title: Margin-free spondylectomy for extended malignant spine tumors: surgical technique and outcome of 13 cases.
abstract: METHODS
  Description of surgical technique and retrospective review of 13 cases.
  
  
  OBJECTIVE
  To describe the surgical technique of margin-free spondylectomy and the outcome of 13 cases and to discuss the advantages and limitations of the procedure.
  
  
  BACKGROUND
  Recently, spondylectomy became a standard procedure by several pioneers. For extended malignant spine tumors involving pedicles or epidural space, however, performing an "en bloc" resection with a tumor-free margin remains a challenge.
  
  
  METHODS
  Our procedure consists of a combined anterior and posterior procedure with one or two stages. In the anterior procedure, tumor vertebrae are covered by the pleura or psoas muscles as a barrier. The posterior procedure includes decompression through the intact posterior elements, coverage of the tumor with all possible soft tissue barriers, and en bloc extirpation by rotating the tumor vertebrae around the spinal cord. We performed this procedure in 13 cases: 3 chondrosarcoma, 3 giant cell tumor, 1 osteosarcoma, 1 chordoma, and 5 metastases.
  
  
  RESULTS
  Neurologic status and pain improved in all cases except asymptomatic cases. There was no local recurrence, except in 2 cases (chondrosarcoma with extirpation of 5 vertebrae, chordoma with multiple previous surgeries). Two cases of chondrosarcoma were disease-free 14 years and 13 years after surgery, respectively.
  
  
  CONCLUSIONS
  Although the best chance for a cure in extended malignant tumors of the spine is realized through wide resection, the procedure is not yet standardized. Margin-free spondylectomy is technically demanding, but the procedure can be used with a confidence as a more radical surgery for tumors extending to the epidural space and the unilateral pedicle. A key to success is the surgical technique, including a 360 degree dissection around the tumor vertebrae, instrumentation, and removal of the lesion with all possible soft tissues maintained intact to function as a barrier, like the dura mater.
authors.affiliation: Niigata Spine Surgery Center, Niigata City, Niigata, Japan. kazu3795jp@yahoo.co.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Takao
authors.initials: T
authors.lastname: Homma
authors.forename: Toru
authors.initials: T
authors.lastname: Hirano
authors.forename: Akira
authors.initials: A
authors.lastname: Ogose
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hotta
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Yajiri
authors.forename: Junji
authors.initials: J
authors.lastname: Nagano
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Inoue
mesh_terms: D000293:Adolescent; D000328:Adult; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome