En bloc resection, including the cord for tumor-free margin, in a multilevel osteosarcoma of the spine: 20-year disease-free survival. Illustrative case

J Neurosurg Case Lessons, 2025 · DOI: 10.3171/CASE24771 · Published: March 10, 2025

Simple Explanation

This case report discusses a rare instance of a 17-year-old female with osteosarcoma (OS) of the spine who achieved a 20-year disease-free survival after undergoing aggressive treatment. The treatment involved neoadjuvant chemotherapy followed by en bloc resection, which included the removal of the spinal cord to ensure tumor-free margins. The patient's initial paraplegia influenced the decision to proceed with a radical resection, and the case highlights the importance of considering such aggressive approaches when tumor-free margins are otherwise unattainable.

Study Duration

20 Years

Participants

1 female patient, 17 years old

Evidence Level

Case Report

Key Findings

1
En bloc resection with tumor-free margins, including the spinal cord, can lead to long-term disease-free survival in spinal osteosarcoma, challenging the notion that spinal OS has a universally poor prognosis.
2
The initial neurological status of the patient (paraplegia) played a critical role in the decision-making process, allowing for a more radical surgical approach.
3
The use of carbon fiber implants combined with modern radiotherapy techniques, such as proton therapy, may offer an alternative approach in cases where complete en bloc resection is not feasible due to functional considerations.

Research Summary

This case report presents a 17-year-old female with spinal osteosarcoma who achieved 20-year disease-free survival following neoadjuvant chemotherapy and en bloc resection, including spinal cord amputation, to obtain tumor-free margins. The patient's pre-existing paraplegia influenced the decision to proceed with radical resection, and the reconstruction was performed using a carbon fiber stackable cage system. The report emphasizes the importance of achieving tumor-free margins in spinal osteosarcoma and suggests that advanced radiation techniques and carbon fiber implants may offer alternatives when complete resection is not possible due to functional concerns.

Practical Implications

Surgical Strategy

This case supports considering en bloc resection, even with spinal cord sacrifice, for improved outcomes in certain spinal osteosarcoma cases.

Treatment Paradigm

The case challenges the perception of universally poor prognosis in spinal OS, emphasizing the role of aggressive surgical and adjuvant therapies.

Technology Adoption

The use of carbon fiber implants combined with advanced radiation techniques can be explored as alternatives when complete resection is not feasible.

Study Limitations

1
Single case report limits generalizability.
2
The patient's initial neurological deficit influenced treatment decisions, which may not be applicable to all cases.
3
Long-term follow-up is needed to validate alternative treatment approaches involving less radical resection combined with advanced radiation therapies.

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