Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 98. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 972 Section Tumors and Inflammation Case Study 3 Cont. tumor. The axial T2W scans c demonstrated extension to the ribcage. A biopsy revealed the histological diagnosis of a Grade II chondrosarcoma. No metastases were discovered. An en bloc resection was planned. The lines indicate the level of osteotomies of the laminae pedicles and ribs. The skin with the biopsy channel was excised d . Prior to tumor resection the spine was instrumented with pedicle screws at T3-T12 on the right side and at T3 T4 T11 and T12 on the left side. Tumor resection was performed along the indicated lines. The en bloc resection was done with serial contralateral lami-notomies at T5-T10 e ipsilateral pedicle osteotomies at T5-T9 and rib osteotomies at T5-T10. An en bloc resection of the tumor was achieved with wide margins f g . Particularly the osteotomies at the level of the pedicles arrows and ribs arrowheads were tumor free. The resected pleura was covered with an artificial membrane asterisk and the dura with Gelfoam sponges arrowheads . The spine was stabilized at T3-T12 and fusion was carried out on the right side h . The defect was covered with an ipsilateral latissimus dorsi flap i . Three years after surgery the patient is functioning well although he had initial problems with the mobility of the left shoulder unstable scapula . The follow-up radiographs show the stabilization of the spine at T3-T12 j k . Regular follow-up imaging studies MRI and thoracoabdominal CT scan demonstrate a tumor-free course so far. Primary Tumors of the Spine Chapter 33 973 S3 a combined anterior and posterior approach is preferred 21 . The possible disadvantages of a posterior only approach include hemorrhage and laceration of pelvic viscera including ureters. The combined approach allows exposure of the entire pelvic contents and safe ligation of the internal iliac vessels which assists in reducing bleeding during mobilization of the specimen from posteriorly. It has been shown that the combined .
