En bloc spondylectomy for treatment of tumor-induced osteomalacia

Case report

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En bloc spondylectomy represents a radical resection of a spinal segment most often reserved for patients presenting with a primary extradural spine tumor or a solitary metastasis in the setting of an indolent, well-controlled systemic malignancy. The authors report a case in which en bloc spondylectomy was conducted to control a metabolically active spine tumor. A 56-year-old woman, who suffered from severe tumor-induced osteomalacia, was found to have a fibroblast growth factor-23–secreting phosphaturic mesenchymal tumor in the T-8 vertebral body. En bloc resection was conducted, leading to resolution of her tumor-induced osteomalacia. This case suggests that radical spondylectomy may be beneficial in the management of metabolically or endocrinologically active tumors of the spine.

Abbreviations used in this paper: BMP = bone morphogenic protein; FGF-23 = fibroblast growth factor-23; PMT = phosphaturic mesenchymal tumor; PTH = parathyroid hormone.

Article Information

Address correspondence to: Daniel M. Sciubba, M.D., 600 North Wolfe Street, Meyer 8-161, Baltimore, Maryland 21287. email:dsciubb1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial images through the T-8 vertebral body showing a right-sided lesion on a T2-weighted MR image (upper) and a CT scan (lower).

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    Illustration of posterior approach to thoracic en bloc spondylectomy. Following resection of posterior elements and stabilization of spine with a pedicle screw and rod construct, the vertebral body is separated from the spine via radical discectomies and the specimen is rotated out of the patient (green arrow).

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    Photomicrographs of histopathological specimens of the resected lesion showing features consistent with a PMT. Tumor cells are observed within the surrounding bone trabeculae. Additional stains (not shown here) found that tumor cells focally stained for S100 and CD31 highlighted vessels, consistent with PMT. H & E, original magnification × 100 (left) and × 400 (right).

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    Sagittally reconstructed postoperative CT scan showing placement of the interbody cage, pedicle screws, and rods following T-8 en bloc spondylectomy. No osseous fusion mass is apparent.

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