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Abstract
Objectives
To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy.
Summary of Literature Review
A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for vari-ous spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications.
Material and Methods
Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparo-scopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow- up period was 19 months.
Results
Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. A t the last follow- up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction.
Conclusion
Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
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Fig. 1.
Preoperative radiographic studies of case 1. AP (A) and lateral (B) plain roentgenographs show radiopacity at left sided upper half of sacrum. Sagittal MRI (C) shows the involvement of tumor at mid sacrum and axial MRI (D, E) show that the tumor involves especially in left side of sacrum.
Fig. 2.
Postoperative AP (A) and lateral (B) features of case 1. Sacrum is totally excised including both sacroiliac joints. The strut allograft is inserted thorough to both iliac wings and the instrumented reconstruction is done. At latest follow-up, union of grafted site and the maintenance of construct is seen (C).
Fig. 3.
Preoperative radiographic studies of case 2. AP (A) and lateral (B) plain roentgenographs show radiolucency at the lower half of sacrum. Sagittal T-2 weighted MRI (C), aixal T-1 weighted MRI (D), and axial T-2 weighted MRI (E) show the that the tumor mass is arising from lower sacrum and expending into the pelvic cavity.
Fig. 4.
Postoperative AP (A) and lateral (B) features of case 2. Sacrum and coccyx are totally excised from S3 level. At latest follow-up AP (C) and lateral (D) films show no definite change at operative site.
Fig. 5.
Preoperative radiographic studies of case 3. AP (A) and lateral (B) plain roentgenographs show radiolucency at T10 vertebra including right pedicle. Sagittal T-2 weighted MRI (C), aixal T-2 weighted MRI (D), and axial T-1 weighted MRI (E) show the that the tumor mass involves entire T10 vertebral body, right sided pedicle, and the proximal portion of right sided 10th rib. The mass is protruding into the spinal canal and the spinal cord is compressed by tumor mass.
Fig. 6.
Postoperative AP (A) and lateral (B) features of case 3. T10 vertebra and tumor mass are totally excised including proximal portion of both sided 10th ribs. At latest AP (C) and lateral (D) films show the union of lower side of allograft. At upper portion of allograft. there is no definite union but the evidence of healing can be found. The total feature of reconstruction is well maintained.
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