Seven-year follow-up of vertebral excision and reconstruction for malignant hemangioendothelioma of bone.

Abstract

This study reports the 7-year follow-up of an L5 vertebral hemangioendothelioma treated with tumor excision and allograft reconstruction stabilized with transpedicular fixation. A review of vertebral hemangioendotheliomas is provided to outline the rationale for surgical excision in such cases. Radiation therapy has been the mainstay of therapy in surgically inaccessible lesions of the spine. The long-term follow-up of radical spinal tumor excision and reconstruction in previously surgically inaccessible areas has not been reported for vertebral hemangioendothelioma. After embolizations, anterior L5 corpectomy and allograft femoral reconstruction was performed. Second-stage (same day) posterior element excision was followed by VSP stabilization of L4-S1 with artificial pedicles anchored into the femoral allograft at L5. Radiation therapy followed. Satisfactory long-term (7-year) segmental reconstruction using allograft and VSP was realized, even in the face of postoperative radiation therapy. Contemporary spinal reconstructive techniques have been developed that continue to limit the number of surgically inaccessible tumors in the spine. The present report shows these techniques to be durable and apparently effective in vertebral hemangioendothelioma.