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Scheurer F, Kaiser D, Kobe A, Smolle M, Suter D, Spirig JM, Müller D. The effect of preoperative embolization on giant cell tumors of the bone localized in the iliosacral region of the pelvis. Surg Oncol 2024; 55:102101. [PMID: 39018867 DOI: 10.1016/j.suronc.2024.102101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Giant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region. METHODS Five surgeries (January-December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered. RESULTS Tumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min. CONCLUSION Curettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases.
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Affiliation(s)
- Fabrice Scheurer
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland.
| | - Dominik Kaiser
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - Adrian Kobe
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Maria Smolle
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Suter
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - José Miguel Spirig
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Müller
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
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Baksh N, Yeung C, Vaynrub M. Percutaneous lumbopelvic fixation for pathologic sacral fractures and spinopelvic dissociation: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23205. [PMID: 37581594 PMCID: PMC10555589 DOI: 10.3171/case23205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Because patients with advanced cancer live longer, the number of patients with the sequelae of metastatic spine disease has increased. Pathologic instability of the mobile spine has been classified, and minimally invasive surgery has been well described. However, pathologic sacral instability is uncommon and often underdiagnosed. Although most sacral fractures are stable, patients with unstable U- or H-type fractures have spinopelvic dissociation and can experience progressive pain, sacral kyphosis, and neurological injury. Open lumbopelvic fusion carries a high perioperative risk for this patient population, which has often been previously radiated and is medically frail. The authors investigated the utility and safety of percutaneous lumbopelvic fixation, as previously described for traumatic spinopelvic dissociation, in the oncological setting. The authors retrospectively reviewed five consecutive patients with unstable pathologic sacral fractures who had undergone percutaneous lumbopelvic fixation after conservative management failed. OBSERVATIONS Patients experienced significant improvement between pre- and postoperative visual analog scale scores (9.2 and 1.6, respectively) and Eastern Cooperative Oncology Group grades (median 3 and 1, respectively). All patients were independently ambulatory at the final follow-up. Sagittal alignment remained stable in four patients and worsened in one. There were no major medical or surgical complications. LESSONS Percutaneous lumbopelvic fixation shows promising results for palliation, durability, and safety for pathologic sacropelvic instability.
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Tian QH, -Han K, Wang T, Min DL, Wu CG. Percutaneous Sacroplasty with or without Radiofrequency Ablation for Treatment of Painful Sacral Metastases. AJNR Am J Neuroradiol 2022; 43:1222-1227. [PMID: 35863777 PMCID: PMC9575424 DOI: 10.3174/ajnr.a7587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Percutaneous sacroplasty is a variation of percutaneous vertebroplasty that has gained attention as a therapeutic option for patients with painful sacral insufficiency fractures due to osteoporosis or metastases. Additionally, percutaneous sacroplasty can also be used to treat painful sacral metastases without a pathologic fracture. The purpose of this retrospective study was to compare the efficacy and safety of fluoroscopy-guided percutaneous sacroplasty alone versus percutaneous sacroplasty plus radiofrequency ablation for the treatment of painful sacral metastases. MATERIALS AND METHODS For this retrospective study, 126 patients (with a total of 162 painful sacral metastases) were enrolled from October 2012 to February 2021 and assigned to receive either percutaneous sacroplasty plus radiofrequency ablation (n = 51, group A) or percutaneous sacroplasty alone (n = 75, group B). Four different approaches were used for percutaneous sacroplasty: transiliac, interpedicular, anterior-oblique, and posterior. The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale were used to evaluate outcomes. RESULTS The Visual Analog Scale, Oswestry Disability Index, and Karnofsky Performance Scale scores showed significant improvement in both groups after treatment (P < .05). The overall pain relief rate was significantly better in group A than in group B (90% versus 76%, P = .032). There were no significant differences in the incidence of polymethylmethacrylate leakage between the 2 groups or among the 4 different approaches (P > .05). CONCLUSIONS Both percutaneous sacroplasty alone and the combination of percutaneous sacroplasty and radiofrequency ablation are safe and effective for treatment of painful sacral metastases. The combination of percutaneous sacroplasty and radiofrequency ablation appears to be more effective than percutaneous sacroplasty alone.
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Affiliation(s)
- Q-H Tian
- From the Departments of Diagnostic and Interventional Radiology (Q.-H.T., T.W., C.-G.W.)
| | - K -Han
- Oncology (K.-H., D.-L.M.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - T Wang
- From the Departments of Diagnostic and Interventional Radiology (Q.-H.T., T.W., C.-G.W.)
| | - D-L Min
- Oncology (K.-H., D.-L.M.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - C-G Wu
- From the Departments of Diagnostic and Interventional Radiology (Q.-H.T., T.W., C.-G.W.)
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Tabarestani TQ, Sykes D, Murphy KR, Wang TY, Shaffrey CI, Goodwin CR, Horne P, Than KD, Abd-El-Barr MM. Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience. Front Surg 2022; 9:889906. [PMID: 35784931 PMCID: PMC9243459 DOI: 10.3389/fsurg.2022.889906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Interest in robotic-assisted spine surgery has grown as surgeon comfort and technology has evolved to maximize benefits of time saving and precision. However, the Food and Drug Administration (FDA) has currently only approved robotics to assist in determining the ideal trajectory for pedicle screw placement after extensive research supporting its efficacy and efficiency. To be considered a durable and effective option, robotics need to expand beyond the indication of just placing pedicle screws. This article aims to illustrate a multi-surgeon, single-institution experience with unique applications of robotic technologies in spine surgery. We will explore accessing Kambin's Triangle in percutaneous transforaminal interbody fusion (percLIF), iliac fixation in metastatic cancer, and sacroiliac (SI) fusions. Each of these topics will be covered in depth with associated background information and subsequent discussion. We show that with proper understanding of its limitations, robots can help surgeons perform difficult surgeries in a safe manner.
