Figure 1. A surgical protocol of margin-free spondylectomy 1. Anterior procedure –Approach: transpleural or retroperitoneal or both –Tumor barrier: pleura or psoas muscle –Ligation and cut of segmental vesseles –Coverage of the lesion by Gore-Tex patch 2. Posterior procedure –Temporally instrumentation –Decompression of spinal cord through the tumor- free site –360-degrees dissection of the tumor vertebrae –En-bloc extirpation of the tumor vertebrae through the gap of laminotomy by rotating them around the dural tube –Completion of instrumentation and bone graft –Repair of soft tissue defects

Figure 2D. A 360-degree dissection of the tumor vertebrae Dural tube

Figure 4. Surgical classification 3) of thirteen cases ① ① ② ① ② ⑥

Figure 5. Results A. Neurologic status evaluated by modified Frankel grade 4) A B C D1 D2 D3 E Before surgeryFollow-up

Figure 5. Result B. Pain status evaluated by Denis pain scale 5) P1 P2 P3 P4 P5 Before surgeryFollow-up