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"En-bloc" vertebrectomy in the mobile lumbar spine
R F Heary1, A R Vaccaro, J Benevenia
1Division of Neurological Surgery, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark, USA.
Surgical Neurology
|December 31, 1998
Summary
En-bloc resection of lumbar spine tumors offers a potential surgical cure, unlike intralesional excision. This advanced technique shows promising results with no recurrence in early follow-up.
Area of Science:
- Spine surgery
- Surgical oncology
- Orthopedic oncology
Background:
- Primary vertebral tumors historically treated with intralesional excision, leading to high recurrence rates.
- Radiation therapy offers limited control for vertebral tumors.
- Previous piecemeal tumor removal methods were insufficient for a surgical cure.
Observation:
- A novel combined posterior-anterior approach for en-bloc resection of lumbar vertebral tumors.
- This technique facilitates marginal (extralesional) resection of the tumor and involved vertebra.
- Nerve roots are preserved, and spinal stability is achieved through combined posterior and anterior instrumentation and fusion.
Findings:
- Successful en-bloc resection in three patients with lumbar vertebral chordomas.
- No permanent neurological complications were observed.
- Absence of tumor recurrence at a mean follow-up of 31 months, with acceptable overall morbidity.
Implications:
- En-bloc resection is a technically demanding but potentially curative option for primary lumbar spine tumors.
- This approach may overcome the limitations of intralesional excision and radiation therapy.
- Long-term follow-up is crucial to confirm the sustained efficacy of this surgical cure.