Abstract
Total en-bloc spondylectomy (TES) offered a new therapeutic approach by applying the radical oncosurgical concepts of Enneking’s compartment-oriented resections to the thoracolumbar spine. It thereby demonstrated encouraging oncosurgical results by achieving marginal to wide resection margins in the treatment of primary spinal tumours and solitary spinal metastases of biologically favourable tumours. Our own study results support the notion that en-bloc spondylectomy is a technically demanding and risky operation but feasible treatment option for primary malignant vertebral bone tumours and solitary spinal metastasis of certain tumour entities. En-bloc spondylectomy for mono-level tumours followed by defect reconstruction allowed radical resections with negative margins in all investigated patients. While low recurrence rates and an encouraging overall survival rate were achieved new distant metastatic disease was evidenced. For extra — compartmental and multisegmental tumour localisations of sarcomas and clinical evident solitary metastases it could also be demonstrated that an oncosurgical sufficient resection is possible by TES. By achieving wide to marginal resection margins the combination of surgical procedure and adjuvant therapies demonstrated low local recurrence rates. Development of metastatic disease in contrast was seen in one third of the patients at the midterm follow-up underscoring the necessity for further advances in (neo-) adjuvant therapies. Careful patient selection, interdisciplinary surgical planning and cooperation, aggressive management of complications together with extensive experience in spine tumour surgery and reconstruction are essential prerequisites for good oncological results, low complication rates and acceptable functional results.
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References
Boriani S, De Iure F, Bandiera S, et al. (2000) Chondrosarcoma of the mobile spine: report on 22 cases. Spine 25: 804–812
Boriani S, Biagini R, De Iure F, et al. (1996) En-bloc resections of bone tumours of the thoracolumbar spine. A preliminary report on 29 patients. Spine 21: 1927–1931
Krepler P, Windhager R, Bretschneider W, et al. (2002) Total vertebrectomy for primary malignant tumours of the spine. J Bone Joint Surg Br 84: 712–715
Melcher I, Disch AC, KhodadadyanKlostermann C, et al. (2007) Primary malignant bone tumours and solitary metastases of the thoracolumbar spine: results by management with total en-bloc spondylectomy. Eur Spine J 16: 1193–1202
Tomita K, Kawahara N, Baba H, et al. (1997) Total en-bloc spondylectomy. A new surgical technique for primary malignant vertebral tumours. Spine 22: 324–333
Tomita K, Kawahara N, Baba H, et al. (1994) Total en-bloc spondylectomy for solitary spinal metastases. Int Orthop 18: 291–298
Mazel C, Grunenwald D, Laudrin P, Marmorat JL (2003) Radical excision in the management of thoracic and cervicothoracic tumours involving the spine: results in a series of 36 cases. Spine (Phila Pa 1976) 28: 782–792; discussion 92
Lievre JA, Darcy M, Pradat P, et al. (1968) [Giant cell tumour of the lumbar spine; total spondylectomy in 2 states]. Rev Rhum Mal Osteoartic 35: 125–130
Stener B (1989) Complete removal of vertebrae for extirpation of tumours. A 20-year experience. Clin Orthop Relat Res: 72–82
RoyCamille R, Saillant G, Bisserie M, et al. (1981) [Total excision of thoracic vertebrae (author’s transl)]. Rev Chir Orthop Reparatrice Appar Mot 67: 421–430
Schaser KD, Melcher I, Luzzati A, Disch AC (2009) Bone sarcoma of the spine. Recent Results Cancer Res 179: 141–167
Abe E, Sato K, Murai H, et al. (2000) Total spondylectomy for solitary spinal metastasis of the thoracolumbar spine: a preliminary report. Tohoku J Exp Med 190: 33–49
Tomita K, Kawahara N, Kobayashi T, et al. (2001) Surgical strategy for spinal metastases. Spine 26: 298–306
Yao KC, Boriani S, Gokaslan ZL, Sundaresan N (2003) En-bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 15: E6
Liljenqvist U, Lerner T, Halm H, et al. (2008) En-bloc spondylectomy in malignant tumours of the spine. Eur Spine J 17: 600–609
Murakami H, Kawahara N, AbdelWanis ME, Tomita K (2001) Total en-bloc spondylectomy. Semin Musculoskelet Radiol 5: 189–194
Sakaura H, Hosono N, Mukai Y, et al. (2004) Outcome of total en-bloc spondylectomy for solitary metastasis of the thoracolumbar spine. J Spinal Disord Tech 17: 297–300
Disch AC, Luzzati A, Melcher I, et al. (2007) Three-dimensional stiffness in a thoracolumbar en-bloc spondylectomy model: a biomechanical in vitro study. Clin Biomech (Bristol, Avon) 22: 957–964
Disch AC, Schaser KD, Melcher I, et al. (2008) En-bloc spondylectomy reconstructions in a biomechanical in-vitro study. Eur Spine J 17: 715–725
