En bloc resections of bone tumors of the thoracolumbar spine - A preliminary report on 29 patients
En bloc resections of bone tumors of the thoracolumbar spine - A preliminary report on 29 patients
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DOI：
10.1097/00007632-199608150-00020
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发表时间：
1996-08-15
期刊：
影响因子：
3
通讯作者：
Zanoni, A
中科院分区：
文献类型：
--
作者：
Boriani, S;Biagini, R;Zanoni, A
研究设计.本文回顾性分析了29例胸腰椎原发性骨肿瘤和单发性转移瘤患者的整体切除术。证明在脊柱中应用与四肢原发性骨肿瘤相同的外科肿瘤学原则的可能性。背景资料概要。目前应用于四肢肿瘤手术的外科肿瘤分期系统难以应用于脊柱肿瘤。解剖条件使得病灶外手术困难或不可能，这限制了脊柱切除手术的更普遍使用。重点放在一个新的手术分期系统和整块椎体切除术。治疗了25例原发性恶性和侵袭性良性骨肿瘤和4例单发转移瘤。患者接受肿瘤学和手术分期以制定手术计划。原发肿瘤按Enneking分期法：IA期3例，IB期8例，IIB期8例，良性3期8例。还根据Weinstein-Boriani-Biagini系统进行分期。13处病变涉及椎体; 9处病变发生在后弓或其一部分，7处病变占据了身体的一部分和弓的一部分。进行了仔细的麻醉评估以及术中持续在线监测生命参数。其中胸椎10例，腰骶椎16例，行多节段切除术。进行重建，旨在替换切除的脊柱。将标本提交给边缘的组织学研究。所有患者均接受随访，并根据临床和影像学检查确定其状态。在20例患者中，实现了宽边缘，8例边缘边缘，1例病灶内边缘。7例患者的边缘被污染。手术时间3-21 h，平均12 h。无患者死于手术或手术并发症。植入物的3次机械失效需要额外手术。出现一处深部感染。观察到的唯一神经系统问题与用于肿瘤学目的的神经根切片有关。随访6-134个月，平均30个月，无局部复发。脊柱肿瘤可以进行整块切除;这种大手术的适应症必须基于肿瘤分期，手术必须仔细计划。为此，Weinstein-Boriani-Biagini系统可能是一个有用的工具。在对适应症做出明确声明之前，必须对长期结果进行加权。
Study Design. Twenty-nine patients with primary bone tumors and solitary metastases of the thoracolumbar spine treated with en bloc resection are reviewed retrospectively.Objective. To demonstrate the possibility to apply in the spine the same principles of surgical oncology adopted for primary bone tumors of the limbs.Summary of Background Data. The surgical oncologic staging systems currently applied in limb tumor surgery are difficult to apply to spinal tumors. The anatomic conditions make extralesional surgery difficult or impossible, which has restrained a more common use of resection surgery in the spine. Focus is put on a new surgical staging system and en bloc vertebral resection.Methods. Twenty-five primary malignant and aggressive benign bone tumors and four solitary metastases were treated. The patients were submitted to oncologic and surgical staging for surgical planning. The primary tumors were classified according to Enneking system: three Stage IA, sic Stage IB, eight Stage IIB, eight Stage 3 benign. Staging according to the Weinstein-Boriani-Biagini system was also done. Thirteen lesions involved the vertebral body; nine lesions developed in the posterior arch, or part of it, and seven lesions occupied part of the body and part of the arch. A careful anesthesiologic evaluation was performed as well a a continuous intraoperative on-line monitoring of the vital parameters. The en bloc resections (multisegmental in five patients) were performed in 10 thoracic, in 16 lumbosacral lesion. Reconstruction was performed, aiming to replace the resected columns. The specimens were submitted to histologic study of the margins. All the patients were followed, and their status was defined on clinical and imaging studies.Results. In 20 patients, a wide margin was achieved, in eight a marginal margin, in one an intralesional margin. The margin was contaminated in seven patients. Surgical time was 3-21 hours (average, 12 hours). No patient died during surgery or from surgical complications. Three mechanical failures of the implants required additional surgery. One deep infection arose. The only neurologic problems observed were related to the nerve roots sectioned for oncologic purpose. No local recurrence was found at follow-up evaluation after 6-134 months (average, 30 months).Conclusions. En bloc resection can be performed in selected tumors of the spine; the indication to such major surgery must be based on the oncologic stage, and the procedure must be carefully planned. For this purpose, the Weinstein-Boriani-Biagini system could be a helpful tool. Long-term results must be weighted before a definitive statement of the indications can be made.