Surgical management of primary and metastatic sarcoma of the mobile spine

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Object

Sarcomas of the spine are a challenging problem due to their frequent and extensive involvement of multiple spinal segments and high recurrence rates. Gross-total resection to negative margins, with preservation of neurological function and palliation of pain, is the surgical goal and may be achieved using either intralesional resection or en bloc excision. The authors report outcomes of surgery for primary and metastatic sarcomas of the mobile spine in a large patient series.

Methods

A retrospective review of patients undergoing resection for sarcomas of the mobile spine between 1993 and 2005 was undertaken. Sarcomas were classified by histology study results and as either primary or metastatic. Details of the surgical approach, levels of involvement, and operative complications were recorded. Outcome measures included neurological function, palliation of pain, local recurrence, and overall survival.

Results

Eighty patients underwent 110 resections of either primary or metastatic sarcomas of the mobile spine. Twenty-nine lesions were primary sarcomas (36%) and 51 were metastatic sarcomas (64%). Intralesional resections were performed in 98 surgeries (89%) and en bloc resections were performed in 12 (11%). Median survival from surgery for all patients was 20.6 months. Median survival for patients with a primary sarcoma of the spine was 40.2 months and was 17.3 months for patients with a metastatic sarcoma. Predictors of improved survival included a chondrosarcoma histological type and a better preoperative functional status, whereas osteosarcoma and a high-grade tumor were negative influences on survival. Multivariate analysis showed that only a high-grade tumor was an independent predictor of shorter overall survival. American Spinal Injury Association scale grades were maintained or improved in 97% of patients postoperatively, and there was a significant decrease in pain scores postoperatively. No significant differences in survival or local recurrence rates between intralesional or en bloc resections for either primary or metastatic spine sarcomas were found.

Conclusions

Surgery for primary or metastatic sarcoma of the spine is associated with an improvement in neurological function and palliation of pain. The results of this study show a significant difference in patient survival for primary versus metastatic spine sarcomas. The results do not show a statistically significant benefit in survival or local recurrence rates for en bloc versus intralesional resections for either metastatic or primary sarcomas of the spine, but this may be due to the small number of patients undergoing en bloc resections.

Abbreviations used in this paper: ASIA = American Spinal Injury Association; CI = confidence interval; LOS = length of stay; NRS = Numerical Rating Scale; RR = rate ratio.

Article Information

Address correspondence to: Laurence D. Rhines, M.D., The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030. email: lrhines@mdanderson.org.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Images obtained in a patient with a sarcoma. A: Preoperative axial CT reconstruction showing a mass originating from the vertebral body at T-6. The mass was biopsied and found to be consistent with a chondrosarcoma. B: Intraoperative photograph showing the patient undergoing en bloc resection of the tumor involving multilevel sagittal osteotomy with reconstruction. C: Photograph of the tumor specimen with the tumor capsule intact and attached to the associated spinal elements and lung tissue. The specimen has been bisected. D: Postoperative axial CT scan showing resection of the lesion with posterior stabilization.

  • View in gallery

    Graph of the Kaplan–Meier survival estimates of patients undergoing resections for primary and metastatic sarcomas of the spine. The difference in the curves is statistically significant (p = 0.01, log-rank test).

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