Total spondylectomy for primary tumor of the thoracolumbar spine

Study Design: Six patients with primary malignant tumor of the thoracolumbar spine who underwent total spondylectomy (TS) by en bloc resection were reviewed retrospectively. Objectives: To report surgical technique and preliminary results of TS and to evaluate its oncological curability. Setting: Japan. Methods: Six patients were treated by TS by er bloc resection of the vertebral tumor. TS through a posterior approach was performed in three cases (T1 osteosarcoma, L1 osteosarcoma and L1 chordoma) and in the others through a single stage anterior and posterior combined approach (T6-8 recurrent giant cell tumor, L4 chordoma and L5 giant cell tumor). Surgical margins of the specimens were evaluated histologically. All patients were followed, and their status was evaluated by clinical and imaging studies. Results: There were no complications related to surgery. Programmed sacrifice of nerve roots were performed in three cases for oncologic excision. A wide surgical margin was achieved in one case, a marginal one in four, and an intralesional margin in one. Five patients were alive without evidence of tumor and one was alive with disease at follow-up evaluation after 2.0-4.8 years. Local recurrence was found in one case of T1 osteosarcoma with an intralesional margin. Conclusions: These preliminary results suggested that TS is an effective procedure in control of local recurrence with acceptable complications.