En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the “rotation–reversion” technique: Feasibility, safety, and clinical outcome of 11 cases

Abstract

BackgroundEn bloc resection of spinal tumors provides better local control and survival outcomes than intralesional resection. Safe margins during en bloc resection of primary spinal tumors with epidural involvement are required for improved outcomes. The present study describes a “rotation–reversion” technique that has been used for en bloc resection of huge primary tumors in the mobile spine with epidural involvement and reported the clinical outcomes in these patients.MethodsAll patients with primary spinal tumors who were treated with the rotation–reversion technique at our institution between 2015 and 2021 were evaluated retrospectively. Of the patients identified, those with both huge extraosseous soft-tissue masses and epidural involvement were selected for a case review. Clinical and radiological characteristics, pathologic findings, operative procedures, complications, and oncological and functional outcomes of these patients were reviewed.ResultsOf the 86 patients identified with primary spinal tumors who underwent en bloc resection using the rotation–reversion technique between 2015 and 2021, 11 had huge extraosseous soft-tissue masses with epidural involvement in the mobile spine. The average maximum size of these 11 tumors was 8.1 × 7.5 × 9.7 cm. Median follow-up time was 28.1 months, mean operation time was 849.1 min (range 465–1,340 min), and mean blood loss was 6,972.7 ml (range 2,500–17,700 ml), with 10 (91%) of the 11 patients experiencing perioperative complications. The negative margin rate was 91%, with only one patient (9%) experiencing local recurrence. Ten patients were able to walk normally or with a crutch at the last follow-up, whereas one was completely paralyzed preoperatively.ConclusionThe rotation–reversion technique is an effective procedure for the en bloc resection of huge primary spinal tumors, with the extension of invasion in selected patients including not only the vertebral body but also the pedicle and part of the posterior arch.

Philosophies and Surgical Techniques for Ewing’s Sarcoma of Spine with Review of Literature

“…Their experience, acceptance, and consent of the functional loss are necessary to execute the plan for disease control and long-term survival. The full extent of the surgical management of each vertebral segment is beyond the scope of this review article, although we tried to review it here briefly [ 21 , 22 ].…”

“…A recent study by Harrop et al [ 21 ] in aggressive osteoblastomas and giant cell tumors of the thoracic and lumbar spine demonstrated that en bloc resection is strongly recommended to minimize the risk of local recurrence when anatomically achievable.…”

“…Either chemotherapy first followed by surgery or immediate primary surgery followed by chemotherapy. Both approaches aim for the local control of the ES and achieve the primary goal of the treatment; the literature evidence is still lacking and needs to be addressed in future [ 21 , 22 , 25 , 26 ].…”

Ewing’s Sarcoma of Spine-Current Concepts and Review of literature

“…The resection will be called as 'intralesional' when the surgeon incidentally or intentionally violates the tumor. Intentional intralesional resection comes in scenarios where a surgical margin requires resection of functional tissues like a nerve, nerve sheath, dura, thoracic duct, or a major vessel as it lies close to the tumor or is infiltrated by the tumor or patient presents with acute neurological deficit secondary to epidural compression [11][12][13][21][22][23].…”