Abstract
Introduction: There is clear evidence that violating the margins of a sarcoma or other malignancy during surgical resection will risk local recurrence and diminish overall survival. Previous publications have retrospectively demonstrated this oncologically sound approach to spine tumor management to be internally valid. The external validity or limited generalizability has not been assessed.
Methods: A prospective cohort study design. Included were all patients who underwent enbloc surgical resection of a primary tumor of the spine between January 1994 and November 2003, at the authors’ institution. Tumors were classified using the Ennking and WBB staging systems. All specimens were submitted to a single experienced musculoskeletal pathologist. Surgery was performed by the authors. Surgical approach, specimen margins, complications, adjuvant therapy, neurological status, local recurrence and survival were prospectively collected.
Results: Twenty-six patients (12 males and 14 females) were eligible for the study. Average age was 42 (range 16 to 70). There were 19 malignant tumors and 7 benign. Review by the pathologist revealed that 13 resections were wide, 5 marginal (at dura) and 7 intralesional (2 planned wide, 1 planned marginal). Except in benign lesions intral-esional or marginal margins occurred at dura.
There are 20 surviving patients with an average follow up of 41.5 months (range 6 to 111 months), 15 of who had malignant tumors. None of these patients have evidence of local recurrence and one has evidence of systemic disease.
The health related quality of life, using the SF-36, shows acceptable morbidity of these procedures (PCS=37.73 ± 11.52, MCS=51.69 ± 9.54).
Conclusions: Principles of wide surgical resection, commonly applied in appendicular oncology, can and should be used for the treatment of primary bone tumors of the spine with anticipated acceptable morbidity and satisfactory survival.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
