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The Surgical Management of Primary Tumorsof the Spine: Initial Results of an Ongoing Prospective Cohort Study

Fisher, Charles G., MD, MHSc; Keynan, Ory, MD; Boyd, Michael C., MD; Dvorak, Marcel F., MD

doi: 10.1097/01.brs.0000174114.90657.74
Surgery
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Study Design. Prospective cohort study.

Objectives. To prospectively validate the application of appendicular surgical oncology principles to the treatment of primary bone tumors of the spine at a quaternary care spine center using local recurrence, survival, and health-related quality of life as outcome measures.

Summary of Background Data. There is clear evidence that violating the margins of a sarcoma or other malignancy during surgical resection will risk local recurrence and diminish overall survival. Previous publications have retrospectively demonstrated this oncologically sound approach to spine tumor management to be internally valid. The external validity or limited generalizability has not been assessed.

Methods. Included were all patients who underwent en bloc surgical resection of a primary tumor of the spine between January 1994 and November 2003, at the authors’ institution. Patients were uniformly staged before surgery and baseline demographic and surgical variables were recorded, as well as a cross-sectional evaluation of generic health-related quality of life.

Results. Twenty-six patients (12 males and 14 females) were eligible for the study. Average age was 42 (range 16 to 70). There were 19 malignant tumors and 7 benign. There are 20 surviving patients with an average follow-up of 41.5 months (range 6 to 111 months), 15 of whom had malignant tumors. None of these patients have evidence of local recurrence, and one has evidence of systemic disease. The health-related quality of life, using the SF-36, shows acceptable morbidity of these procedures (physical component summary = 37.73 ± 11.52, MCS = 51.69 ± 9.54).

Conclusions. Principles of wide surgical resection, commonly applied in appendicular oncology, can and should be used for the treatment of primary bone tumors of the spine with anticipated acceptable morbidity and satisfactory survival.

A prospective cohort study was conducted to validate the application of appendicular surgical oncology principles to the treatment of primary bone tumors of the spine at a quaternary care spine center using local recurrence, survival, and health-related quality of life as outcome measures.

From the Division of Spine, Department of Orthopaedics, University of British Columbia and the Combined Neurosurgical and Orthopaedic Spine Program at the Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.

Acknowledgment date: June 15, 2004. First revision date: August 25, 2004. Second revision date: September 17, 2004. Acceptance date: September 20, 2004.

The study was performed at the Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and requests for reprints to Charles G. Fisher, MD, Vancouver Hospital & Health Sciences Centre, Spine Program, D6–2733 Heather Street, Vancouver, B.C. V5Z 3J5; E-mail: cfisher@vanhosp.bc.ca

© 2005 Lippincott Williams & Wilkins, Inc.