Authors: Dr Vishal Patil, Dr Susmit Naskar,  Dr Viral Papaiya, Dr Mir Tariq Altaf, Dr Mihir Bapat

Authors Affiliations: Kokilaben DhirubhaiAmbani Hospital and Medical Research Institute, Four Bunglows, Andheri West, Mumbai-400053

Address of correspondence: Dr Vishal Patil, MS Ortho, Kokilaben Dhirubhai Ambani Hospital, Mumbai


 

Abstract                                                                                                                 

Introduction: There has been a paradigm shift in surgical treatment of spinal tumors from debulking procedures to radical en-bloc resection. Though en-bloc resection offers a radical excision with minimal spillage, the technique is riddled with high complication rates that are difficult for a spinal surgeon to conquer considering the rarity of presentation of spinal tumors in practice. We present a series of piece-meal total excision of vertebral tumors with clinical and radiological outcomes.

Material & Methods: 22 Dorso-Lumbar tumors were surgically resected between  2009-2013.  These were grouped on the basis of pre-operative planned biopsy as.

  1. Primary benign : Aneurysmal Bone cyst(1), Hemangioma(4), GCT(4) and Osteoblastoma(1).
  2. Primary malignant: Chordoma(2), Chondrosarcoma(1),Plasmacytoma(4)
  3. Metastatic : Breast(2), Thyroid(1), Ovarian(1) and Renal(1).

The chief surgeon, medical oncologist and radiotherapist evaluated all patients before and after surgery. All patients underwent X rays, CT scan and MRI for the vertebral lesion. PET scan, tumor markers and selective scans were ordered for metastic profile. The average age of Primary benign group was 29.5yrs, Primary malignant 42yrs and Metastatic was 62.3 yrs. For the primary group M:F ratio was 3:14 while all patients in the metastatic group were females. The clinical presentation was disabling pain in 19 and progressive neurological deficit in 11.  Out of 11 patients, 9 were ASIA C and 2 were ASIA D

Radiological Grading (Tomita et al)

Tomita grade 3:  Primary benign (3), Metastatic (1)

Tomita grade 4: Primary benign (7), Primary Malignant (6), Metastatic (4).

A pre-operative tumor arterial embolisation was done for all tumors 24 hrs prior to surgery. A single stage posterior resection and reconstruction was planned for all cases. The vertebral body was resected piece-meal along with the periosteum and part of the adjacent reactive zone. .The tumor cavity was irrigated with saline. Intra-operative radiology confirmed total bone resection with no residual bone. Posterior pedicle screw-rod system and anterior mesh cage construct was used in all cases. The medical onco-therapy and radiotherapy was instituted after surgical wound healed .All patient were followed up at 1.5 months and then at 3monthly intervals for 2 years for clinical evaluation. The MRI was obtained yearly till last follow-up.

Results:

Primary Benign tumors: Out of 10 patients followed up for 2 years, Recurrence was noticed in one case of Osteoclastoma at 6 months post-surgery.  The patient remained asymptomatic for 2.5 years and required a debulking procedure with radiotherapy thereafter. For Osteoclastoma a 25% recurrence was observed. No other tumor recurred. All patients reported near normal function at final follow-up with mild non-disabling pain.

Primary Malignant lesions: Chondrosarcoma recurred 3 years of normal function after primary surgery. A repeat piecemeal excision was done.  One patient of chordoma required 3 implant revisions over 2 years and then implant removal after 3 years of primary surgery for painful loosening. However no recurrence was seen with patient maintaining normal function. Out of 4 plasmacytoma, 3 were secretory and were treated with chemotherapy and radiotherapy post-operatively.  None recurred at 2 years follow-up.

Metastatic lesions: None showed local recurrence. At 1 year follow-up the patient with renal disease died. At 2 years, vertebral skip lesions were seen in 3 out of 5 patients and were managed by medical therapist. All patients were functionally independent at final follow-up. However all 4 patients cited significant pain at 2 years.

Conclusion: Though inferior to en-bloc resections, piecemeal excision in conjunction with adjuvant therapy provides lasting tumor free survival with low complications and morbidity.

How to Cite this Abstract
Patil V. CLINICAL OUTCOMES OF VERTEBRECTOMY IN PRIMARY AND     METASTATIC SPINAL TUMOURInternational Journal of Conference Proceedings. March 2015;(2015):27