Enneking WF, Spanier SS, Goodman MA (1980) Current concepts review. The surgical staging of musculoskeletal sarcoma. J Bone Joint Surg Am 62: 1027–1030
Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res: 106–120
Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumours of the spine. Terminology and surgical staging. Spine 22: 1036–1044
Abe E, Sato K, Tazawa H, et al. (2000) Total spondylectomy for primary tumour of the thoracolumbar spine. Spinal Cord 38: 146–152
Tomita K, Toribatake Y, Kawahara N, et al. (1994) Total en-bloc spondylectomy and circumspinal decompression for solitary spinal metastasis. Paraplegia 32: 36–46
Tomita K, Kawahara N, Murakami H, Demura S (2006) Total en-bloc spondylectomy for spinal tumours: improvement of the technique and its associated basic background. J Orthop Sci 11: 3–12
Disch AC, Schaser KD, Melcher I, et al. (2011) Oncosurgical results of multilevel thoracolumbar en-bloc spondylectomy and reconstruction with a carbon composite vertebral body replacement system. Spine (Phila Pa 1976) 36: E647–E655
Tokuhashi Y, Matsuzaki H, Oda H, et al. (2005) A revised scoring system for preoperative evaluation of metastatic spine tumour prognosis. Spine 30: 2186–2191
Tokuhashi Y, Matsuzaki H, Toriyama S, et al. (1990) Scoring system for the preoperative evaluation of metastatic spine tumour prognosis. Spine 15: 1110–1113
Lin B, Chen ZW, Guo ZM, et al. (2011) Anterior Approach Versus Posterior Approach With Subtotal Corpectomy, Decompression, and Reconstruction of Spine in the Treatment of Thoracolumbar Burst Fractures: A Prospective Randomized Controlled Study. J Spinal Disord Tech [Epub ahead of print]
Ashman RB, Galpin RD, Corin JD, Johnston CE 2nd (1989) Biomechanical analysis of pedicle screw instrumentation systems in a corpectomy model. Spine 14: 1398–1405
Knop C, Lange U, Bastian L, Blauth M (2000) Three-dimensional motion analysis with Synex. Comparative biomechanical test series with a new vertebral body replacement for the thoracolumbar spine. Eur Spine J 9: 472–485
Vahldiek MJ, Panjabi MM (1998) Stability potential of spinal instrumentations in tumour vertebral body replacement surgery. Spine 23: 543–550
Fisher CG, DiPaola CP, Ryken TC, et al. (2010) A novel classification system for spinal instability in neoplastic disease: an evidencebased approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35: E1221–E1229
Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66: 271–273
Ware JE, Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30: 473–483
Roy-Camille R, Mazel C, Saillant G, Lapresle P. (1990) Treatment of malignant tumors of the spine with posterior instrumentation. In: Sundaresan SN, Schmidek HH, Schiller LA, et al. (eds), Tumors of the Spine: diagnosis and clinical management. Saunders, Philadelphia, pp 473–487
Roy-Camille R, Mazel C (1991) Vertebrectomy through an enlarged posterior approach for tumors and malunions. In: Bridwell KH, DeWald RD (eds), The textbook of spinal surgery. Lippincott, Philadelphia, pp 1243–1256
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Following his university graduation Dr. Disch served his residency in the department of Professor NP Haas, at the Center for Musculoskeletal Surgery (CMSC), Charité University hospital, Berlin (Germany). Focusing on spinal disorders, he was awarded the 13 months AO Spine longterm fellowship, at the world spine center, University of Innsbruck/Austria in 2006. As a trauma and orthopaedic surgeon, he is in a team leading position at CMSC, responsible for degenerative, trauma and tumor spinal patient care. His clinical research activities are for example: the onco-surgical treatment strategies for spinal tumors, the influence of spinal fusions on alignment and motion and the importance of vertebral body augmentation techniques. He has published on various biomechanical topics dealing with spinal defect situations and the aspects of their reconstruction. He received his ‘habilitation’ on the “reconstruction of tumor associated thoraco-lumbar defects“ in 2010 and is a lecturer at the Humboldt University Berlin. He is currently preparing his PhD thesis on different grades of thoracolumbar defects and their influence on spinal stability. Together with Dr. Klaus-Dieter Schaser he is organiser and supervisor of the international ‘Charite Spine Tumor Days’ held every second year in Berlin (Germany).
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Disch, A.C., Druschel, C., Melcher, I. et al. En-bloc spondylectomy for thoracolumbar primary tumours and solitary metastases of the spine. ArgoSpine News J 23, 163–170 (2011). https://doi.org/10.1007/s12240-011-0030-x
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DOI: https://doi.org/10.1007/s12240-011-0030-x