Principios y técnicas de vertebrectomía en bloque para tumores de hueso de columna toracolumbar: Una visión general.
Robert J. Bohinski, M.D., Ph.D.; Laurence D. Rhines, M.D.
Abstract and Introduction
Abstract Oncological principles for en bloc resection of bone tumors were initially developed for tumors of the long bone by orthopedic surgical oncologists. Recently, spine surgeons have adopted these principles for the treatment of vertebral column tumors. The goal of en bloc resection is to establish a surgical margin that can be designated marginal or wide. In this article, the principles of surgical oncology for bone tumors of the spine are briefly reviewed and the different surgical approaches used to remove these tumors in an en bloc fashion are described in detail.
Introduction Oncological principles for the resection of tumors affecting long bones were proposed more than 20 years ago by Enneking, an orthopedic surgical oncologist, and colleagues. The application of these principles to the spine was initially hindered by concerns about the complex paraspinal vascular and visceral anatomy, as well as by lack of reliable instrumentation for complex spinal reconstruction. Recently, several groups have optimized techniques for removing a single vertebra or as many as three contiguous vertebrae in an en bloc fashion.[1,2,4,7,9,11] En bloc resection of tumors of the spine is a very demanding procedure that requires a highly trained team of spine surgeons, general surgeons, and anesthesiologists. These en bloc techniques are based on the principles of general surgical oncology, and preliminary reports demonstrate improved outcomes compared with intralesional techniques.[1,2,11]