Fujita T, Ueda Y, Kawahara N, Baba H, Tomita K
Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, Japan.
Spine (Phila Pa 1976). 1997 Aug 15;22(16):1905-12. doi: 10.1097/00007632-199708150-00020.
Nineteen solitary metastatic vertebral tumors obtained by total en bloc spondylectomy were analyzed histologically.
To determine the mechanisms of local spread of vertebral tumors and identity barrier tissues to tumor progression in the vertebra.
Histologic studies of specimens resected at amputation or en bloc excision have determined the pattern of local spread of bone and soft tissue tumors in the extremities and identified barrier tissues to tumor spread. However, a similar assessment of vertebral malignancies is difficult. The development of total en bloc spondylectomy for primary vertebral malignancy and solitary has allowed the collection of tissue samples sufficient to analyze the pattern of local spread of tumors, using the concept of compartment and barrier.
Histologic sections of all vertebral elements were prepared from specimens collected after en bloc spondylectomy. Serial 5-mm sections in the sagittal plane were also prepared and examined.
Analysis of tumor location showed that metastatic tumors reached the vertebral column by invading the bone marrow of the dorsal region of the vertebral body. The anterior longitudinal ligament, posterior longitudinal ligament, periosteum abutting the spinal canal, ligamentum flavum, periosteum of the lamina and spinous process, interspinous ligament, supraspinous ligament, cartilaginous endplate and the anulus fibrosus served as barriers to tumor progression. The posterior longitudinal ligament was the weakest barrier tissue and was gradually destroyed by the tumor at the point of perforating vessels. Even after destruction of the barrier tissue, tumor cells were covered with a thin, fibrous reactive membrane. Two pathways allowed tumor spread to the adjacent vertebrae: 1) from the edge of the vertebral body to the adjacent vertebral body beneath the longitudinal ligament, and 2) through the paravertebral muscles to the neighboring lamina.
Each vertebra can be represented by a compartment surrounded by several barriers. The most common path for tumor spread is through the posterior longitudinal ligament to the epidural space.
对通过整块全脊椎切除术获取的19例孤立性转移性椎体肿瘤进行组织学分析。
确定椎体肿瘤局部扩散的机制，并明确椎体中肿瘤进展的屏障组织。
对截肢或整块切除标本的组织学研究已确定了骨与软组织肿瘤在四肢的局部扩散模式，并明确了肿瘤扩散的屏障组织。然而，对椎体恶性肿瘤进行类似评估较为困难。原发性椎体恶性肿瘤和孤立性肿瘤整块全脊椎切除术的发展，使得能够收集足够的组织样本，利用间隔和屏障的概念分析肿瘤的局部扩散模式。
从整块全脊椎切除术后收集的标本中制备所有椎体成分的组织学切片。还制备并检查了矢状面连续5毫米的切片。
肿瘤位置分析显示，转移性肿瘤通过侵入椎体背侧区域的骨髓到达脊柱。前纵韧带、后纵韧带、椎管毗邻的骨膜、黄韧带、椎板和棘突的骨膜、棘间韧带、棘上韧带、软骨终板和纤维环是肿瘤进展的屏障。后纵韧带是最薄弱的屏障组织，在穿通血管处逐渐被肿瘤破坏。即使屏障组织被破坏，肿瘤细胞仍被一层薄的纤维反应膜覆盖。肿瘤扩散至相邻椎体有两条途径：1）从椎体边缘至纵韧带下方的相邻椎体；2）通过椎旁肌至相邻椎板。
每个椎体可由被多个屏障包围的间隔来表示。肿瘤扩散最常见的途径是通过后纵韧带至硬膜外间隙。
