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Review
. 2022 Jun 9;32(2):205-212.
doi: 10.1055/s-0042-1744162. eCollection 2022 Jun.

A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know?

E Smith  1 , G Hegde  1 , M Czyz  2 , S Hughes  2 , S Haleem  2 , M Grainger  2 , S L James  1 , R Botchu  1
Affiliations
Review

A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know?

E Smith et al. Indian J Radiol Imaging. .

Abstract

En bloc resection in the spine is performed for both primary and metastatic bone lesions and has been proven to lengthen disease-free survival and decrease the likelihood of local recurrence. It is a complex procedure, which requires a thorough multi-disciplinary approach. This article will discuss the role of the radiologist in characterizing the underlying tumor pathology, staging the tumor and helping to predict possible intraoperative challenges for en bloc resection of primary bone lesions. The postoperative appearances and complications following en bloc resection in the spine will be considered in subsequent articles.

Keywords: en bloc; primary tumors; spine.

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Conflict of interest statement

Conflict of Interest No conflicts of interest.

Figures

Fig. 1
Fig. 1
Schematic of vertebra showing Weinstein-Boriani-Biagini zones 1–12, extraosseous soft tissue ( a —green), intraosseous superficial ( b —light orange), deep intraosseous ( c —blue), extraosseous, extradural ( d —black), extraosseous intradural ( e —yellow).
Fig. 2
Fig. 2
T2 sagittal ( A ) and axial ( B ) showing large chordoma with epidural component (small arrow). Tumor is compressing but not encasing the inferior vena cava (long arrow) (Weinstein-Boriani-Biagini 4–10, a–d ).
Fig. 3
Fig. 3
Axial computed tomography angiogram image showing tumor displaced left carotid vessels anteriorly and encasing left vertebral artery (arrow).
Fig. 4
Fig. 4
Axial short tau inversion recovery ( A ), T1 ( B and C ) showing large chordoma that is closely related to the aorta with loss of fat plane between the tumor and aorta on image ( C ) (arrow). The tumor extends and involves the left psoas. (Weinstein-Boriani-Biagini 3–10, a–d ).
Fig. 5
Fig. 5
Ewing's sarcoma. Sagittal T2 ( A ), axial T2 ( B ), T1 ( C ), post chemotherapy axial T2 ( D ), T1 ( E ), and sagittal T2 ( F ) showing tumors in the canal and extending into the left psoas (arrow). (Weinstein-Boriani-Biagini 2–5, A–E ). The tumor has decreased significantly post chemotherapy and blue lines denote the resection margin.
Fig. 6
Fig. 6
Chondrosarcoma. Coronal short tau inversion recovery (STIR) ( A ) T1( B ), axial computed tomography ( C ), axial STIR ( D ) and T1 ( E ) showing resection margins (blue lines). Arrow showing the tumor is close to the aorta. (Weinstein-Boriani-Biagini 2–6, A ).
Fig. 7
Fig. 7
Aneurysmal bone cyst. Sagittal computed tomography (CT) (bone windows) ( A ), sagittal CT angiogram ( B ), axial CT angiogram (bone window ( C ), and soft tissue window ( D ) showing site of resection (blue lines). The left vertebral artery and left C6 nerve root need to be resected. (Weinstein-Boriani-Biagini 2–9, a–c ).
Fig. 8
Fig. 8
Chordoma. Sagittal T2 ( A ) and axial T2 ( B ) showing resection marking (blue lines). The arrows demonstrate that the psoas muscle is closely related to the tumor and might have to be resected. (Weinstein-Boriani-Biagini 4–9, a–d ).
See this image and copyright information in PMC

References

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