En Bloc Resection of Solitary Functional Secreting Spinal Metastasis.
Study Design Literature review. Objective Functional secretory tumors metastatic to the spine can secrete hormones, growth factors, peptides, and/or molecules into the systemic circulation that cause distinct syndromes, clinically symptomatic effects, and/or additional morbidity and mortality. En bloc resection has a limited role in metastatic spine disease due to the current paradigm that systemic burden usually determines morbidity and mortality. Our objective is to review the literature for studies focused on en bloc resection of functionally active spinal metastasis as the primary indication. Methods A review of the PubMed literature was performed to identify studies focused on functional secreting metastatic tumors to the spinal column. We identified five cases of patients undergoing en bloc resection of spinal metastases from functional secreting tumors. Results The primary histologies of these spinal metastases were pheochromocytoma, carcinoid tumor, choriocarcinoma, and a fibroblast growth factor 23-secreting phosphaturic mesenchymal tumor. Although studies of en bloc resection for these rare tumor subtypes are confined to case reports, this surgical treatment option resulted in metabolic cures and decreased clinical symptoms postoperatively for patients diagnosed with solitary functional secretory spinal metastasis. Conclusion Although the ability to formulate comprehensive conclusions is limited, case reports demonstrate that en bloc resection may be considered as a potential surgical option for the treatment of patients diagnosed with solitary functional secretory spinal metastatic tumors. Future prospective investigations into clinical outcomes should be conducted comparing intralesional resection and en bloc resection for patients diagnosed with solitary functional secretory spinal metastasis.
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
C Rory
CR
Goodwin
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States.
Michelle J
MJ
Clarke
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Ziya L
ZL
Gokaslan
Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
Charles
C
Fisher
Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States.
Ilya
I
Laufer
Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada.
Michael H
MH
Weber
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Daniel M
DM
Sciubba
carcinoid; choriocarcinoma; en bloc; functional secretory tumor; metastasis; pheochromocytoma; spine; surgery