Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background

Enneking et al. examined the process of local spread of primary bone and soft tissue tumors of the extremities and proposed a “surgical staging system” and “the concept of compartment and anatomic barriers.”17 Applying this concept to the spine, we studied the histology of 19 vertebral tumor specimens resected by TES. We found that the following tissues served as barriers to spinal tumor progression;1 the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), periosteum abutting the spinal canal, ligamentum flavum, periosteum of the lamina and spinal process, interspinous ligament, supraspinous ligament, cartilaginous endplate, and cartilaginous annulus fibrosus. However, both the PLL and the periosteum on the lateral side of the vertebral body were weak anatomical barriers. In contrast, the ALL, cartilaginous endplate, and annulus fibrosus were much stronger barriers.1 We concluded that in the spine one vertebra could be regarded a single oncologic compartment and the abovementioned surrounding tissues as barriers to tumor spread (Fig. 1).