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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(02): 205-212
DOI: 10.1055/s-0042-1744162
Review Article

A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know?

E. Smith
1   Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
G. Hegde 
1   Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
M. Czyz
2   Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
S. Hughes
2   Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
S. Haleem
2   Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
M. Grainger
2   Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
S. L. James
1   Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
R. Botchu
1   Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
› Author Affiliations Financial Disclosures No financial disclosures.
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Abstract

En bloc resection in the spine is performed for both primary and metastatic bone lesions and has been proven to lengthen disease-free survival and decrease the likelihood of local recurrence. It is a complex procedure, which requires a thorough multi-disciplinary approach. This article will discuss the role of the radiologist in characterizing the underlying tumor pathology, staging the tumor and helping to predict possible intraoperative challenges for en bloc resection of primary bone lesions. The postoperative appearances and complications following en bloc resection in the spine will be considered in subsequent articles.

Keywords

en bloc - spine - primary tumors


Publication History

Article published online:
09 June 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine 1997; 22 (09) 1036-1044
    Search in Google Scholar
  • 2 Boriani S. En bloc resection in the spine: a procedure of surgical oncology. J Spine Surg 2018; 4 (03) 668-676
    CrossrefPubMedSearch in Google Scholar
  • 3 Stener B. Complete removal of vertebrae for extirpation of tumors. A 20-year experience. Clin Orthop Relat Res 1989; (245) 72-82
    PubMedSearch in Google Scholar
  • 4 Tomita K, Kawahara N, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci 2006; 11 (01) 3-12
    CrossrefPubMedSearch in Google Scholar
  • 5 Jawad MU, Scully SP. In brief: classifications in brief: Enneking classification: benign and malignant tumors of the musculoskeletal system. Clin Orthop Relat Res 2010; 468 (07) 2000-2002
    CrossrefPubMedSearch in Google Scholar
  • 6 Viswanathan S, Jambhekar NA. Metastatic giant cell tumor of bone: are there associated factors and best treatment modalities?. Clin Orthop Relat Res 2010; 468 (03) 827-833
    CrossrefPubMedSearch in Google Scholar
  • 7 Wilartratsami S, Muangsomboon S, Benjarassameroj S, Phimolsarnti R, Chavasiri C, Luksanapruksa P. Prevalence of primary spinal tumors: 15-year data from Siriraj Hospital. J Med Assoc Thai 2014; 97 (Suppl. 09) S83-S87
    PubMedSearch in Google Scholar
  • 8 Boriani S, Bandiera S, Casadei R. et al. Giant cell tumor of the mobile spine: a review of 49 cases. Spine 2012; 37 (01) E37-E45
    CrossrefPubMedSearch in Google Scholar
  • 9 Si MJ, Wang CG, Wang CS. et al. Giant cell tumours of the mobile spine: characteristic imaging features and differential diagnosis. Radiol Med (Torino) 2014; 119 (09) 681-693
    CrossrefPubMedSearch in Google Scholar
  • 10 Sanjay BK, Sim FH, Unni KK, McLeod RA, Klassen RA. Giant-cell tumours of the spine. J Bone Joint Surg Br 1993; 75 (01) 148-154
    CrossrefPubMedSearch in Google Scholar
  • 11 Donthineni R, Boriani L, Ofluoglu O, Bandiera S. Metastatic behaviour of giant cell tumour of the spine. Int Orthop 2009; 33 (02) 497-501
    CrossrefPubMedSearch in Google Scholar
  • 12 Luksanapruksa P, Buchowski JM, Singhatanadgige W, Bumpass DB. Systematic review and meta-analysis of en bloc vertebrectomy compared with intralesional resection for giant cell tumours of the mobile spine. Global Spine J 2016; 6 (08) 798-803
    CrossrefPubMedSearch in Google Scholar
  • 13 Arkader A, Dormans JP. Osteoblastoma in the skeletally immature. J Pediatr Orthop 2008; 28 (05) 555-560
    CrossrefPubMedSearch in Google Scholar
  • 14 Pieterse AS, Vernon-Roberts B, Paterson DC, Cornish BL, Lewis PR. Osteoid osteoma transforming to aggressive (low grade malignant) osteoblastoma: a case report and literature review. Histopathology 1983; 7 (05) 789-800
    CrossrefPubMedSearch in Google Scholar
  • 15 Jacobs W, Fehlings M. Primary Vertebral Column Tumours. Spinal Cord and Spinal Column Tumours: Principles and Practice. New York: Thieme; 2006: 369-386
    Search in Google Scholar
  • 16 Boriani S, Weinstein JN. Oncologic Classification of Vertebral Neoplasms. Spinal Cord and Spinal Column Tumours. New York: Thieme Medical Publishers, Inc.; 2006: 37
    Search in Google Scholar
  • 17 Harrop JS, Schmidt MH, Boriani S, Shaffrey CI. Aggressive “benign” primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor. Spine 2009; 34 (22, Suppl): S39-S47
