General
- A staged method for Total En Bloc Spondylectomy (TES)
- Prioritizes the management of major vascular structures before proceeding with the main tumor resection.
Indication
- Indicated for complex tumors, usually classified as Type 5 (paravertebral extension) or Type 6 (adjacent vertebral extension), where the tumor involves major vessels or segmental arteries.
Surgical procedure
Anterior Approach (Dissection and Preparation)
- Approach
- Thoracotomy (for the thoracic spine)
- A thoracoscopic or mini-open approach is often preferred for this anterior dissection nowadays.
- Extraperitoneal approach (for the lumbar spine).
- Vascular Dissection: The primary focus is the dissection of major vessels from the tumor-bearing vertebral segment.
- If the tumor adheres to or involves major vessels, a vascular surgeon may be required to dissect the vessels from the tumor vertebra(e).
- If the tumor extends to the anterior paravertebral area, this preliminary anterior dissection is performed to aid surgeons in safely executing the subsequent posterior TES procedure.
- Organ Management:
- If the lung is invaded, a thoracic surgeon can perform a lobectomy during this stage.
- Specific Lumbar Management:
- For tumors involving the L2–L3 vertebrae, the initial anterior approach may involve detachment of the diaphragmatic crura from the affected vertebra.
Posterior Approach (Resection and Reconstruction)
- Procedure: This stage involves the completion of the standard two steps of TES:
- En bloc resection of the posterior element (laminectomy).
- En bloc resection of the anterior part/column (corpectomy) to salvage the spinal cord.
- Tumor Removal: The complete tumor resection en bloc is performed, achieving the oncological goal of removing the vertebral body and lamina as one compartment.
- Spinal Reconstruction: This is followed by anterior reconstruction (e.g., using a vertebral spacer) and posterior instrumentation (e.g., using pedicle screws and rods) to ensure spinal stability.
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