title: Combined modified en bloc corpectomy with replacement of the aorta in curative interdisciplinary treatment of a large osteosarcoma infiltrating the aorta.
abstract: We report a case of a large three-level spinal osteosarcoma infiltrating the adjacent aorta. This is the first case in which a combined modified three-level en bloc corpectomy with resection and replacement of the adjacent aorta was successful as a part of interdisciplinary curative treatment.
  
  
  
  Case report.
  
  
  
  The surgical procedure was performed as a two-step treatment. A heart lung machine (HLM) was not used, in order to avoid cerebral and spinal ischemia and to decrease the risk of hematogenous tumor metastases. Instead, a bypass from the left subclavian artery the distal descending aorta was used. We modified the en bloc corpectomy procedure, leaving a dorsal segment of the vertebral bodies to enable rapid surgery. The procedure was successful and the en bloc resection of the vertebral body with aortal resection could be achieved. Except for pallhypesthesia in the left dermatomes Th7-Th10, the patient does not have any postoperative neurologic deficits.
  
  
  
  Combined corpectomy with aortic replacement should be considered as a reasonable option in the curative treatment of osteosarcoma with consideration of the immense surgical risks. The use of an HLM is not necessary, especially considering the inherent risk of hematogenous tumor metastases. Modified corpectomy leaving a dorsal vertebral body segment was considered a reasonable variation since tumor-free margins could still be expected.
authors.affiliation: Department of Orthopedics, Trauma Surgery and Reconstructive Surgery, Regio Hospital Pinneberg, Fahltskamp 74, 25421, Pinneberg, Germany. a.pilger@web.de.
authors.forename: Amrei
authors.initials: A
authors.lastname: Pilger
authors.affiliation: Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsilimparis
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
authors.affiliation: Department of Internal Medicine II and Oncology Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Trepel
authors.affiliation: Department of Spine Surgery in the Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Dreimann
mesh_terms: D001013:Aorta, Thoracic / Q000473:pathology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012516:Osteosarcoma / Q000473:pathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000473:pathology* / Q000601:surgery; D013348:Subclavian Artery / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*
keywords: Aortic prosthesis; En bloc corpectomy; Resection of the aorta; Spinal osteosarcoma; Spinal tumor