Figure - available from: European Journal of Orthopaedic Surgery & Traumatology
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A two-stage combined anterior and posterior approach is commonly used for total resection of giant spinal tumors. However, an anterior approach at the lower lumbar level is technically challenging because of the anatomy of the iliac wing, major vessels and nerves of the lumbosacral plexus. We report a case of fifth vertebral tumor treated posterior...
Citations
... In our study, a safe resection with tumor-free margin cannot be performed without vascular repair or replacement due to the tumor circumferential growth pattern. To our knowledge, despite numerous studies reporting the surgical management of giant lumbar spinal tumors, no vessel replacement was reported in their operations (16)(17)(18). Indeed vascular injury through anterior exposure sometimes is inevitable due to the unclear boundary caused by the aggressive growth of the tumor, and the occurrence of vascular injury is an intractable problem which can be life-threatening (19). Moreover, the morbidity can be up to 3 to 5 times in revision lumbar surgery in contrast with primary ones (20). ...
Purpose
Surgical treatments are technically challenging for lumbar spinal tumor (LST) with extensive retroperitoneal involvements. Our study aimed to report the experience and outcomes concerning interdisciplinary surgical collaborations in managing such LSTs.
Patients and Methods
Nine patients underwent interdisciplinary surgical treatments which were performed by specialists, namely, spinal, vascular, and urinary surgeries. Data on clinical characteristics were collected, and the Visual Analogue Scale (VAS) and the Japanese Orthopaedic Association Score (JOAS) were used in the evaluation before and after surgery. The postoperative complications and the long-term outcomes were reported as well.
Results
The interdisciplinary work included double J catheter indwelling ( n = 9), nephrostomy ( n = 5), replacement of the common iliac vein ( n = 2), abdominal aorta repair ( n = 3), and vital vessel repair ( n = 8). The early-stage complications included complaints of moderate low back pain and slight implant shift ( n = 1, 11.1%) and tardive ureterodialysis ( n = 1, 11.1%). The 3- and 5-year disease-free survival rates were 76.2 ± 14.8 and 50.8 ± 23.0%, respectively, during the mean follow-up of 34.6 ± 17.9 months (range, 9.5–68.7). Besides this, more blood loss was associated with recurrent and metastatic tumor status ( p = 0.043) and surgery time >5 h ( p = 0.023). Remarkable pain relief and favorable quality of life were achieved based on the postoperative VAS (3.3 ± 0.9, p < 0.001) and JOAS (16.6 ± 0.5, p < 0.001).
Conclusions
The treatments of LSTs with wide-range retroperitoneal involvements require interdisciplinary surgical collaborations to lower the risks and improve the long-term outcomes. High-quality prospective cohort studies with large samples are warranted to establish general surgical protocols in managing LSTs with extensive retroperitoneal involvements.
... Giant invasive spinal schwannoma is an extremely rare benign neoplasm that affects two or more spinal motion segments with destruction of the adjacent vertebrae and extends into paraspinal tissues [5]. Giant invasive schwannomas account for no more than 2.5 % of primary intradural tumors, with the lumbar spine being most often affected [6]. An asymptomatic course and a long-term absence of neurological deficit underlie a prolonged diagnostic pause resulting in late diagnosis and significant tumor growth [7]. ...
The paper presents a rare clinical case of surgical treatment of a patient with a giant invasive schwannoma of the thoracolumbar spine. A single-stage en block resection of the tumor through a combined posteroanterior approach was performed followed by replacement of post-resection interbody diastasis with a carbon implant and by posterior instrumental fixation of the spine. The pain syndrome regressed from VAS scores 7 and 8 (back, lower limbs) to scores 4 and 1, respectively. The follow-up examination was conducted at 6 and 12 months after surgery: there were no signs of relapse. Publications on giant invasive spinal schwannomas were analyzed. Представлен редкий клинический случай хирургического лечения пациента с гигантской инвазивной шванномой грудопояснично-го отдела позвоночника. Выполнена одномоментная en-block-резекция опухоли из комбинированного (дорсально-вентрального) доступа с замещением пострезекционного межтелового диастаза углеродным имплантатом и задней инструментальной фиксацией позвоночника. Достигнут регресс болевого синдрома с 7 и 8 баллов по ВАШ (спина, нижние конечности) до 4 и 1 балла соответ-ственно. Катамнез прослежен в сроки 6 и 12 мес. после операции: признаки рецидива отсутствуют. Проанализированы публикации, посвященные гигантским инвазивным шванномам позвоночника. Ключевые слова: опухоль, гигантская инвазивная шваннома позвоночника, en-block-резекция. Для цитирования: Куклин Д.В., Наумов Д.Г., Беляков М.В., Совпенчук И.А. Сердобинцев М.С. Еn-block-резекция гигантской инвазивной шванномы грудопоясничного отдела позвоночника // Хирургия позвоночника.
