Abstract
We have developed a new surgical technique, ‘total en bloc spondylectomy’ (TES), to treat a solitary metastasis in the thoracic or lumbar vertebra. This operation is designed as a local cure for the metastatic site and involves the radical resection of the affected vertebra with a wide margin. The spondylectomy consists of two steps: en bloc laminectomy with posterior spinal instruments for stabilisation (first step) and en bloc corporectomy and replacement using a vertebral prosthesis (second step). TES makes it possible to remove the affected vertebra extracompartmentally with its tumour barrier and accomplishes circumferential decompression of the spinal cord. Before clinical practice, we constructed experimental models using cats to examine spinal cord blood flow (SCBF) after ligation of the nerve roots and circumspinal decompression. The changes of SCBF were negligible, so it was proved that TES on one vertebra has little effect on spinal cord circulation. This method was used in 24 patients. Fourteen of the 18 patients with neurological deficits improved remarkably, and the 23 evaluable cases experienced pain relief. Impending paralysis was prevented in all six patients by this surgical intervention. There has been no recurrence of the local tumour after surgery. After a median follow up period of 14.1 months, 12 patients have survived. These data suggest that TES may have a significant clinical value in the treatment of spinal metastasis.
Similar content being viewed by others
Article PDF
References
Anderson D K, Nicolosi G R, Means E D, Hartley L E (1987) Effect of laminectomy on spinal cord blood flow. J Neurosurg 48: 232–238.
Bradshaw P (1958) Arteries of the spinal cord in the cat. J Neurosurg Psychiatry 21: 284–289.
Tomita K, Kawahara N, Baba H, Kikuchi Y, Nishimura H (1990) Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and the yellow ligament. Spine 15: 1114–1120.
Lievre J A, Darcy M, Pradat P, Camus J P, Bénichou C, Attali P et al (1968) Tumeur a cellues géantes du rachis lombaire, spondylectomie totale en deux temps. Rev Rhum 35: 125–130 (in French).
Stener B (1971) Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg 53(B): 288–295.
Roy-Camille R, Saillant G, Bisserié M, Judet T H, Hautefort E, Mamoudy P (1981) Resection vertebrale totale dans la Chirurgie tumorale au niveau du rachis dorsal par voie posterieure pure. Rev Chir Orthop 67: 421–430.
Sundaresan N, Digiacinto G V, Krol G, Hughes J E (1989) Spondylectomy for malignant tumor of the spine. J Clin Oncol 7: 1485–1491.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tomita, K., Toribatake, Y., Kawahara, N. et al. Total en bloc spondylectomy and circumspinal decompression for solitary spinal metastasis. Spinal Cord 32, 36–46 (1994). https://doi.org/10.1038/sc.1994.7
Issue Date:
DOI: https://doi.org/10.1038/sc.1994.7
Keywords
This article is cited by
-
Cervical subtotal en-bloc spondylectomy of C6 mesenchymal chondrosarcoma
European Spine Journal (2016)
-
Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine
European Spine Journal (2016)
-
Expert’s comment concerning “Chest wall reconstruction after en bloc Pancoast tumor resection with the use of MatrixRib and SILC Fixation systems: technical note” (Marcin Czyz, Emmanuel Addae-Boateng, Bronek M. Boszczyk)
European Spine Journal (2015)
-
Tokuhashi score is predictive of survival in a cohort of patients undergoing surgery for renal cell carcinoma spinal metastases
European Spine Journal (2015)
-
The direct anterior approach to the thoracolumbar junction: an anatomical feasibility study
European Spine Journal (2014)