En-bloc spondylectomy for thoracolumbar primary tumours and solitary metastases of the spine

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.