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Abstract
Purpose
To evaluate the efficacy of a total en bloc spondylectomy in solitary metastatic spinal tumors.
Summery of Literature Review
In a conventional operation of a spinal metastatic tumor it is difficult to perform a wide excision, and several reports have suggested a total en bloc spondylectomy for wide or marginal resections.
Materials and Methods
Ten patients, with solitary spinal metastasis, were underwent a total en bloc spondylectomy, with a mean followup of 15 months. The locations of the tumors were the thoracic spine and lumbar spine in 4 and 6 cases, respectively. The clinical and radiological outcomes were assessed using the McA fee pain scale, Frankel neurologic grading, radiological extent of the lesion and local recurrence. Metastatic spinal tumors were classified by the system of Tomita. A pathological study of the resected vertebra was performed to evaluate the surgical margin.
Results
The preoperative back pain was grades IV, III, II and 0 in 4, 3, 2 and 1 case, respectively. The postoperative back pain was grades III, I and 0 in 3, 1 and 6 cases by the McA fee pain scale, respectively. The neurologic deficit was improved completely in all cases. There were 3 and 7 cases of types 4 and 5 by the Tomita’s classification, respectively. The pathological results were wide margin and marginal margin in 4 and 6 cases, respectively. There were no local recurrences at the time of the last followup.
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Figures and Tables%
Fig. 1.
65-year-old man who had a bladder cancer (A) Preoperative radiographs shows destruction of both pedicle of T7. (B) Axial and sagittal MR image demonstrate solitary T7 metastasis and Tomita type 5. (C) Radiographs of 1 year 3 months after operation shows no evidence of local recurrence. (D) Photograph and radiograph of the excised T7 vertebra.
Fig. 2.
55-year-old man who had a cholangiocarcinoma. (A) Preoperative radiography shows destruction of right pedicle at L5. T1WI sagittal(B) and axial(C) MR image demonstrates solitary mass of L5 and Tomita type 5. (D) Radiograph of 2 year 9 months after operation shows no evidence of local recurrence. (E) Radiograph and photograph of the excised L5 vertebra.
Table 1.
4 point scale by McAfee9)
Table 2.
Neurologic status change: Classification by Frankel10)
Table 3.
Tomita's surgical classification of spinal tumors6)
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