Gasbarrini Alessandro, Pasini Stefano, Fu Zhaozong, Ghermandi Riccardo, Pipola Valerio, Gargiulo Mauro, Innocenti Marco, Boriani Stefano
Spine Surgery Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy.
J Clin Med. 2025 Jan 8;14(2):349. doi: 10.3390/jcm14020349.
: EnBloc resections of bone tumors of the spine are very demanding as the target to achieve a tumor-free margin specimen (sometimes impossible due to the extracompartimental tumor extension) is sometimes conflicting with the integrity of neurological functions and spine stability. : The surgical treatment of a huge multi-level chordoma of the thoracic spine with unusual extension is reported. Anteriorly, the tumor widely invaded the mediastinum and displaced the aorta; on the left side, it expanded in the subpleuric region; posteriorly, it was uncommonly distant 13 mm from the posterior wall. : EnBloc resection is largely performed for primary bone tumors of the spine and many reports have been published concerning brilliant solutions to difficult issues of surgical anatomy. One of the major challenges is still the compatibility between oncological and functional requirements. : Oncological staging, careful imaging analysis, a multidisciplinary surgical team, and utilization of the most recent technologies like navigation and robotics have made an oncologically appropriate EnBloc resection of a multi-level chordoma of the thoracic spine possible without affecting the continuity of the spinal canal and without any involvement of its content by an original "L"-shaped osteotomy.
整块切除脊柱骨肿瘤要求极高，因为要实现切缘无肿瘤标本（有时由于肿瘤跨区间延伸而无法做到）的目标，有时会与神经功能完整性和脊柱稳定性相冲突。
报道了一例具有不寻常延伸的巨大胸椎多节段脊索瘤的手术治疗。肿瘤向前广泛侵犯纵隔并使主动脉移位；在左侧，它在胸膜下区域扩展；在后方，它距后壁异常远达13毫米。
脊柱原发性骨肿瘤大多采用整块切除，并且已经发表了许多关于解决手术解剖学难题的出色方案的报告。主要挑战之一仍然是肿瘤学和功能需求之间的兼容性。
肿瘤分期、仔细的影像学分析、多学科手术团队以及使用导航和机器人技术等最新技术，使得通过原始的“L”形截骨术在不影响椎管连续性且不涉及椎管内容物的情况下，对胸椎多节段脊索瘤进行符合肿瘤学要求的整块切除成为可能。
