Novel whole spinal tumor excision method
By adopting a single posterior approach method with the ‘rotation-circulation’ technology in spinal tumor surgery, the problem of whole-block resection of spinal tumors is solved, safer and more thorough tumor resection is achieved, and the risk of recurrence is reduced.
Patent Information
- Application Number
- CN202411290727.8
- Authority / Receiving Office
- CN · China
- Patent Type
- Applications(China)
- Current Assignee / Owner
- Filing Date
- 2024-09-14
- Publication Date
- 2025-02-07
AI Technical Summary
The prior art is difficult to achieve the whole-piece resection of spinal tumors, especially in the thoracic vertebra. Due to the complex anatomical structure and the wide range of tumor invasion, the operation is difficult and easy to damage the spinal cord nerves and important blood vessels, increasing the risk of recurrence.
Using the 'rotation-rotation' technology, the tumor vertebra is subjected to En-bloc resection through a single posterior approach. The boundary between the dural and nerve roots and the tumor envelope is separated under direct vision by rotating operation, ensuring safe resection of the boundary and avoiding it. Vascular damage.
A more thorough resection of the spinal tumor under direct vision is achieved, reducing the risk of vascular and nerve damage during surgery, and reducing the possibility of tumor residues and recurrence.
Smart Images
Figure CN119385653A_ABST
Abstract
Description
Technical Field
[0001] The present invention relates to the technical field of spinal tumor resection, and more specifically, to a novel method for resecting a spinal tumor in one piece. Background Art
[0002] At present, en bloc resection with negative surgical margins is recognized as the best method for treating primary malignant tumors of the spine and some benign invasive tumors. However, en bloc resection of spinal tumors is usually not possible in clinical practice due to the complex anatomical structure of the spinal region, the limitations of the surrounding important blood vessels and nerve structures, and the huge size of the tumor. Especially in the thoracic spine segment, compared with the lumbar spine, the front of the thoracic spine is a hollow chest structure, and the surface of the thoracic vertebral body lacks anatomical barriers such as muscle and soft tissue. Vertebral malignant tumors are prone to grow and break through the vertebral cortex and anterior longitudinal ligament, grow outside the vertebrae to form a huge mass, and are more likely to invade the surrounding important neurovascular structures, thereby further increasing the difficulty of en bloc resection of thoracic tumors. Damage to the spinal nerves and surrounding important blood vessels during en bloc resection of spinal tumors is the main cause of major complications such as paralysis and death. When the tumor breaks through the vertebral cortex and approaches the large blood vessels in front of the vertebral body, it is usually necessary to use the anterior approach to separate the blood vessels from the tumor capsule, and then use the posterior approach to remove the tumor in one piece. This often requires more operation time and intraoperative blood loss. If a simple posterior approach is used for en bloc resection, Tomita et al. proposed that the surgeon's fingers enter the front of the vertebral body and push and peel the large blood vessel structure on the ventral side of the vertebra along the front edge of the vertebral body. Since the operation cannot be performed under direct vision, the surgeon can only rely on the tactile sense of the surgeon's fingertips to separate the tumor and blood vessels. There is a possibility of contamination and residue caused by damage to the large blood vessels and damage to the tumor capsule. Secondly, for Tomita type 3-6 spinal tumors, the tumor invasion range includes not only the vertebral body, but also the pedicles and part of the posterior arch. In this case, if the TES surgical method is used, that is, after bilateral pedicle osteotomy, the posterior arch and the anterior vertebral body are divided into two parts and removed in sequence, it will inevitably cause contamination due to the transtumoral resection of the pedicle osteotomy on the tumor-invaded side. In addition, tumor invasion extends into the spinal canal, resulting in extradural involvement (i.e., Weinstein-Boriani-Biagini (WBB) stage Layer D) in clinical cases. Little is known about how to separate the affected dura mater and the tumor capsule to achieve a safe tumor resection margin during en bloc resection, and no detailed reports have been found in the literature. This is crucial to controlling tumor recurrence at the dura mater boundary. Inadvertent contamination during surgical separation is the root cause of tumor recurrence at the dura mater boundary. Summary of the invention
[0003] The present invention aims to solve the above technical problems at least to a certain extent, and provides a novel method for en bloc resection of spinal tumors, which can separate tumor boundaries, more thoroughly remove the tumor, and avoid residual tumor recurrence.
