The authors describe the surgical technique of en bloc resection of musculoskeletal neoplasms that originate and invade the posterior arch of the thoracolumbar spine. Surgery is indicated for the treatment of aggressive benign tumors (Enneking stage 3) and malignant tumors. For surgical margins to be adequate, both pedicles must be free of the tumor.

Bone Transplantation↗

PubMedDate not supplied

The sitting position in posterior access to the cervical spine for the treatment of neoplasm.

The authors evaluate the posterior approach to the cervical spine with the patient in a sitting position for the surgical treatment of neoplasms of the vertebral arch. Advantages and risks, particularly those related to anesthesia, are examined. Two cases in which the sitting position was advantageous are reported.

Aged↗

PubMedDate not supplied

Surgical technique: dorsal vertebral hemiresection for bone tumors.

The authors describe the technique of sagittal vertebral hemiresection used for the treatment of tumors of the thoracic spine involving one or more hemivertebrae. This type of treatment is not frequently indicated because of the rare asymmetrical distribution of vertebral tumors.

Anesthesia↗

PubMedDate not supplied

Lumbar vertebrectomy for the treatment of bone tumors: surgical technique.

The authors describe lumbar vertebral resection for the treatment of bone tumors by double approach (posterior longitudinal with the patient in prone position, and retroperitoneal lobotomy in lateral position), usually performed in one-stage surgery. The indication includes aggressive benign tumors (e.g., stage 3 giant cell tumor, osteoblastoma) and low-grade malignant tumors (e.g., chordoma, chondrosarcoma). In these cases an oncologically adequate surgical margin may be obtained, provided that the neoplasm is entirely or largely intracompartmental and at least one of the vertebral pedicles is uninvolved. The different stages of surgery and anesthesia-related problems are described, and possible complications are discussed.

Anesthesia↗

PubMedDate not supplied

Low back pain in tumors: diagnosis and treatment.

On the basis of the authors' experience in the treatment of 257 skeletal neoplasms of the lumbar spine, the features of back pain, which in 96% of the cases constitutes the first symptom of these diseases, are discussed. The overall clinical aspects firstly depend on the stage of the primary tumor: latent, active, aggressive for benign tumors; intra- and extra-compartmental for malignant tumors. Symptoms may include elements which suggest specific lesions, such as osteoid osteoma, eosinophilic granuloma, aneurysmal bone cyst, or high-grade malignant tumors such as Ewing's sarcoma, while lumbar metastasis from carcinoma do not seem to have distinctive features. Site and localization of the tumor are also important variables. The treatment of neoplastic back pain depends on diagnosis, and cannot be adequate if it is not planned on the basis of a complete preoperative study, taking into account not only surgery, but also adjuvant therapy.

Adolescent↗

PubMedDate not supplied

Giant cell tumor of the vertebral column.

The authors report 23 cases of giant cell tumor (GCT) of the mobile spine, treated between 1975 and 1993, with mean follow-up of 9 years. The series was homogeneous in terms of diagnosis, staging, and treatment, carried out at the Rizzoli Orthopaedic Institute, and isolated from a series of 28 cases recorded at the Tumor Center of the Rizzoli Institute. Five of the cases were excluded either because of insufficient documentation (4), or because the tumor had occurred on Paget's disease (1). GCT of the spine is a rare disease, and has a favorable diagnosis if treatment is correct, consisting in intralesional curettage of "active" forms and extracapsular curettage associated with adjuvant radiotherapy (or en bloc resection) in "aggressive" forms.

Adolescent↗

PubMedDate not supplied

Reconstruction techniques in the treatment of vertebral neoplasms.

The authors present a new system for the topographical description of vertebral neoplasms. The general criteria of reconstruction after curettage or vertebral resection are evaluated. The literature is reviewed in terms of the use of prostheses, bone grafts, cement and stabilization systems in the treatment of tumors of the spine. Indications for the different methods are discussed.

Bone Neoplasms↗

PubMedDate not supplied

Neurologic deficit after resection of the sacrum.

The authors describe neurologic deficit (sensory, motor, and sphincteral) resulting from sacrifice of the sacral nerve roots removed during resection of the sacrum. The anatomical and functional bases of sphincteral continence and the amount of neurologic deficit are discussed based on level of sacral resection. A large review of the literature on the subject is reported and discussed. The authors emphasize how the neurophysiological bases of sphincteral continence (rectum and bladder) and of sexual ability are still not well known, and how the literature reveals disagreement on the subject. A score system is proposed to evaluate neurologic deficit. The clinical model of neurologic deficit caused by resection of the sacrum may be extended to an evaluation of post-traumatic deficit.

Anal Canal↗

PubMedDate not supplied

Vertebral tumors: differential diagnosis between primary and secondary neoplasms.

The authors discuss the criteria of differential diagnosis between primary and secondary tumors, emphasizing the role played by biopsy.

Biopsy, Needle↗

PubMedDate not supplied

Resection surgery in the treatment of vertebral tumors.

With the purpose of clarifying the limits of resection surgery (en bloc excision) for the treatment of bone tumors of the spine, the authors report the indications and results of 43 operations. This series was homogeneous in terms of oncological and surgical staging, as well as with regard to surgical method used and anaesthesiology. Three different types of surgery were performed: en bloc resection of tumors of the body (sectors 5-9 or 4-8 depending on the WBB staging system), of the posterior arch (sectors 10-3) or characterized by eccentric growth (sectors 2-5 or 8-11). The surgical margins were histologically studied in all of the cases: based on the evaluation and on histological diagnosis further chemo- and/or radiation therapy were decided on. Long-term follow-up was obtained for all of the cases (from 6 to 153 months, mean 30 months; 26 cases followed for more than 24 months). Six of the patients died as a result of the disease from 10 to 28 months after resection. There were 4 local recurrences, 4 pulmonary metastases, and 5 metastatic disseminations to the skeleton and to other tissues observed in 11 patients. At final follow-up 33 patients (77%) were thus disease-free (32 continually), in excellent condition, and capable of living a normal life. Complications and treatment are also reported. A careful study of the neoplasm, an appropriate selection of the patients based on diagnosis and histological staging, a knowledge of the natural progression of bone neoplasms and of the surgical anatomy of the vertebral column, the application of suitable measures of anaesthesiological control, allow for a correct cost/benefit evaluation of this type of surgery as compared to oncological methods that are less effective but more diffused. On the basis of these considerations indications for en bloc resection in tumors of the spine are defined.

Adolescent↗