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En-bloc-Spondylektomie und Defektrekonstruktion bei Primärtumoren und Solitärmetastasen der Wirbelsäule

En-bloc spondylectomy and reconstruction for primary tumors and solitary metastasis of the spine

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Zusammenfassung

Bei Primärtumoren der Wirbelsäule und mit Einschränkungen bei Solitärmetastasen ist das Ziel der operativen Behandlung die Heilung der Erkrankung. Da die Prognose primär maligner Knochentumoren bei intraläsionalem Vorgehen extrem schlecht ist, muss eine extraläsionale En-bloc-Spondylektomie bzw. Resektion angestrebt werden. Hierfür ist es zur Therapieplanung wichtig, ein erprobtes chirurgisches Stagingsystem zu benutzen. An der Wirbelsäule hat sich dabei das WBB-Stagingsystem bewährt, welches die Prinzipien der Enneking-Klassifikation für Extremitätentumoren an die Wirbelsäule transferiert. Im Anschluss an die möglichst extraläsionale En-bloc-Spondylektomie erfolgt eine primärstabile dorsoventrale Rekonstruktion und Stabilisation der Wirbelsäule, dorsal mit winkelstabilem Fixateur, ventral idealerweise mittels Wirbelkörperersatzimplantat. Ob eine extraläsionale Resektion möglich ist, hängt von der Lage und Ausdehnung des Tumors ab. Literatur und eigene Ergebnisse belegen für primär maligne Knochentumoren eine gute Prognose, sofern der Tumor extraläsional resektabel war und einen guten Regressionsgrad aufwies. Deutlich schlechter ist die Prognose bei Vorliegen einer Solitärmetastase, sodass hier v. a. die lokale Tumorkontrolle im Vordergrund steht, wenn gleich auch hier primär ein kurativer Therapieansatz besteht.

Abstract

In primary tumors of the spine and, with limitations, solitary metastasis, the surgical approach should aim for curative treatment of the disease. Because the prognosis of malignant bone tumors is extremely limited, if an intralesional approach is performed, an extralesional en bloc resection is the treatment of choice. Therefore, it is mandatory to use an appropriate staging system. For the spine, the WBB staging system has been approved, which transfers the principles of the Enneking classification for treating primary malignant tumors of the limb to the spine. After en bloc spondylectomy, rigid and primary stable instrumented dorsoventral reconstruction must be performed – posteriorly with a dual-rod system using pedicle screws, and anteriorly in the ideal case by means of a vertebral body replacement cage. The possibility of extralesional (wide or marginal) resection of spinal tumors depends on tumor size and location. Extralesional resection and, if indicated, other neoadjuvant, adjuvant, or local therapeutic modalities have a strong positive influence on long-term survival rates. A good prognosis for primary tumors is associated with a good response to chemotherapy and extralesional resection. Solitary metastases have a much worse quod vitam prognosis. Therefore, local control of the disease in en bloc resections of solitary metastasis is a second relevant goal, although curative treatment is the primary aim.

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Authors and Affiliations

  1. Klinik für Wirbelsäulenchirurgie und Skoliosezentrum, Klinikum Neustadt, Am Kiebitzberg 20, 23730, Neustadt i.H., Deutschland

    H. Halm & A. Richter

  2. Abteilung für Wirbelsäulenchirurgie, St. Franziskus-Hospital, Münster, Deutschland

    T. Lerner & U. Liljenqvist

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  1. H. Halm
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  2. A. Richter
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  3. T. Lerner
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  4. U. Liljenqvist
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Correspondence to H. Halm.

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Halm, H., Richter, A., Lerner, T. et al. En-bloc-Spondylektomie und Defektrekonstruktion bei Primärtumoren und Solitärmetastasen der Wirbelsäule. Orthopäde 37, 356–366 (2008). https://doi.org/10.1007/s00132-008-1231-7

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