[0004] The technical solution of the present invention is: a novel method for en bloc resection of spinal tumors, which comprises the following steps:
[0005] S1. After anesthesia, the patient is placed in the prone position. The skin and soft tissue structures around the posterior arch of the tumor segment are incised and freed according to the preoperatively designed surgical safety margin, and pedicle screws are inserted in the normal vertebrae above and below the tumor vertebra.
[0006] S2. Part of the normal ribs of the tumor vertebral segment are removed on both sides, and the thoracic cavity is entered through the pleura. Only at the osteotomy level of the normal vertebra at the upper and lower ends of the tumor vertebra, the surgeon's fingers are used to enter the front of the vertebral body and bluntly dissect the large blood vessel structure on the ventral side of the vertebra along the front edge of the vertebral body. A protective baffle is placed between the vertebral body and the free blood vessels in the dissection gap, and a wire saw is placed respectively;
[0007] S3. En-bloc resection of the tumor vertebra was then performed using the rotation-circumflexion technique.
[0008] The removal process is as follows:
[0009] (1) After removing the healthy posterior arch bone structure (lamina and pedicle) of the tumor vertebra (healthy side), a safety window is opened to allow entry into the spinal canal and to ligate and segment the nerve roots on the healthy side.
[0010] (2) Because the vertebral lamina and pedicle on the tumor-invaded side (the affected side) are invaded by the tumor, and the nerve roots and part of the dura mater on the affected side are covered by the tumor, they cannot be directly exposed and separated, making it difficult to obtain a safe tumor resection margin along the dura mater on the affected side.
[0011] (3) Select the osteotomy level (intervertebral disc or vertebral body) at the head and tail ends of the tumor vertebra and use a pre-placed wire saw to perform osteotomy; after complete cutting, the tumor vertebra can be rotated around the longitudinal axis.
[0012] (4) After osteotomy, the tumor vertebra is first rotated around the longitudinal axis toward the affected side, so that the boundary between the affected dura mater and nerve roots and the tumor capsule can be separated under direct vision, and the affected nerve roots are ligated and cut off.
[0013] (5) The specimen is then rotated around the longitudinal axis toward the healthy side (circumcision). At the same time, the large vascular structures on the ventral side of the tumor vertebra are circumcised together with the tumor vertebra, allowing the vascular separation operation to be performed while circumcising under direct vision from the posterior approach, thus avoiding damage to the blood vessels and ensuring a safe resection margin for the tumor.
[0014] (6) Finally, the entire tumor vertebra is removed posteriorly using a cyclotorsion maneuver.
[0015] (7) Reconstruct the anterior vertebral defect and connect the posterior pedicle screw fixation.
[0016] Compared with the prior art, the beneficial effects are: the combined anterior and posterior approach of the present invention will certainly increase the operation time, postoperative blood loss and surgical risk. However, the en bloc resection of thoracic tumors through a simple posterior approach is usually impossible because the free anterior vertebral blood vessels cannot be obtained under direct vision, and because the lamina and pedicles are invaded by the tumor, the dura mater sac and nerve roots cannot be easily separated from the tumor capsule, which increases the risk of vascular and nerve damage and limits the chance of achieving a safe tumor resection boundary by separating the dura mater and tumor capsule. The use of the "rotation-circumduction" technology can solve the above problems to a certain extent.
[0017] A single posterior approach solves the problem, avoiding the need for anterior approach surgery, which results in longer operation time, more bleeding, and more complicated surgical operations and risks.
