Total En Bloc Spondylectomy

医学 外科 椎体切除术 恶性肿瘤 椎板切除术 椎体切除术 椎骨 关节融合术 椎管 减压 转移 脊髓 癌症 替代医学 病理 内科学 精神科
作者
Katsuro Tomita,Norio Kawahara,H. Baba,Hiroyuki Tsuchiya,Takuya Fujita,Yasumitsu Toribatake
出处
期刊:Spine [Lippincott Williams & Wilkins]
卷期号:22 (3): 324-333 被引量:486
标识
DOI:10.1097/00007632-199702010-00018
摘要

The study of seven patients with primary malignant or benign aggressive tumors who underwent a new aggressive surgical technique termed "total en bloc spondylectomy" is reported.To report a new surgical technique of total en bloc spondylectomy for complete, resection of primary spinal malignancy and for oncologic curability.The conventional approach for primary spinal malignancy is via intralesional piecemeal resection, and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.Total en bloc spondylectomy, consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation, was performed in five patients with primary malignant tumors and two patients with giant cell tumors. Patients were observed for 2 years to 6.5 years, except for one patient who died 7 months after surgery because of a mediastinal metastasis.All patients, except one, attained significant clinical improvement after surgery with no major complications. Histologically, the margins were wide or marginal except for the pedicles, and occasionally the spinal canal and the posterior, where they were accepted to be intralesional. One patient died of metastasis that was not directly related to surgery itself. There was no local recurrence.The advantages of total en bloc spondylectomy include resection of the involved vertebra(e) in two major blocs, rather than in a piecemeal pattern, and completion of the procedure during one surgical session posteriorly. The "total en bloc spondylectomy" offers one of the most aggressive modes of therapy for primary spinal malignancy.
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