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Corpectomy/En Bloc Resection
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Pre-Procedure

      • Post-Procedure

        • Outcomes

          TERMINOLOGY

          • Synonyms

            • Vertebrectomy
          • Definitions

            • En bloc = surgical removal of tumor in a single piece, fully encased within layer of healthy tissue (margin)
              • Margins may be intralesional, marginal, or wide
                • Intralesional is cutting within tumor mass
                • Marginal is operating on layer of reactive tissue surrounding mass (pseudocapsule)
                  • Many spine en bloc resections are marginal around the dura
                • Wide margin is outside of pseudocapsule
                • Radical is not possible in spine (resection of whole compartment of tumor origin)
            • Spine tumors categorization methods
              • Vertebral body divided into 4 zones (I, II, III, IV)
                • IA: Spinous process and pars + inferior facets
                • IIA: Superior articular facet, transverse process, pedicle from level of pars to junction with vertebral body (VB)
                • IIIA: Anterior 3/4 of VB
                • IVA: Posterior 1/4 of VB
              • Tumor extension defined
                • A: Intraosseous
                • B: Extraosseous
                • C: Distant spread
            • Cord compression
              • Common with metastatic disease (5-20%)
                • Direct compression from soft tissue mass
                • Pressure from fracture and bony retropulsion of fragments
                • Kyphosis with VB collapse
                • Intradural metastases
            • BWB classification (Boriani, Weinstein, and Biagini)
              • Anatomy of vertebrae divided into 12 transverse zones
              • Axial space occupied by tumor (intradural to adjacent soft tissues) is determined
              • Provides guide for type of surgery that is needed

          PRE-PROCEDURE

          • Indications

            • Pre-Procedure Imaging

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Alternative Procedures/Therapies

                    POST-PROCEDURE

                    • Expected Outcome

                      OUTCOMES

                      • Problems

                        • Complications

                          Selected References

                          1. Demura S et al: Total en bloc spondylectomy for spinal metastases in thyroid carcinoma. J Neurosurg Spine. 14(2):172-6, 2011
                          2. Fadel E et al: Long-term outcomes of en bloc resection of non-small cell lung cancer invading the thoracic inlet and spine. Ann Thorac Surg. 92(3):1024-30, 2011
                          3. Vos CG et al: En bloc resection of 3 vertebra in a pancoast patient: long-term stability using a free vascularized fibular graft. Ann Thorac Surg. 91(1):295-8, 2011
                          4. Cloyd JM et al: En bloc resection for primary and metastatic tumors of the spine: a systematic review of the literature. Neurosurgery. 67(2):435-44; discussion 444-5, 2010
                          5. Schoenfeld AJ et al: Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts General Hospital. Spine J. 10(8):708-14, 2010
                          6. Smitherman SM et al: Image-guided multilevel vertebral osteotomies for en bloc resection of giant cell tumor of the thoracic spine: case report and description of operative technique. Eur Spine J. 19(6):1021-8, 2010
                          7. Cloyd JM et al: En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature. Spine J. 9(11):928-35, 2009
                          8. Sciubba DM et al: En bloc spondylectomy for treatment of tumor-induced osteomalacia. J Neurosurg Spine. 11(5):600-4, 2009
                          9. Sciubba DM et al: Ewing and osteogenic sarcoma: evidence for multidisciplinary management. Spine (Phila Pa 1976). 34(22 Suppl):S58-68, 2009
                          10. Yamazaki T et al: Feasibility and safety of en bloc resection for primary spine tumors: a systematic review by the Spine Oncology Study Group. Spine (Phila Pa 1976). 34(22 Suppl):S31-8, 2009
                          11. Chen F et al: En bloc total vertebrectomy for lung cancer invading the spine. Lung Cancer. 61(1):137-9, 2008
                          12. Liljenqvist U et al: En bloc spondylectomy in malignant tumors of the spine. Eur Spine J. 17(4):600-9, 2008
                          13. Rao G et al: Surgical management of primary and metastatic sarcoma of the mobile spine. J Neurosurg Spine. 9(2):120-8, 2008
                          14. Boriani S et al: Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976). 22(9):1036-44, 1997
                          15. Tomita K et al: Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976). 22(3):324-33, 1997
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Pre-Procedure

