Embolization procedures are recommended to reduce operative blood loss in hypervascular tumors, especially during more extensive resections.
Embolization should be considered for hypervascular tumors, such as giant cell tumors, aneurysmal bone cysts, and hemangiomas.
The role of the embolization is:
To reduce the vascularity of the tumor
To facilitate dissection around the tumor
Embolization on its own may also have a therapeutic effect.
This image shows the embolization of a hypervascular tumor.
A posterior approach is by far the most common procedure for these tumors.
For the rare instances when an anterior approach is chosen for an intralesional resection, please refer to the anterior resection of metastatic tumors in the dedicated section of the AO Surgery Reference.
The relationship between the tumor and the vertebral artery is important and should be assessed on preoperative MRI and CT scans.
A wide visualization is essential in these cases, and a laminectomy involving half a level above and below the tumor is recommended.
The goal is to achieve:
Good visualization of normal and abnormal anatomy
Safe decompression of the neural elements
Typically, two levels above and below the affected vertebra are included.
As the procedure is often curative, it is important to verify that the spine is reconstructed in good alignment, and a solid bony union should be attempted.
If a posterior element tumor only involves segments 1 and/or 12, resection can be performed without the need for an instrumented fusion.
Most benign primary tumors will be localized in the posterior element with variable extension into the vertebral body.
Every case is unique.
To illustrate the surgical principle of a posterior intralesional resection, we will use a C5 tumor located in segments 1–4 of the WBB classification.
Consideration is given to using pedicle or laminar screws when doing an occiput to C2 fusion, as the starting point for pars screws often compromises the facet joint.
Lateral mass screws vs pedicle screws (C3–C7)
Fixation can be achieved with either lateral mass screws, pedicle screws, or a combination of the two.
Because lateral mass fixation is generally sufficient and carries less risk, pedicle screw fixation is limited to rare cases where lateral mass fixation would be insufficient or is not possible. A pedicle screw is most often used in C7 if instrumented.