En Bloc Resection of Solitary Functional Secreting Spinal Metastasis

Abstract

Study Design Literature review. Objective Functional secretory tumors metastatic to the spine can secrete hormones, growth factors, peptides, and/or molecules into the systemic circulation that cause distinct syndromes, clinically symptomatic effects, and/or additional morbidity and mortality. En bloc resection has a limited role in metastatic spine disease due to the current paradigm that systemic burden usually determines morbidity and mortality. Our objective is to review the literature for studies focused on en bloc resection of functionally active spinal metastasis as the primary indication. Methods A review of the PubMed literature was performed to identify studies focused on functional secreting metastatic tumors to the spinal column. We identified five cases of patients undergoing en bloc resection of spinal metastases from functional secreting tumors. Results The primary histologies of these spinal metastases were pheochromocytoma, carcinoid tumor, choriocarcinoma, and a fibroblast growth factor 23–secreting phosphaturic mesenchymal tumor. Although studies of en bloc resection for these rare tumor subtypes are confined to case reports, this surgical treatment option resulted in metabolic cures and decreased clinical symptoms postoperatively for patients diagnosed with solitary functional secretory spinal metastasis. Conclusion Although the ability to formulate comprehensive conclusions is limited, case reports demonstrate that en bloc resection may be considered as a potential surgical option for the treatment of patients diagnosed with solitary functional secretory spinal metastatic tumors. Future prospective investigations into clinical outcomes should be conducted comparing intralesional resection and en bloc resection for patients diagnosed with solitary functional secretory spinal metastasis.

Malignant pheochromocytoma with multiple vertebral metastases causing acute incomplete paralysis during pregnancy

“…Since metastatic lesions are endocrinologically active, any stimulation bears a huge risk of unwanted release of catecholamine, resulting in hemodynamic complications. [ 16 ] Accordingly, we believe that changes in the intra-abdominal pressure or direct compression of the tumor by the enlarged uterus could have caused catecholamines to be released from the tumor, leading to the elevated blood pressure observed in our patient.…”

A blinded study using laser induced endogenous fluorescence spectroscopy to differentiate ex vivo spine tumor, healthy muscle, and healthy bone

“…Future studies should evaluate TumorID's ability to serve as an adjunctive tool for intraoperative assessment of surgical margins and surgical decision-making.Spinal tumors represent a heterogenous population of neoplasms categorized as primary or metastatic lesions 1,2 . Surgical resection remains a mainstay of treatment for the majority of spine tumors, with identification of normal versus tumor involved tissue being the most important determinant of recurrence, and for primary tumors, potential cure 3,4 . Extent of resection is often based on interpretation of pre-operative imaging, principles of intraoperative resection, and histopathologic review of the resected tissue.…”

Total en bloc spondylectomy

“…Conversely metastatic spine disease is a significant health burden. Ten percent to 30% of patients with metastatic disease to the spine will be symptomatic, and up to 90% of patients with terminal disease demonstrate evidence of spinal metastases (3). Almost exclusively metastatic spinal disease is not suitable for TES, whereas in many cases of primary spinal tumours, radical resection has been proven to be the most important factor influencing the oncological outcome (4).…”