Vertebrectomy

Abstract: Objective We analyzed the outcome of patients with symptomatic vertebral hemangiomas treated at University of California, San Francisco, over a 20 year period. Treatment included transarterial embolization, embolization followed by surgical decompression or vertebral reconstruction with arthrodesis, and percutaneous vertebroplasty alone. Methods All medical, surgical, and radiological records were reviewed retrospectively. All patients underwent follow-up neurological examination and evaluation of back pain. Results Sixteen patients diagnosed with symptomatic vertebral hemangiomas causing pain or neurological deficit were treated at University of California, San Francisco, between 1984 and 2004. Mean follow-up was 81 months. Seven of nine patients undergoing surgical decompression and tumor resection reported pain relief and demonstrated improvement in neurological deficit when present. Two patients had recurrent myelopathy: one was successfully treated with a second decompressive surgery, whereas the second underwent a staged vertebrectomy. All three patients undergoing vertebrectomy had cord compression from extraosseous tumor growth. Preoperative embolization reduced expected intraoperative blood loss in four patients. Three of four patients who underwent transarterial embolization alone experienced resolution of back pain. Two of four patients treated with vertebroplasty had long-term pain relief. Conclusion Transarterial embolization followed by laminectomy is a safe and effective procedure for the treatment of cord compression by vertebral hemangioma causing stenosis without instability or deformity. Vertebrectomy preceded by embolization and followed by reconstruction can be used to treat cord compression from extraosseous tumor extension. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.

Abstract: Long-term results of complete removal of vertebrae with a minimum follow-up period of seven years are reported in 23 consecutive patients from March 1968 to January 1981. Seven patients were treated with vertebrectomy above the sacrum: three for a giant-cell tumor (T11, T12, and L1; T11; and L4), one for chondrosarcoma (one-half T6, T7, and one-half T8), one for chordoma (L3), one for plasmocytoma (L1), and one for a metastasis of renal carcinoma (L1). The latter two patients eventually died of generalized disease, whereas the other five patients have no evidence of tumor after seven to 20 years. In the six patients in whom the spine was reconstructed using corticocancellous iliac bone, a block-vertebra was created by the grafts and the adjacent vertebrae, allowing two women to complete one or more pregnancies successfully. Sixteen patients were treated with removal of sacral vertebrae (from one-half S3, S4, and S5 to all). None of the seven patients treated with adequate surgery for a sacral chordoma has had a local recurrence. Two women have given birth to children after sacral amputations, one performed for rhabdomyosarcoma and the other for a huge ganglioneuroma. A patient treated with a hemicorporectomy for chondrosarcoma 18 years ago has no evidence of tumor.

Abstract: A video-assisted thoracoscopic microsurgical approach was developed in the laboratory and subsequently used clinically to resect abnormalities of the thoracic vertebrae, to decompress the thoracic spinal cord, and to reconstruct the thoracic vertebral bodies. This report describes the development of the clinical operative techniques for microsurgical thoracoscopic vertebrectomy, neural decompression, and spinal reconstruction. This minimally incisional approach was clinically used in 17 patients to treat vertebral osteomyelitis, tumors, and compression fractures. Microsurgical thoracoscopic techniques were performed using several narrow, flexible, working portals placed in small incisions in the intercostal spaces. Access to the thoracic spine was achieved through the pleural cavity after temporary deflation of one lung using a double-lumen endotracheal tube. The parietal pleura, segmental vessels, and rib heads were dissected off the surfaces of the involved vertebrae to expose the region of interest. Long narrow spine dissection tools were used to perform the spinal decommpression and reconstruction. This technique achieved the same amount of spinal dissection as that achieved with conventional open spinal procedures and used microsurgical visualization techniques. The small incisions with reduced soft tissue dissection may reduce postoperative pain, shorten the length of hospitalization, and have cosmetic and functional advantages. Thoracoscopic vertebrectomies and reconstruction of the spine were technically feasilble procedures that were performed with excellent clinical results. This minimally incisional technique provides a viable alternative to thoracotomy or to posterolateral approaches for thoracic vertebrectomy and vertebral body reconstruction.