Total en bloc spondylectomy for spinal tumours: Technical aspects and surgical details

• Published in: Neurocirugía (Asturias, Spain) Spain), 2017-03, Vol.28 (2), p.51-66
• Main Authors: Delgado-López, Pedro David, Rodríguez-Salazar, Antonio, Martín-Velasco, Vicente, Castilla-Díez, José Manuel, Martín-Alonso, Javier, Galacho-Harriero, Ana, Gil-Polo, Cecilia, Araus-Galdós, Elena
• Format: Article
• Language: eng ; spa
• Subjects: En bloc spondylectomy; Extirpación radical; Radical resection; Spinal tumour; Surgical technique; Tomita; Total vertebrectomy; Tumor vertebral; Técnica quirúrgica; Vertebrectomía en bloque; Vertebrectomía total
• ISSN: 2529-8496; 1130-1473; 2529-8496
• DOI: 10.1016/j.neucie.2016.07.002

To describe the specific surgical details and report the lessons learned with a series of patients suffering from spinal tumours that underwent total en bloc spondylectomy (TES). A retrospective case series review is presented, together with an analysis of the clinical and technical variables, as well as the outcomes. A total of 10 patients underwent TES (2000–2016) for primary (osteosarcoma, chondrosarcoma, fibrosarcoma and chordoma) and secondary spinal tumours (lung, breast, thyroid, oesophagus, and meningioma metastases). According to the Tomita classification, 2 patients had intra-compartmental tumours, and the rest presented as extra-compartmental. All patients experienced an improvement in their pain level after surgery. Nine patients preserved ambulation post-operatively and one patient developed paraplegia. Six patients needed subsequent operations for wound debridement, tumour recurrence, or revision of the fixation. Other complications included pneumothorax, pleural effusion and venous thrombosis. Four patients remain alive (4 months to 15 years follow-up). The rest died due to primary tumour progression (6.5 months to 12 years). A detailed description of the surgical steps, tips, and pitfalls is provided. Modifications of the technique and adjuncts to resection are commented on. Observation of some considerations (selection of candidates, careful blunt vertebral dissection, strict blood loss control, careful handling of the spinal cord, and maintenance of the radical resection concept at all stages) is key for a successful operative performance. TES is a paradigmatic operation, in which the concept of radical resection provides functional effectiveness and improves survival in selected patients suffering from spinal tumours. Our preliminary experience allows us to highlight some specific and relevant features, especially those favouring a simpler and safer operation. Describir detalles quirúrgicos específicos y comentar algunas lecciones aprendidas, a partir de una serie de pacientes con tumores vertebrales a los que se les practicó una vertebrectomía total en bloque (VTB). Presentamos una serie retrospectiva de casos. Se analizan variables clínicas, técnicas y de resultado. Se intervinieron 10 pacientes (2000-2016) mediante VTB por tumor primario vertebral (osteosarcoma, condrosarcoma, fibrosarcoma y cordoma) o secundario (pulmón, mama, tiroides, esófago y meningioma). Según la clasificación de Tomita, 2 pacientes presentaban lesiones intracom