"En-bloc" vertebrectomy in the mobile lumbar spine

BACKGROUND Primary tumors of the vertebral bodies have previously been treated with to tal or subtotal excision in a piecemeal fashion (intralesional excision). R adiation therapy has been used to help control tumor growth, Recurrence rat es with an intralesional, piecemeal removal of vertebral tumors have been u nacceptably high. This study describes a method to excise a lumbar vertebra "en-bloc," and in the process, to perform a marginal (extralesional) resec tion of a primary tumor of the mobile lumbar spine that allows for a potent ial surgical cure. METHODS A combined posterior-anterior procedure allows for an extralesional, margin al resection of the tumor and the involved vertebra. All posterior bony ele ments, including the pedicles and the adjacent intervertebral discs, are re moved via a posterior approach. An anterior, retroperitoneal approach is th en used to remove the vertebral body/tumor as a single specimen. The nerve roots at the involved levels are spared and the spine is instrumented and f used both posteriorly and anteriorly. RESULTS Three patients successfully had combined posterior-anterior resections of l umbar vertebral chordomas. No permanent neurological complications occurred . Overall morbidity of the procedure was acceptable. At 31-month follow-up, no tumor recurrence has been detected. CONCLUSIONS "En-bloc" resection of a primary vertebral tumor of the lumbar spine is tec hnically demanding, but potentially curative. The alternative approaches-in tralesional excision, radiation therapy, or a combination-are unable to cur e these tumors. Long-term, 10-year follow-up will be necessary to confirm w hether this en-bloc approach provides a surgical cure. (C) 1998 by Elsevier Science Inc.