    CrossrefPubMedSearch in Google Scholar
  • 18 Dickey ID, Rose PS, Fuchs B. et al. Dedifferentiated chondrosarcoma: the role of chemotherapy with updated outcomes. J Bone Joint Surg Am 2004; 86 (11) 2412-2418
    CrossrefPubMedSearch in Google Scholar
  • 19 Lee IJ, Lee RJ, Fahim DK. Prognostic factors and survival outcome in patients with chordoma in the United States: a population-based analysis. World Neurosurg 2017; 104: 346-355
    CrossrefPubMedSearch in Google Scholar
  • 20 Bailey CS, Fisher CG, Boyd MC, Dvorak MF. En bloc marginal excision of a multilevel cervical chordoma. Case report. J Neurosurg Spine 2006; 4 (05) 409-414
    CrossrefPubMedSearch in Google Scholar
  • 21 Boriani S, Bandiera S, Biagini R. et al. Chordoma of the mobile spine: fifty years of experience. Spine 2006; 31 (04) 493-503
    CrossrefPubMedSearch in Google Scholar
  • 22 Snider JW, Schneider RA, Poelma-Tap D. et al. Long-term outcomes and prognostic factors after pencil-beam scanning proton radiation therapy for spinal chordomas: a large, single-institution cohort. Int J Radiat Oncol Biol Phys 2018; 101 (01) 226-233
    CrossrefPubMedSearch in Google Scholar
  • 23 Strike SA, McCarthy EF. Chondrosarcoma of the spine: a series of 16 cases and a review of the literature. Iowa Orthop J 2011; 31: 154-159
    PubMedSearch in Google Scholar
  • 24 Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J 2007; 16 (03) 405-409
    CrossrefPubMedSearch in Google Scholar
  • 25 Nisson PL, Berger GK, James WS, Hurlbert RJ. Surgical techniques and associated outcomes of primary chondrosarcoma of the spine. World Neurosurg 2018; 119: e32-e45
    CrossrefPubMedSearch in Google Scholar
  • 26 Boriani S, De Iure F, Bandiera S. et al. Chondrosarcoma of the mobile spine: report on 22 cases. Spine 2000; 25 (07) 804-812
    CrossrefPubMedSearch in Google Scholar
  • 27 Feng D, Yang X, Liu T. et al. Osteosarcoma of the spine: surgical treatment and outcomes. World J Surg Oncol 2013; 11 (01) 89
    CrossrefPubMedSearch in Google Scholar
  • 28 Arshi A, Sharim J, Park DY. et al. Chondrosarcoma of the osseous spine: an analysis of epidemiology, patient outcomes, and prognostic factors using the SEER registry from 1973 to 2012. Spine 2017; 42 (09) 644-652
    CrossrefPubMedSearch in Google Scholar
  • 29 Sundaresan N, Rosen G, Huvos AG, Krol G. Combined treatment of osteosarcoma of the spine. Neurosurgery 1988; 23 (06) 714-719
    CrossrefPubMedSearch in Google Scholar
  • 30 Fielding JW, Fietti Jr VG, Hughes JE, Gabrielian JC. Primary osteogenic sarcoma of the cervical spine. A case report. J Bone Joint Surg Am 1976; 58 (06) 892-894
    CrossrefPubMedSearch in Google Scholar
  • 31 Ilaslan H, Sundaram M, Unni KK, Shives TC. Primary vertebral osteosarcoma: imaging findings. Radiology 2004; 230 (03) 697-702
    CrossrefPubMedSearch in Google Scholar
  • 32 Schwab J, Gasbarrini A, Bandiera S. et al. Osteosarcoma of the mobile spine. Spine 2012; 37 (06) E381-E386
    CrossrefPubMedSearch in Google Scholar
  • 33 Ewing J. The Classic: Diffuse endothelioma of bone. Proceedings of the New York Pathological Society. 1921;12:17. Clin Orthop Relat Res 2006; 450: 25-27
    PubMedSearch in Google Scholar
  • 34 Bernstein M, Kovar H, Paulussen M. et al. Ewing's sarcoma family of tumors: current management. Oncologist 2006; 11 (05) 503-519
    CrossrefPubMedSearch in Google Scholar
  • 35 Mechri M, Riahi H, Sboui I, Bouaziz M, Vanhoenacker F, Ladeb M. Imaging of malignant primitive tumours of the spine. J Belg Soc Radiol 2018; 102 (01) 56
    CrossrefPubMedSearch in Google Scholar
  • 36 Sewell MD, Tan KA, Quraishi NA, Preda C, Varga PP, Williams R. Systematic review of en bloc resection in the management of Ewing's sarcoma of the mobile spine with respect to local control and disease-free survival. Medicine (Baltimore) 2015; 94 (27) e1019
    CrossrefPubMedSearch in Google Scholar
  • 37 Boriani S, Amendola L, Corghi A. et al. Ewing's sarcoma of the mobile spine. Eur Rev Med Pharmacol Sci 2011; 15 (07) 831-839
    PubMedSearch in Google Scholar
  • 38 Keynan O, Fisher CG, Boyd MC, O'Connell JX, Dvorak MF. Ligation and partial excision of the cauda equina as part of a wide resection of vertebral osteosarcoma: a case report and description of surgical technique. Spine 2005; 30 (04) E97-E102
    CrossrefPubMedSearch in Google Scholar
  • 39 Pilger A, Tsilimparis N, Bockhorn M, Trepel M, Dreimann M. Combined modified en bloc corpectomy with replacement of the aorta in curative interdisciplinary treatment of a large osteosarcoma infiltrating the aorta. Eur Spine J 2016; 25 (1, Suppl 1): 58-62
    CrossrefPubMedSearch in Google Scholar
  • 40 Salame K, Maimon S, Regev GJ. et al. Electrophysiological monitoring during preoperative angiography to guide decisions regarding permanent occlusion of major radicular arteries in patients undergoing total en bloc spondylectomy. Neurosurg Focus 2016; 41 (02) E19
    CrossrefPubMedSearch in Google Scholar