Total en bloc spondylectomy - A new surgical technique for primary malignant vertebral tumors

Study Design. The study of seven patients with primary malignant or benign aggressive tumors who underwent a new aggressive surgical technique termed ''total en bloc spondylectomy'' is reported. Objectives. To report a new surgical technique of total en bloc spondylectomy for complete resection of primary spinal malignancy and for oncologic curability. Summary of Background Data. The conventional approach for primary spinal malignancy is via intralesional piecemeal resection, and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins. Methods. Total en bloc spondylectomy, consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation. was performed in five patients with primary malignant tumors and two patients with giant cell tumors. Patients were observed for 2 years to 6.5 years, except for one patient who died 7 months after surgery because of a mediastinal metastasis. Results. All patients, except one, attained significant clinical improvement after surgery with no major complications. Histologically, the margins were wide or marginal except for the pedicles, and occasionally the spinal canal and the posterior, where they were accepted to be intralesional. One patient died of metastasis that was not directly related to surgery itself. There was no local recurrence. Conclusions. The advantages of total en bloc spondylectomy include resection of the involved vertebra(e) in two major blocs, rather than in a piecemeal pattern, and completion of the procedure during one surgical session posteriorly. The ''total en bloc spondylectomy'' offers one of the most aggressive modes of therapy for primary spinal malignancy.