Advertisement

Surgical Treatment of Primary Malignant Tumors

  • Branco Prpa
  • Robert F. McLain
Part of the Current Clinical Oncology book series (CCO)

Abstract

The primary goal of treatment for patients with malignant primary spine tumors is to provide cure, or the best chance of cure, if possible. If cure is not possible, we seek to palliate pain and provide early return to function and activity, to maintain or improve neurological function, and to provide a stable spinal column. The “upside” to an aggressive resection of a primary spinal malignancy has never been higher, making the “downside” to a poorly planned or executed surgery all the more unacceptable. With improved medical and radiotherapies, the treating physician now has the opportunity—and the obligation—to carefully tailor treatment to the biology and stage of each specific spine tumor (Table 1). The role of surgery differs depending on tumor type, stage, and location.

Keywords

Vertebral Body Pedicle Screw Spinal Metastasis Posterior Instrumentation Primary Malignant Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Enneking WF, Spanier SS, Goodmann MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980; 153:106–120.PubMedGoogle Scholar
  2. 2.
    Weinstein JN. Surgical approach to spine tumors. Orthopaedics 1989; 12:897–905.Google Scholar
  3. 3.
    Sundaresan N, Rosen G, Huvos AG, Krol G. Combined treatment of osteosarcoma of the spine. Neurosurgery 1988; 23:714–719.PubMedCrossRefGoogle Scholar
  4. 4.
    Weinstein JN, McLain RF. Primary tumors of the spine. Spine 1987; 12:843–851.PubMedCrossRefGoogle Scholar
  5. 5.
    Barwick KW, Huvos AG, Smith J. Primary osteogenic sarcoma of the vertebral column. Cancer 1980; 46:595–604.PubMedCrossRefGoogle Scholar
  6. 6.
    Shives TC, Dahlin DC, Sim FH, Pritchard DJ, Earle JD. Osteosarcoma of the spine. J Bone Joint Surg 1986; 68A:660–668.Google Scholar
  7. 7.
    Spiegel DA, Richardson WJ, Scully SP, Harrelson JM. Long-term survival following total sacrectomy with reconstruction for the treatment of primary osteosarcoma of the sacrum. A case report. J Bone Joint Surg 1999; 81:848–855.PubMedGoogle Scholar
  8. 8.
    Ozaki T, Flege S, Liljenqvist U, et al. Osteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group. Cancer 2002; 94:1069–1077.PubMedCrossRefGoogle Scholar
  9. 9.
    Grubb MR, Currier BL, Pritchard DJ, Ebersold MJ. Primary Ewing’s sarcoma of the spine. Spine 1994; 19:309–313.PubMedGoogle Scholar
  10. 10.
    Pilepich MV, Vietti TJ, Nesbit ME, et al. Ewing’s sarcoma of the vertebral column. Int J Radiat Oncol Biol Phys 1981; 7:27–31.PubMedGoogle Scholar
  11. 11.
    Poulsen JO, Jensen JT, Tommesen P. Ewing’s sarcoma simulating vertebra plana. Acta Orthop Scand 1975; 46:211–215.PubMedCrossRefGoogle Scholar
  12. 12.
    Hadfield MG, Quezado MM, Williams RL, Williams RL, Luo VY. Ewing’s family of tumors involving structures related to the central nervous system: a review. Pediatr Dev Pathol 2000; 3:203–210.PubMedCrossRefGoogle Scholar
  13. 13.
    Yamaguchi T, Yamato M, Saotome K. First histologically confirmed case of a classic chordoma arising in a precursor benign notochordal lesion: differential diagnosis of benign and malignant notochordal lesions. Skeletal Radiol 2002; 31:413–418.PubMedCrossRefGoogle Scholar
  14. 14.
    Boriani S, Chevalley F, Weinstein JN, et al. Chordoma of the spine above the sacrum: treatment and outcome in 21 cases. Spine 1996; 21:1569–1577.PubMedCrossRefGoogle Scholar
  15. 15.
    Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer 2000; 88:2122–2134.PubMedCrossRefGoogle Scholar
  16. 16.
    Dahlin DC. Bone Tumors: General Aspects and Data on 6,221 Cases. 3rd ed. Springfield, IL: Charles C. Thomas; 1978.Google Scholar
  17. 17.
