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POSTERIORONLY APPROACH FOR TOTAL EN BLOC SPONDYLECTOMY FOR MALIGNANT PRIMARY SPINAL NEOPLASMS: ANATOMIC CONSIDERATIONS AND OPERATIVE NUANCES

Hsieh, Patrick C. M.D.; Li, Khan W. M.D.; Sciubba, Daniel M. M.D.; Suk, Ian B.Sc., B.M.C.; Wolinsky, Jean-Paul M.D.; Gokaslan, Ziya L. M.D.

Neurosurgery:
doi: 10.1227/01.NEU.0000345630.47344.17
SPINE: Operative Nuances
Abstract

MALIGNANT PRIMARY SPINAL tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. Total en bloc spondylectomy involves removal of vertebral segment(s) in whole to achieve wide tumor excision. Total en bloc spondylectomy can be performed through staged or combined anterior and posterior approaches, or from a posterior-only approach. The posterior-only approach offers the advantage of achieving complete tumor excision and circumferential spinal reconstruction in a single setting. In this report, we discuss the operative management of malignant primary vertebral tumors using the posterior-only approach for total en bloc spondylectomy. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.

Author Information

Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California (Hsieh)

Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Li) (Sciubba) (Suk) (Wolinsky) (Gokaslan)

Reprint requests: Patrick C. Hsieh, M.D., University of Southern California Keck School of Medicine, Department of Neurological Surgery, 1200 N. State Street, Suite 5046, Los Angeles, CA 90033. Email: phsieh@usc.edu

Received, August 12, 2008.

Accepted, December 11, 2008.

Copyright © by the Congress of Neurological Surgeons