.org/10.1007/s00132-012-1911-1

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  • DOI: https://doi.org/10.1007/s00132-012-1911-1

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