                              • Post-Procedure

                                • Outcomes

                                  TERMINOLOGY

                                  • Synonyms

                                    • Vertebrectomy
                                  • Definitions

                                    • En bloc = surgical removal of tumor in a single piece, fully encased within layer of healthy tissue (margin)
                                      • Margins may be intralesional, marginal, or wide
                                        • Intralesional is cutting within tumor mass
                                        • Marginal is operating on layer of reactive tissue surrounding mass (pseudocapsule)
                                          • Many spine en bloc resections are marginal around the dura
                                        • Wide margin is outside of pseudocapsule
                                        • Radical is not possible in spine (resection of whole compartment of tumor origin)
                                    • Spine tumors categorization methods
                                      • Vertebral body divided into 4 zones (I, II, III, IV)
                                        • IA: Spinous process and pars + inferior facets
                                        • IIA: Superior articular facet, transverse process, pedicle from level of pars to junction with vertebral body (VB)
                                        • IIIA: Anterior 3/4 of VB
                                        • IVA: Posterior 1/4 of VB
                                      • Tumor extension defined
                                        • A: Intraosseous
                                        • B: Extraosseous
                                        • C: Distant spread
                                    • Cord compression
                                      • Common with metastatic disease (5-20%)
                                        • Direct compression from soft tissue mass
                                        • Pressure from fracture and bony retropulsion of fragments
                                        • Kyphosis with VB collapse
                                        • Intradural metastases
                                    • BWB classification (Boriani, Weinstein, and Biagini)
                                      • Anatomy of vertebrae divided into 12 transverse zones
                                      • Axial space occupied by tumor (intradural to adjacent soft tissues) is determined
                                      • Provides guide for type of surgery that is needed

                                  PRE-PROCEDURE

                                  • Indications

                                    • Pre-Procedure Imaging

                                      • Getting Started

                                        PROCEDURE

                                        • Patient Position/Location

                                          • Alternative Procedures/Therapies

                                            POST-PROCEDURE

                                            • Expected Outcome

                                              OUTCOMES

                                              • Problems

                                                • Complications

                                                  Selected References

                                                  1. Demura S et al: Total en bloc spondylectomy for spinal metastases in thyroid carcinoma. J Neurosurg Spine. 14(2):172-6, 2011
                                                  2. Fadel E et al: Long-term outcomes of en bloc resection of non-small cell lung cancer invading the thoracic inlet and spine. Ann Thorac Surg. 92(3):1024-30, 2011
                                                  3. Vos CG et al: En bloc resection of 3 vertebra in a pancoast patient: long-term stability using a free vascularized fibular graft. Ann Thorac Surg. 91(1):295-8, 2011
                                                  4. Cloyd JM et al: En bloc resection for primary and metastatic tumors of the spine: a systematic review of the literature. Neurosurgery. 67(2):435-44; discussion 444-5, 2010
                                                  5. Schoenfeld AJ et al: Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts General Hospital. Spine J. 10(8):708-14, 2010
                                                  6. Smitherman SM et al: Image-guided multilevel vertebral osteotomies for en bloc resection of giant cell tumor of the thoracic spine: case report and description of operative technique. Eur Spine J. 19(6):1021-8, 2010
                                                  7. Cloyd JM et al: En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature. Spine J. 9(11):928-35, 2009
                                                  8. Sciubba DM et al: En bloc spondylectomy for treatment of tumor-induced osteomalacia. J Neurosurg Spine. 11(5):600-4, 2009
                                                  9. Sciubba DM et al: Ewing and osteogenic sarcoma: evidence for multidisciplinary management. Spine (Phila Pa 1976). 34(22 Suppl):S58-68, 2009
                                                  10. Yamazaki T et al: Feasibility and safety of en bloc resection for primary spine tumors: a systematic review by the Spine Oncology Study Group. Spine (Phila Pa 1976). 34(22 Suppl):S31-8, 2009
                                                  11. Chen F et al: En bloc total vertebrectomy for lung cancer invading the spine. Lung Cancer. 61(1):137-9, 2008
                                                  12. Liljenqvist U et al: En bloc spondylectomy in malignant tumors of the spine. Eur Spine J. 17(4):600-9, 2008
                                                  13. Rao G et al: Surgical management of primary and metastatic sarcoma of the mobile spine. J Neurosurg Spine. 9(2):120-8, 2008
                                                  14. Boriani S et al: Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976). 22(9):1036-44, 1997
                                                  15. Tomita K et al: Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. Spine (Phila Pa 1976). 22(3):324-33, 1997