EN BLOC VERTEBRECTOMY FOR THORACOLUMBAR SPINE TUMORS: PRINCIPLES, TECHNIQUES, AND ILLUSTRATIVE CASES

VERTEBRECTOMIA EM BLOCO DE TUMORES DA COLUNA TORACOLOMBAR: PRINCÍPIOS, TÉCNICAS E CASOS ILUSTRATIVOS

VERTEBRECTOMÍA EN BLOQUE DE TUMORES DE LA COLUMNA TORACOLUMBAR: PRINCIPIOS, TÉCNICAS Y CASOS ILUSTRATIVOS

En bloc vertebrectomy (EV) is an oncologic surgical technique aimed at the complete resection of vertebrae affected by tumors, in a single specimen and with negative margins, according to the principles proposed by Enneking. It is especially indicated for primary malignant tumors and aggressive benign tumors. Achieving adequate oncologic margins depends on careful preoperative planning, mainly based on the Weinstein-Boriani-Biagini (WBB) and Tomita classifications, which guide tumor extension, surgical approach, and technical strategy. This article systematically presents the oncologic principles of EV, clinical indications, surgical planning, and available technical approaches. The posterior-only approach is highlighted for its lower morbidity and effectiveness in selected cases, particularly in the thoracic and upper lumbar spine. Two illustrative cases demonstrate the practical application of the technique and reinforce the feasibility of the posterior-only approach. Despite its high morbidity, when properly indicated and planned, EV remains a potentially curative and effective strategy for the treatment of thoracolumbar spine tumors. Level of Evidence III; Review Article.

Keywords:
Spinal Neoplasms; Surgical Oncology; Spine