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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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REFERENCES
1). Roy-Camille R, Mazel CH, Sailant G, Lapresle PH. Treatment of malignant tumors of the spine with posterior instrumentation. (in Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI(eds), Tumor of the spine. WB saunders. Philadelphia. 473–487. 1990.
2). Stener B. Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg. 1971; 53-B:288–295.
3). Sundaresan N, DiGiacinto GV, Krol G, et al. Spondylectomy for malignant tumors of the spine. J Clin Oncol. 1989; 7:1485–1491.
4). Abe E, Sato K, Tazawa H, et al. Total spondylectomy for primary tumor of the thoracolumbar spine. Spinal Cord. 2000; 38:146–152.
5). Lubicky JP, Patel NS, DeWald RL. Two-stage spondylectomy for giant cell tumor of L4. A case report. Spine. 1983; 8:112–115.
6). Tomita K, Kawahara N, Baba H, et al. Total en bloc spondylectomy: A new surgical technique for primary malignant vertebral tumors. Spine. 1997; 22:324–333.
7). De Wald RL, Bridwell KH, Prodromas C, Rodts MF. Reconstructive spinal surgery as palliation for metastatic malignancies of the spine. Spine. 1985; 10:21–26.
8). Solini A, Paschero B, Orsini G, Guerico N. The surgical treatment of metastatic tumors of the lumbar spine. Ital J Orthop Traumatol. 1985; 11:427–442.
9). McAfee PC, Zdeblick TA. Tumors of the thoracic and lumbar spine: Surgical treatment via the anterior approach. J Spinal Disord. 1989; 2:145–154.
10). Frankel HL, Hancock DO, Hyslop G, et al. The value of postual reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia. 1969; 7:179–192.
11). Paul LA. Metastatic disease of the spine. (in Bridwell KH and DeWald RL eds, The Textbook of Spinal Surgery. 2nd ed.Philadelphia: Lippincott-Raven;p. 2027–2033. 1997.
12). Kim WJ. Spinal tumors. (in Suk SI: Spinal Surgery. 436–469. 1997.
13). Savini R, Gherlinzoni F, Morandi M, et al. Surgic al treatment of giant-cell tumor of the spine. The experience at the Istituto Ortopedico Rizzoli. J Bone Joint Surg. 1983; 65-A:1283–1289.
14). Boriani S, Biagini R, De Lure F, et al. En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report. Spine. 1996; 21:1927–1931.
15). Van Dijk M, Cuesta MA, Wuisman PIJM. Thorascopi -cally assisted total en bloc spondylectomy: two-case report. Surg Endosc. 2000; 14:849–852.
16). Chung JY. Spinal tumors. J Kor Spine Surg. 1999; 6:316–325.
17). Tomita K, Kawahara N, Kobayashi T, et al. Surgi cal Strategy for Spinal Metastases. Spine. 2001; 26:298–306.
18). Kostuik JP, Errico TJ, Gleason TF, et al. Spinal stabilization of vertebral column tumors. Spine. 1988; 13:250–256.
19). Harrington KD. Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg. 1984; 61:107–117.
20). Hosono N, Yonenobu K, Fuji T, Ebara S, Tamoshita K, Ono K. Orthopedic management of spinal metastasis. Clin Orthop. 1995; 312:148–159.
21). Eric M, Laurence DR, Jeffrey SW, Ziya LG. Total en bloc lumbar spondylectomy. J Neurosurg. 2001; 95:264–269.
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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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