    Shives TC, McLeod RA, Unni KK, Schray MF. Chondrosarcoma of the spine. J Bone Joint Surg 1989; 71:1158–1165.PubMedGoogle Scholar
  18. 18.
    Hermann G, Sacher M, Lanzieri CF, Anderson PJ, Rabinowitz JG. Chondrosarcoma of the spine: an unusual radiographic presentation. Skeletal Radiol 1985; 14:178–183.PubMedCrossRefGoogle Scholar
  19. 19.
    Stener B. Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg 1971; 53B:288–295.Google Scholar
  20. 20.
    Bergh P, Gunterberg B, Meis-Kindblom JM, Kindblom LG. Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a center-based study of 69 cases. Cancer 2001; 91:1201–1212.PubMedCrossRefGoogle Scholar
  21. 21.
    Boriani S, De Iure F, Bandiera S, et al. Chondrosarcoma of the mobile spine: report on 22 cases. Spine 2000; 25:804–812.PubMedCrossRefGoogle Scholar
  22. 22.
    York JE, Berk RH, Fuller GN, et al. Chondrosarcoma of the spine: 1954 to 1997. J Neurosurg 1999; 90:73–78.PubMedGoogle Scholar
  23. 23.
    Valderrama JAF, Bullough PG. Solitary myeloma of the spine. J Bone Joint Surg 1998; 50B:82–90.Google Scholar
  24. 24.
    McLain RF, Weinstein JN. Solitary plasmacytomas of the spine: a review of 84 cases. J Spinal Disord 1989; 2:69–74.PubMedCrossRefGoogle Scholar
  25. 25.
    Talac R, Yaszemski MJ, Currier BL, et al. Relationship between surgical margins and local recurrence in sarcomas of the spine. Clin Orthop 2002; 397:127–132.PubMedCrossRefGoogle Scholar
  26. 26.
    Abdel-Wanis MS, Kawahara N, Murata A, et al. Thyroid cancer spinal metastases: report on 25 operations in 14 patients. Anticancer Res 2002; 22:2509–2516.PubMedGoogle Scholar
  27. 27.
    Bohm P, Huber J. The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg 2002; 84:521–529.CrossRefGoogle Scholar
  28. 28.
    Jackson RJ, Gokaslan ZL, Loh SC. Metastatic renal cell carcinoma of the spine: surgical treatment and results. J Neurosurg 2001; 94:18–24.PubMedGoogle Scholar
  29. 29.
    Murakami H, Kawahara N, Abdel-Wanis ME, Tomita K. Total en bloc spondylectomy. Semin Musculoskel Radiol 2001; 5:189–194.CrossRefGoogle Scholar
  30. 30.
    Nakai S, Yoshizawa H, Kobayashi S, Maeda K, Okumura Y. Anorectal and bladder function after sacrifice of the sacral nerves. Spine 2000; 25:2234–2239.PubMedCrossRefGoogle Scholar
  31. 31.
    Raque GH Jr, Vitaz TW, Shields CB. Treatment of neoplastic diseases of the sacrum. J Surg Oncol 2001; 76:301–307.PubMedCrossRefGoogle Scholar
  32. 32.
    Boland PJ, Lane JM, Sundaresan N. Metastatic disease of the spine. Clin Ortho 1982; 169:95–102.Google Scholar
  33. 33.
    Harrington KD. Metastatic disease of the spine. J Bone Joint Surg 1986; 68:1110–1115.PubMedGoogle Scholar
  34. 34.
    Constans JP, Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations: review of 600 Cases. J Neurosurg 1983; 59:111–118.PubMedGoogle Scholar
  35. 35.
    Helweg-Larsen S, Sorensen PS, Kreiner S. Prognostic factors in metastatic spinal cord compression: a prospective study using multivariate analysis of variables influencing survival and gait function in 153 patients. Int J Radiat Oncol Biol Phys 2000; 46:1163–1169.PubMedGoogle Scholar
  36. 36.
    Tatsui H, Onomura T, Morishita S, Oketa M, Inoue T. Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation. Spine 1996; 21:2143–2148.PubMedCrossRefGoogle Scholar
  37. 37.
    Harrington KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Ortho 1988; 233:177–197.Google Scholar
  38. 38.
    Klekamp J, Samii H. Surgical results for spinal metastases. Acta Neurochir 1998; 140:957–967.CrossRefGoogle Scholar
  39. 39.
    Kostuik JP. Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation, results. Spine 1983; 8:512–531.PubMedCrossRefGoogle Scholar
  40. 40.
    Gokaslan ZL, York JE, Walsh GL, et al. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg 1998; 89:599–609.PubMedGoogle Scholar
  41. 41.
