Function Preservation or Oncological Appropriateness in Spinal Bone Tumors? A Case Series of Segmental Resection of the Spinal Canal Content (Spinal Amputation).

STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To evaluate (1) if the segmental resection of the content of the spinal canal could provide an Enneking Appropriate (EA) tumor-free margin for local control of primary bone tumors surrounding and invading the canal and (2) the safety profile of the segmental resection of the neurostructures. SUMMARY OF BACKGROUND DATA: Treatment outcomes of primary malignant and benign aggressive bone tumors of the spine have been dramatically changed by the application of the musculoskeletal oncologic principles described by Enneking. However, the efficacy of spinal oncology surgery might be limited by unique features of spinal anatomy. METHODS: Database search was conducted with the following inclusion criteria: en bloc resection, segmental inclusion of the spinal canal content in the surgical specimen, histologically proven diagnosis, minimum follow-up of 2 years. Exclusion criteria were: piecemeal excision of the tumor (debulking), and diagnosis other than primary bone tumors (metastasis, or local extension of extraosseous tumors). RESULTS: A consecutive cohort of 8 patients (3 males, 5 females) was available for review. Two patients died within 3 months from the surgery for systemic disease progression or sequelae of the surgery. En bloc resection with segmental spinal canal content inclusion was able to achieve local control of the disease in 4 out of remaining 6 cases (66.7%) at average 68,7 months follow-up (range 12-174 months). 3 patients in whom local control was achieved are free from disease at an average 98.7 months follow-up (range 38-174), and 1 died for systemic disease progression (after 38 months). 7 out of 8 patients (87.5%) experienced overall 16 complications. CONCLUSION: En bloc resection including the spinal canal content (spinal amputation) to achieve a tumor-free margin might be considered to perform an EA treatment for motivated patients. LEVEL OF EVIDENCE: 4.