title: Posterior-only approach for total en bloc spondylectomy for malignant primary spinal neoplasms: anatomic considerations and operative nuances.
abstract: MALIGNANT PRIMARY SPINAL tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. Total en bloc spondylectomy involves removal of vertebral segment(s) in whole to achieve wide tumor excision. Total en bloc spondylectomy can be performed through staged or combined anterior and posterior approaches, or from a posterior-only approach. The posterior-only approach offers the advantage of achieving complete tumor excision and circumferential spinal reconstruction in a single setting. In this report, we discuss the operative management of malignant primary vertebral tumors using the posterior-only approach for total en bloc spondylectomy. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.
authors.affiliation: Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA. phsieh@usc.edu
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Hsieh
authors.forename: Khan W
authors.initials: KW
authors.lastname: Li
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods; D018212:Giant Cell Tumor of Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011859:Radiography; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*