TOTAL EN-BLOC SPONDYLECTOMY - A NEW SURGICAL TECHNIQUE FOR PRIMARY MALIGNANT VERTEBRAL TUMORS

Study Design. The study of seven patients with primary malignant or be nign aggressive tumors who underwent a new aggressive surgical techniq ue termed ''total en bloc spondylectomy'' is reported. Objectives. To report a new surgical technique of total en bloc spondylectomy for com plete resection of primary spinal malignancy and for oncologic curabil ity. Summary of Background Data. The conventional approach for primary spinal malignancy is via intralesional piecemeal resection, and very few reports have described en bloc extralesional resectioning with his topathologically wide or marginal surgical margins. Methods. Total en bloc spondylectomy, consisting of en bloc laminectomy and en bloc corp ectomy followed by anterior instrumentation with spacer grafting and p osterior spinal instrumentation. was performed in five patients with p rimary malignant tumors and two patients with giant cell tumors. Patie nts were observed for 2 years to 6.5 years, except for one patient who died 7 months after surgery because of a mediastinal metastasis. Resu lts. All patients, except one, attained significant clinical improveme nt after surgery with no major complications. Histologically, the marg ins were wide or marginal except for the pedicles, and occasionally th e spinal canal and the posterior, where they were accepted to be intra lesional. One patient died of metastasis that was not directly related to surgery itself. There was no local recurrence. Conclusions. The ad vantages of total en bloc spondylectomy include resection of the invol ved vertebra(e) in two major blocs, rather than in a piecemeal pattern , and completion of the procedure during one surgical session posterio rly. The ''total en bloc spondylectomy'' offers one of the most aggres sive modes of therapy for primary spinal malignancy.