Reconstruction for extensive vertebral tumor resection

K Tomita, H Tsuchiya, N Kawahara, H Murakami
Clear disadvantages of piecemeal excision of the malignant vertebral tumors include high risk of tumor cell contamination to the surrounding structures and residual tumor tissue at the site due to difficulty in demarcating of tumor from healthy tissue. These contribute to incomplete resection of the tumor as well as high local recurrence rates of the spinal malignant tumor. Our total en bloc spondylectomy (TES) technique involves en bloc removal of the lesion, that is, removal of the whole
more » ... bra, both body and lamina as one compartment , according to oncologic concept in spinal tumor by either a single posterior approach or antero-posterior double approach. The major concern in TES operation include excessive bleeding, injury of the major vessels, spinal cord injury, possible contamination by tumor cells, complete spinal instability resulting from extensive spinal resection. Since TES operation includes a complete resection of the affected one, two or three vertebrae with the surrounding musculo-ligamentous supportive tissues, spinal column become completely unstable. Reconstruction for this defect is performed applying primary rigid antero-posterior spinal instrumentation together with bone graft. Temporary support is maintained by these hardware instrumentations, whereas permanent support is expected by bone graft which needs biomechanical stress to be kept remodeled. We would like to present how it is elaborated.