    Kanayama M, Ng JTW, Cunningham BW, Abumi K, Kaneda K, McAfee PC. Biomechanical analysis of anterior versus circumferential spinal reconstruction for various anatomic stages of tumor lesions. Spine 1999; 24:445–450.PubMedCrossRefGoogle Scholar
  42. 42.
    Akeyson EW, McCutcheon IE. Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg 1996; 85:211–220.PubMedCrossRefGoogle Scholar
  43. 43.
    Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine 2000; 25:2240–2250.PubMedCrossRefGoogle Scholar
  44. 44.
    McLain RF. Endoscopically assisted decompression for metastatic thoracic neoplasms. Spine 1998; 23:1130–1135.PubMedCrossRefGoogle Scholar
  45. 45.
    Boriani S, Biagini R, De Iure F, et al. En bloc resections of bone tumors of the thoracolumbar spine: a preliminary report on 29 patients. Spine 1996; 21:1927–1931.PubMedCrossRefGoogle Scholar
  46. 46.
    Fourney DR, Abi-Said D, Rhines LD, et al. Simultaneous anteriorposterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. J Neurosurg 2001; 94:232–244.PubMedGoogle Scholar
  47. 47.
    Heary RF, Vaccaro AR, Benevenia J, Cotler JM. En bloc vertebrectomy in the mobile lumbar spine. Surg Neurol 1998; 50:548–556.PubMedCrossRefGoogle Scholar
  48. 48.
    Krepler P, Windhager R, Bretschneider W, Toma CD, Kotz R. Total vertebrectomy for primary malignant tumours of the spine. J Bone Joint Surg 2002; 84:712–715.CrossRefGoogle Scholar
  49. 49.
    Tomita K, Kawahara N, Baba H, Tsuchiya H, Fujita T, Toribatake Y. Total en bloc spondylectomy: a new surgical technique for primary malignant vertebral tumors. Spine 1997; 22:324–333.PubMedCrossRefGoogle Scholar
  50. 50.
    Fourney DR, Abi-Said D, Lang FF, McCutcheon IE, Gokaslan ZL. Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures. J Neurosurg 2001; 94:25–37.PubMedGoogle Scholar
  51. 51.
    McLain RF, Sparling E, Benson DR. Failure of short segment pedicle instrumentation in thoracolumbar fractures: complications of Cotrel-Dubousset instrumentation. J Bone Joint Surg 1993; 75:162.PubMedGoogle Scholar
  52. 52.
    Jang JS, Lee SH, Rhee CH, Lee SH. Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors. Technical note. J Neurosurg 2002; 96:131–134.PubMedGoogle Scholar
  53. 53.
    Caspar W, Pitzen T, Papavero L, Geisler FH, Johnson TA. Anterior cervical plating for the treatment of neoplasms in the cervical vertebrae. J Neurosurg 1999; 90:27–34.PubMedGoogle Scholar
  54. 54.
    Miller DJ, Lang FF, Walsh GL, Abi-Said D, Wildrick DM, Gokaslan ZL. Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection. J Neurosurg 2000; 93:181–190.Google Scholar
  55. 55.
    Akamaru T, Kawahara N, Tsuchiya H, Kobayashi T, Murakami H, Tomita K. Healing of autologous bone in a titanium mesh cage used in anterior column reconstruction after total spondylectomy. Spine 2002; 27:E329–E333.PubMedCrossRefGoogle Scholar
  56. 56.
    Munting E, Faundez A, Manche E. Vertebral reconstruction with cortical allograft: long-term evaluation. Eur Spine J 2001; 10:S153–S157.PubMedCrossRefGoogle Scholar
  57. 57.
    Hall DJ, Webb JK. Anterior plate fixation in spine tumor surgery. Indications, technique, and results. Spine 1991; 16:580–583.CrossRefGoogle Scholar
  58. 58.
    Boriani S, Biagini R, Bandiera S, Gasbarrini A, De LF. Reconstruction of the anterior column of the thoracic and lumbar spine with a carbon fiber stackable cage system. Orthopedics 2002; 25:37–42.PubMedGoogle Scholar

Copyright information

© Humana Press, Inc., Totowa, NJ 2006

Authors and Affiliations

  • Branco Prpa
    • 1
  • Robert F. McLain
    • 2
  1. 1.Department of Orthopaedic SurgeryThe Cleveland Clinic FoundationCleveland
  2. 2.Lerner College of Medicine and The Cleveland Clinic Spine Institute Department of Orthopaedic SurgeryThe Cleveland Clinic FoundationCleveland

Personalised recommendations