En Bloc Resection of Vertebral Tumors of Thoracic and Lumbar Spine: Indications and Techniques

sent 11% of all primary tumors of the musculoskeletal system, 4.2% of all spinal tumors, and approximately 0.4% of all cancers. The incidence of primary spinal tumors is calculated to range from 2.5 to 8.5 per 100,000 individuals per year. Plasmacytoma, which has a considerable tendency to appear in the vertebras, is often considered in the discussion of spinal tumors, even though it originates in the lymphoreticular system. Due to the rarity of these primary tumors in spine, and diffi culties reported in the past with partial resections and the high recurrence index of these tumors, en bloc resection techniques have been developed to follow oncologic criteria in the surgical resection of spinal tumors. This type of resection was conceived initially by Enneking and others for treatment of bone tumors and soft tissue tumors of the extremities. This new procedure dramatically reduced amputations and notably improved control of the disease in association with other adjuvant therapies. Whether this philosophy can be applied to spinal tumors has been debated, due to the anatomic characteristics and the proximity of unresectable structures. Steiner was the pioneer of this type spinal tumor resection, followed by Roy-Camille and Tomita in the 70s and 80s.