title: Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy.
abstract: Primary malignant spinal tumors and solitary vertebral metastases of selected tumor entities in the thoracolumbar spine are indications for total en bloc spondylectomy (TES). This study aimed to describe our oncological and surgical management and to analyze the treatment results by management with TES for extra- and intracompartmental solitary spinal metastases and primary malignant vertebral bone tumors. In 15 patients (3 malignant bone tumors and 12 solitary metastases), tumors were distributed in the thoracic (n = 8) and lumbar (n = 7) spine. Tumors were classified as intra- (n = 8) and extracompartmental (n = 7). All patients underwent TES via a laterally extended posterior approach followed by dorsoventral reconstruction. Function and quality of life were assessed by Oswestry disability index (ODI) and SF-36 score. At follow-up (100%; mean: 33 +/- 22 months), 11 patients had no evidence of disease. Two patients were alive with the disease and two were dead of the disease (no primary bone tumors). Histology revealed negative margins (R0) in all patients with wide (n = 11) and marginal (n = 4) resections. Two patients developed pulmonal metastases of which they died at 4 and 16 months of survival. No local recurrence was observed. Major complications did not occur. TES resulted in an acceptable outcome in the quality of life and function. TES is a demanding procedure reaching wide to marginal resections in a curative approach. In conjunction with multimodal therapies, local recurrences can effectively be prevented while control of distant disease needs to be improved. Proper selection of adequate patients combined with careful surgical planning are prerequisites for low complication rates, acceptable function and improved overall prognosis.
authors.affiliation: Center for Musculoskeletal Surgery, Department of Trauma and Reconstructive Surgery and Department of Orthopaedics, Charité - University Medicine Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany. ingo.melcher@charite.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Melcher
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Disch
authors.forename: Cyrus
authors.initials: C
authors.lastname: Khodadadyan-Klostermann
authors.forename: Stefan
authors.initials: S
authors.lastname: Tohtz
authors.forename: Mirko
authors.initials: M
authors.lastname: Smolny
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Haas
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Schaser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D019637:Orthopedic Procedures / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome