title: [Total en bloc spondylectomy for spinal tumours: Technical aspects and surgical details].
abstract: OBJECTIVE
  To describe the specific surgical details and report the lessons learned with a series of patients suffering from spinal tumours that underwent total en bloc spondylectomy (TES).
  
  
  METHODS
  A retrospective case series review is presented, together with an analysis of the clinical and technical variables, as well as the outcomes.
  
  
  RESULTS
  A total of 10 patients underwent TES (2000-2016) for primary (osteosarcoma, chondrosarcoma, fibrosarcoma and chordoma) and secondary spinal tumours (lung, breast, thyroid, oesophagus, and meningioma metastases). According to the Tomita classification, 2 patients had intra-compartmental tumours, and the rest presented as extra-compartmental. All patients experienced an improvement in their pain level after surgery. Nine patients preserved ambulation post-operatively and one patient developed paraplegia. Six patients needed subsequent operations for wound debridement, tumour recurrence, or revision of the fixation. Other complications included pneumothorax, pleural effusion and venous thrombosis. Four patients remain alive (4 months to 15 years follow-up). The rest died due to primary tumour progression (6.5 months to 12 years). A detailed description of the surgical steps, tips, and pitfalls is provided. Modifications of the technique and adjuncts to resection are commented on. Observation of some considerations (selection of candidates, careful blunt vertebral dissection, strict blood loss control, careful handling of the spinal cord, and maintenance of the radical resection concept at all stages) is key for a successful operative performance.
  
  
  CONCLUSIONS
  TES is a paradigmatic operation, in which the concept of radical resection provides functional effectiveness and improves survival in selected patients suffering from spinal tumours. Our preliminary experience allows us to highlight some specific and relevant features, especially those favouring a simpler and safer operation.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España. Electronic address: pedrodl@yahoo.com.
authors.forename: Pedro David
authors.initials: PD
authors.lastname: Delgado-López
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Salazar
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Martín-Velasco
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Castilla-Díez
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Martín-Alonso
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Galacho-Harriero
authors.affiliation: Servicio de Neurología, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gil-Polo
authors.affiliation: Servicio de Neurofisiología Clínica, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Araus-Galdós
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D000075204:Contraindications, Procedure; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D019637:Orthopedic Procedures / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome
keywords: En bloc spondylectomy; Extirpación radical; Radical resection; Spinal tumour; Surgical technique; Tomita; Total vertebrectomy; Tumor vertebral; Técnica quirúrgica; Vertebrectomía en bloque; Vertebrectomía total