Indications and results of combined anterior-posterior approaches for spine tumor surgery

Abstract

Spinal instrumentation currently allows gross-total resection and reconstruction in cases of malignancies at all levels of the spine. The authors analyzed the results in 110 patients who underwent surgery for primary and metastatic spinal tumors over a 5 year period (1989–1993) at a single institution. Major primary sites of tumor included breast (14 cases), chordoma (14 cases), lung (12 cases), kidney (11 cases), sarcoma (13 cases), plasmacytoma (10 cases), and others (36 cases). Prior to surgery, 55 patients (50%) had received prior treatment. Forty eight patients (44%) were nonambulatory, and severe paraparesis was present in 20 patients. Fifty three patients (48%) underwent combined anterior-posterior resection and instrumentation, 33 (30%) underwent anterior resection with instrumentation, 18 (16%) underwent anterior or posterior resection alone, and the remaining six patients (5%) underwent posterior resection and instrumentation. Major indications for anterior-posterior resection included three-column involvement, high-grade instability, involvement of contiguous vertebral bodies, and solitary metastases. Postoperatively, 90 patients improved neurologically. The overall median survival was 16 months, with 46% of patients surviving 2 years. Fifty-three patients (48%) suffered postoperative complications. Despite the high incidence of complications, the majority of patients reported improvement in their quality of life at follow-up review. Our findings suggest that half of all patients with spinal malignancies require combined anterior-posterior surgery for adequate tumor removal and stabilization.

Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas

“…Before the development of specialized surgical techniques to remove sacral and spinal tumors, adequate surgical margins could not be achieved. [15][16][17][32][33][34] These factors partially account for the high rate of local recurrence and low survival rate of patients with chondrosarcomas in these sites. Moreover, the surgical expertise required to remove axial chondrosarcomas is relatively rare and usually found only at centralized tumor treatment centers.…”

Ligation and Partial Excision of the Cauda Equina as Part of a Wide Resection of Vertebral Osteosarcoma: A Case Report and Description of Surgical Technique

“…22 Similar trends have been previously reported in the literature. 5,21,23,24 In that same study, a relationship was also found between type of resection and rate of local recurrence, showing en bloc resection with negative margins lead to a recurrence rate of 11%, as compared to 33% for piecemeal resection with negative margins. Other reports have shown that failure to achieve negative margins will significantly increase the risk of local recurrence.…”

Il trattamento delle metastasi vertebrali

“…Le tecniche chirurgiche impiegate nel trattamento delle metastasi vertebrali possono essere classificate come segue: decompressione e stabilizzazione, escissione intralesionale ("cu- rettage", "debulking") o resezione in blocco, seguite da varie procedure ricostruttive. Queste tecniche chirurgiche possono essere eseguite con accesso anteriore, posteriore o combinato [1,2,14,15].…”