En-bloc Spondylektomie: Indikation und Technik

Die En-bloc-Spondylektomie ist ein operatives Verfahren zur extraläsionalen Resektion primär maligner und lokal aggressiver Tumore sowie solitärer Metastasen der Wirbel. Ziel dieser Technik sollte stets die Resektion des oder der Wirbel im Gesunden (d.h. tumorfreie Resektionsränder) sein. Voraussetzung dafür ist ein tumorfreier Korridor, durch den das Resektat vom Duralschlauch gelöst werden kann. Der Beitrag beschreibt die Indikationen und die operative Technik.

Abstract

The en-bloc spondylectomy enables removal of large parts of one oder more vertebrae in one piece. It is indicated in locally aggressive tumors, solitary metastases and in primary malignant tumors of the spine. The goal is to achieve clear margins (i.e., extralesional resection). In thoracic lesions a posterior only approach is possible, in lumbar lesions or cases with a larger soft tissue involvement a combined posteroanterior approach is recommended. Prerequisite for an extralesional resection is an area of normal, i.e., a tumorfree corridor, through which the dural tube can be released from the resected vertebrae. After resection the focus is to be laid upon a biomechanically solid and biologically durable reconstruction of the spine.

Schlüsselwörter

Spondylektomie - Wirbelsäulentumore - Operationstechnik - spinale Tumore

Keywords

Spondylectomy - spinal tumors - surgical technique

• Literatur

• 1 Stener B. Total spondylectomy in chondrosarcoma arising from the seventh thoracic vertebra. J Bone Joint Surg Br 1971; 53: 288-295
• 2 Boriani S, Biagini R, DeLure F. En bloc resections of bone tumors of the thoracolumbar spine. Spine 1996; 21: 1927-1931
• 3 Boriani S, Weinstein J, Biagini R. Primary bone tumors of the spine. Spine 1997; 22: 1036-1044
• 4 Tomita K, Kawahara N, Baba H. et al. Total en bloc spondylectomy for solitary spinal metatases. Int Orthop 1994; 18: 291-298
• 5 Tomita K, Kawahara N, Baba H. et al. Total en bloc spondylectomy. Spine 1997; 22: 324-333
• 6 Roy-Camille R, Saillant G, Bisserie M. et al. Total excision of thoracic vertebrae. Rev. Chir Orthop Reparatrice Appar Mot 1981; 67: 421-430
• 7 Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop 1980; 204: 9-24
• 8 Fisher CG, Saravanja DD, Dvorak MF. et al. Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence. Spine 2011; 36: 830-836
• 9 Liljenqvist U, Lerner T, Halm H. et al. En bloc spondylectomy in malignant tumors of the spine. Eur Spine J 2008; 17: 600-609
• 10 Ozturk AK, Gokaslan ZL, Wolinsky JP. et al. Surgical treatment of sarcomas of the spine. Curr Treat Options Oncol 2014; 15: 482-492
• 11 Boriani S, Amendola L, Bandiera S. et al. Staging and treatment of osteoblastoma in the mobile spine. Eur Spine J 2012; 21: 2003-2010
• 12 Boriani S, Bandiera S, Casadei R. et al. Giant cell tumor of the mobile spine. Spine 2012; 37: E37-45
• 13 Liljenqvist U, Bullmann V. Primäre Tumoren der Wirbelsäule. Orthop u Unfallchir update 2010; 5: 333-350
• 14 Druschel C, Disch A, Pumberger M. et al. Solitary spinal metastases. Is aggressive surgical management justified?. Orthopade 2013; 42: 706-724
• 15 Demura S, Kato S, Shinmura K. et al. Perioperative complications of total en bloc spondylectomy for spinal tumours. Bone Joint J 2021; 103-B: 976-983
• 16 Oitment C, Bozzo A, Martin A. et al. Primary sarcomas of the spine. Spine J 2021; 21: 296-301