1. Primary sarcomas of the spine. A 5-year retrospective analysis. Hadjigeorgiou GF, Zisakis A, Markogiannakis G, Petrosyan T, Mylonakis I, Panteli A, Hadjigeorgiou FG, Varsos V Department of Neurosurgery, Red Cross Hospital, Athens, Greece Keywords: primary, sarcomas, spine

2.  Primary sarcomas of the spine are rare malignant tumours, which tend to occur in adolescents and young adults.  Frequently they involve multiple spinal segments and their resection to negative margins constitutes a challenging problem. Introduction

3.  In this study we report the outcome of surgery in four cases of primary spinal sarcomas. Aim

4. January 2008 December 2012  A retrospective review of patients undergoing resection for primary sarcomas of the spine between January 2008 and December 2012 was undertaken. Material and Methods

5.  4 3 male:1 female  4 cases (3 male:1 female) matched with the aforementioned criteria. 19 to 55 mean age 32,3 years  The ages of patients ranged from 19 to 55 years (mean age 32,3 years).  Case 1hemangiosarcoma  Case 1 patient diagnosed with hemangiosarcoma of the thoracic spine  Case 2neurofibrosarcoma  Case 2 patient diagnosed with neurofibrosarcoma of the lower cervical spine  Case 3 a low grade myofibroblastic sarcoma  Case 3 patient diagnosed with a low grade myofibroblastic sarcoma originating to the thoracic spine and Case 4rhabdomyosarcoma of the thoracic spine.  Case 4 patient diagnosed with a rhabdomyosarcoma of the thoracic spine. Results

6.  All patients presented with  Painprogressive neurological deficits  Pain and progressive neurological deficits of the lower extremities. 3 days to 3 months  The time which elapsed between the onset of symptoms and diagnoses ranged from 3 days to 3 months.  Pre-operative radiological diagnoses were obtained by  Plain x-rays  Plain x-rays,  CT scans  CT scans and  MR imaging  MR imaging of the spine.  In one case performed a total resection (Case 3) and  In three cases (Cases 1, 2, 4) a subtotal resection, with spinal decompressive laminectomy.  In two cases (Cases 1, 4) spinal fusion with screws and rods was also made. Results

7.  All cases treated postoperatively with  radiotherapy and one case (Case 1) also received chemotherapy.  All cases improved neurologically gradually on the postoperative period.  On the follow-up Cases 1 and 4 died at 12 and 6 months after the diagnosis respectively, due to progression of their primary disease and local recurrence.  Case 2 was lost on the follow-up period and  Case 3 remains disease free 18 months postoperatively Results

8. Case 2 pre and post surgery Case 1 pre

9. Results Case 3 pre Case 3 post Case 4

10.  Surgery for primary sarcomas of the spine is associated with an improvement in neurological status and palliation of pain.  En bloc resection with tumor-free margins followed postoperatively by radiotherapy/chemotherapy provides substantial improvement in functional outcome.  However, due to the rarity of the disease more cases should be reported in the literature, in order to define the optimal treatment. Discussion