[0018] For better understanding and implementation, the present invention is described in detail below with reference to the accompanying drawings. BRIEF DESCRIPTION OF THE DRAWINGS
[0019] Figure 1 Schematic diagram of en bloc resection through a single posterior approach to the thoracic spine using the rotation-inversion technique. DETAILED DESCRIPTION
[0020] The drawings are only for illustrative purposes and cannot be construed as limiting the present invention. To better illustrate the present embodiment, some parts of the drawings may be omitted, enlarged, or reduced, and do not represent the size of the actual product. For those skilled in the art, it is understandable that some well-known structures and their descriptions may be omitted in the drawings. The positional relationships described in the drawings are only for illustrative purposes and cannot be construed as limiting the present invention.
[0021] The same or similar numbers in the drawings of the embodiments of the present invention correspond to the same or similar parts; in the description of the present invention, it should be understood that if the terms "upper", "lower", "left", "right" and the like indicate directions or positional relationships based on the directions or positional relationships shown in the drawings, it is only for the convenience of describing the present invention and simplifying the description, rather than indicating or implying that the device or element referred to must have a specific direction, be constructed and operated in a specific direction. Therefore, the terms describing the positional relationship in the drawings are only used for illustrative purposes and cannot be understood as limitations on this patent. For ordinary technicians in this field, the specific meanings of the above terms can be understood according to specific circumstances.
[0022] like Figure 1The figure shows a diagram of en bloc resection through a single posterior approach to the thoracic spine using the rotation-reversal technique. The purpose of the present invention is to use the "rotation-circumduction" technique to perform en bloc resection of thoracic and lumbar tumors through the posterior approach. First, it avoids the separation and operation of nerves and blood vessels under non-direct vision, causing damage, and ensures the safety of the operation; second, it separates the tumor boundaries under direct vision, removes the tumor more thoroughly, and avoids tumor residue and recurrence.
[0023] A novel method for en bloc resection of spinal tumors, comprising the following steps:
[0024] S1. After anesthesia, the patient is placed in the prone position. The skin and soft tissue structures around the posterior arch of the tumor segment are incised and freed according to the preoperatively designed surgical safety margin, and pedicle screws are inserted in the normal vertebrae above and below the tumor vertebra.
[0025] S2. Part of the normal ribs of the tumor vertebral segment are removed on both sides, and the thoracic cavity is entered through the pleura. Only at the osteotomy level of the normal vertebra at the upper and lower ends of the tumor vertebra, the surgeon's fingers are used to enter the front of the vertebral body and bluntly dissect the large blood vessel structure on the ventral side of the vertebra along the front edge of the vertebral body. A protective baffle is placed between the vertebral body and the free blood vessels in the dissection gap, and a wire saw is placed respectively;
[0026] S3. En-bloc resection of the tumor vertebra was then performed using the rotation-circumflexion technique.
[0027] The removal process is as follows:
[0028] (1) After removing the healthy posterior arch bone structure (lamina and pedicle) of the tumor vertebra (healthy side), a safety window is opened to allow entry into the spinal canal and to ligate and segment the nerve roots on the healthy side.
[0029] (2) Because the vertebral lamina and pedicle on the tumor-invaded side (the affected side) are invaded by the tumor, and the nerve roots and part of the dura mater on the affected side are covered by the tumor, they cannot be directly exposed and separated, making it difficult to obtain a safe tumor resection margin along the dura mater on the affected side.
[0030] (3) Select the osteotomy level (intervertebral disc or vertebral body) at the head and tail ends of the tumor vertebra and use a pre-placed wire saw to perform osteotomy; after complete cutting, the tumor vertebra can be rotated around the longitudinal axis.
[0031] (4) After osteotomy, the tumor vertebra is first rotated around the longitudinal axis toward the affected side, so that the boundary between the affected dura mater and nerve roots and the tumor capsule can be separated under direct vision, and the affected nerve roots are ligated and cut off.
[0032] (5) The specimen is then rotated around the longitudinal axis toward the healthy side (circumcision). At the same time, the large vascular structures on the ventral side of the tumor vertebra are circumcised together with the tumor vertebra, allowing the vascular separation operation to be performed while circumcising under direct vision from the posterior approach, thus avoiding damage to the blood vessels and ensuring a safe resection margin for the tumor.
