Primary tumours and solitary metastases of the spine and sacrum are indications for wide/marginal en bloc excisions. Due to deranged spinal anatomy and spatial vicinity of neurovascular structures oncological sufficient resections of the spine are technically demanding. New concepts of imageguided navigation of resection planes and implant positioning have attracted major interest. This report aimed to describe the technique and oncosurgical treatment results of navigation-assisted resections of tumours/solitary metastatic lesions of the thoracolumbar spine and sacrum. Using an CT-based optoelectronic navigation system 14 patients (spinal/sacral primary tumours n=10, solitary metastatic diseases n=4) have been included. At the thoracolumbar spine, in 3 patients an anterior-posterior navigated resection was performed while an anterior-only approach was used in 1 patient. In 10 patients CT-based guidance of sacrectomy was scheduled. 6 patients received neoadjuvant polychemotherapy. Navigation was successful in 11 patients. Resections were performed at the thoracolumbar spine as hemivertebrectomies in 4 patients. In sacrectomy, segments S2-5, S3-5 and S4-5 were resected in 5, 5 and 1 patients, respectively. Resection margins were tumour-free in 11 patients and marginal with microscopic residual disease in 3 patients. Local recurrence was observed in 3 patients after free interval of 21. 5 months. 11 patients have currently no evidence of disease with a mean follow up of 47. 7 ± 7. 0 months. Mean survival time for patients with solitary metastases was 290 ± 23 months. 1 patient with sacral Ewing sarcoma developed pulmonary metastatic disease of which he died 60 months postoperatively. The mean disease specific survival for navigated sacrectomies and hemivertebrectomies was 48. 3 ± 28. 5 and 32. 7 ± 22. 0 months. In particular in segments of the non-exposed spine navigated resections of spinal/ sacral tumours allows for a excellent intraoperative 3D-visualization of spinal anatomy, the tumour and planned resection planes. Potential problems may be caused by erroneous surface matching, insufficient exposure of landmarks and increased mobility of the resected bone segment leading to inaccuracy of navigation and reference. Tremendous gain in orientation along with decreased intraoperative radiation exposure appears to result in avoidance of unnecessarily large resection defects and improved local recurrence rates with acceptable systemic tumour control.
- image guided resection
- spinal tumours
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
- Clinical Neurology
- Biomedical Engineering
- Radiology Nuclear Medicine and imaging