[0033] (6) Finally, the entire tumor vertebra is removed posteriorly using a cyclotorsion maneuver.
[0034] (7) Reconstruct the anterior vertebral defect and connect the posterior pedicle screw fixation.
[0035] Specifically, Figure 1 In the middle, a safety window is opened at the posterior arch and the nerve roots on the unaffected side are sectioned. The dura is separated from the lesion, and the nerve roots on the tumor-covered side are sectioned under direct visualization using the rotation technique. Tumor invasion of the large vessels and surrounding structures on the ventral side of the vertebra is blunt dissected using the reversion technique from the posterior approach under direct visualization. The entire mass is continued to be turned over until the posterior aspect is completely removed.
[0036] Obviously, the above embodiments of the present invention are merely examples for clearly illustrating the present invention, and are not intended to limit the embodiments of the present invention. For those skilled in the art, other different forms of changes or modifications can be made based on the above description. It is not necessary and impossible to list all the embodiments here. Any modifications, equivalent substitutions and improvements made within the spirit and principles of the present invention should be included in the protection scope of the claims of the present invention.
Claims
1. A novel method for en bloc resection of spinal tumors, characterized in that: The following steps are involved: S1. After anesthesia, the patient is placed in the prone position. The skin and soft tissue structures around the posterior arch of the tumor segment are incised and freed according to the preoperatively designed surgical safety margin, and pedicle screws are inserted in the normal vertebrae above and below the tumor vertebra. S2. Part of the normal ribs of the tumor vertebral segment are removed on both sides, and the thoracic cavity is entered through the pleura. Only at the osteotomy level of the normal vertebra at the upper and lower ends of the tumor vertebra, the surgeon's fingers are used to enter the front of the vertebral body and bluntly dissect the large blood vessel structure on the ventral side of the vertebra along the front edge of the vertebral body. A protective baffle is placed between the vertebral body and the free blood vessels in the dissection gap, and a wire saw is placed respectively; S3. En-bloc resection of the tumor vertebra was then performed using the rotation-circumflexion technique.
2. A novel method for en bloc resection of spinal tumors according to claim 1, characterized in that: The specific resection process is as follows: after removing the normal and healthy posterior arch bone structure of the tumor vertebra, a safety window is opened to allow entry into the spinal canal through this window, and the nerve roots on the healthy side are ligated and cut.
3. A novel method for en bloc resection of spinal tumors according to claim 2, characterized in that: After the nerve roots on the healthy side are ligated and segmented, the lamina and pedicle on the tumor-invaded side are invaded by the tumor, and the nerve roots and part of the dura mater on the affected side are covered by the tumor. They cannot be directly exposed and separated, making it difficult to obtain a safe tumor resection margin along the dura mater on the affected side.
4. A novel method for en bloc resection of spinal tumors according to claim 3, characterized in that: Osteotomy is performed at selected osteotomy levels at the head and tail ends of the tumor vertebra using a pre-placed wire saw; after complete transection, the tumor vertebra can be rotated around the longitudinal axis.
5. A novel method for en bloc resection of spinal tumors according to claim 4, characterized in that: After osteotomy, the tumor vertebra is first rotated around the longitudinal axis toward the affected side, so that the boundary between the affected dura mater and nerve roots and the tumor capsule can be separated under direct vision, and the affected nerve roots can be ligated and cut off.
6. A novel method for en bloc resection of spinal tumors according to claim 5, characterized in that: The specimen is then rotated around the longitudinal axis toward the healthy side. At the same time, the large vascular structures on the ventral side of the tumor vertebra are rotated together with the tumor vertebra, allowing the vascular separation operation to be performed while rotating under direct vision from the posterior approach, avoiding damage to the blood vessels and ensuring a safe resection margin for the tumor.
7. A novel method for en bloc resection of spinal tumors according to claim 6, characterized in that: Finally, the entire tumor vertebra was removed posteriorly using a cyclotorsion maneuver.
8. A novel method for en bloc resection of spinal tumors according to claim 7, characterized in that: The anterior vertebral defect was reconstructed and connected with posterior pedicle screw fixation.