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Affiliation(s)
- Troy Q Tabarestani
- Duke University School of Medicine, Duke University Hospital, Durham, Durham, NC
| | - David Sykes
- Duke University School of Medicine, Duke University Hospital, Durham, Durham, NC
| | - Kelly R Murphy
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
| | | | - C Rory Goodwin
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
| | - Phillip Horne
- Department of Orthopedic Surgery, Duke University Hospital, Durham, Durham, NC
| | - Khoi D Than
- Department of Neurosurgery, Duke University Hospital, Durham, Durham, NC
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Sun M, Zuo D, Wang H, Sheng J, Ma X, Wang C, Zan P, Hua Y, Sun W, Cai Z. Surgical Treatment of Sacral Metastatic Tumors. Front Oncol 2021; 11:640933. [PMID: 34249683 PMCID: PMC8267802 DOI: 10.3389/fonc.2021.640933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 05/25/2021] [Indexed: 12/25/2022] Open
Abstract
Objective This study intends to retrospectively analyze the data of patients with sacral metastases in our center, and analyze the treatment methods and therapeutic effects of sacral metastases. Methods 73 patients with sacral metastases treated in our hospital from June 2013 to June 2019 were retrospectively analyzed. There were 54 cases of neurological symptoms, 42 cases of sacroiliac joint instability, 24 cases of lower limb muscle weakness and 19 cases of abnormal urination and defecation. Four patients with tumors below S3 underwent complete tumor resection, 23 patients with tumors above S3 and without sacroiliac joint instability underwent tumor curettage and nerve root lysis, 34 patients with tumors above S3 and sacroiliac joint instability underwent tumor curettage, nerve root release and screw rod reconstruction. 12 patients with multiple metastases underwent percutaneous radiofrequency ablation and sacroplasty. VAS was used to evaluate the preoperative and postoperative pain scores, and the postoperative pain relief, neurological function, bowel function, wound healing and complications were evaluated. Results There were no perioperative death, 8 cases of poor wound healing, 5 cases of nerve injury, postoperative sensory and motor loss of lower limbs. Cerebrospinal fluid (CSF) leak in 7 cases. The patients were followed up for 6-25 months (mean 12 months). The VAS scores of patients with pain symptoms were 7 points before operation and 1.44 points after operation, In 19 patients with abnormal urination and defecation function, 12 patients recovered to normal 3-6 months after operation, 5 cases had no significant change compared with preoperative, and 2 cases had aggravated symptoms; 17 cases of patients with lower limb muscle strength were significantly recovered after operation, and the average muscle strength was increased by 2 grades; 30 cases of patients with unstable sacroiliac joint got internal fixation had significantly pain relief. Pain symptoms of 9 patients were significantly relieved after percutaneous radiofrequency ablation. Conclusion the operation of sacral metastases mainly adopts a relatively conservative surgical method, which can effectively improve the quality of life of patients with sacral metastases by retaining the nerve function and relieving the pain of patients, combining with radiofrequency ablation, sacroplasty and targeted drugs.
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Affiliation(s)
- Mengxiong Sun
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Dongqing Zuo
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Hongsheng Wang
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Jiakang Sheng
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Xiaojun Ma
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Chongren Wang
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Pengfei Zan
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Yingqi Hua
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Wei Sun
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai General Hospital, Shanghai, China
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Senne J, Nguyen V, Staner D, Stensby JD, Bhat AP. Demystifying Sacral Masses: A Pictorial Review. Indian J Radiol Imaging 2021; 31:185-192. [PMID: 34316126 PMCID: PMC8299490 DOI: 10.1055/s-0041-1729766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The sacrum is a triangular shaped bone made up of five fused vertebral bodies. It is composed of bone, cartilage, marrow elements as well as notochord remnants and is a common site for both benign and malignant (primary and secondary) tumors. Familiarity with the imaging features and clinical presentations of sacral bone tumors could be helpful in narrowing the differential diagnosis. Magnetic resonance imaging and computed tomography are the preferred imaging modalities for evaluating sacral masses. This pictorial review will highlight imaging features of common sacral tumors with pathologic correlation. Additionally, this article will review some critical principles and helpful tips to successfully biopsy these lesions.
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Affiliation(s)
- Julie Senne
- Department of Radiology, University of Missouri-Columbia, Columbia, Missouri, United States
| | - Van Nguyen
- Department of Pathology, University of Missouri-Columbia, Columbia, Missouri, United States
| | - Derek Staner
- Department of Radiology, University of Missouri-Columbia, Columbia, Missouri, United States
| | - James D Stensby
- Department of Radiology, University of Missouri-Columbia, Columbia, Missouri, United States
| | - Ambarish P Bhat
- Department of Radiology, University of Missouri-Columbia, Columbia, Missouri, United States
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Kowalchuk RO, Waters MR, Richardson KM, Spencer K, Larner JM, McAllister WH, Sheehan JP, Kersh CR. Stereotactic body radiation therapy for spinal metastases: a novel local control stratification by spinal region. J Neurosurg Spine 2020; 34:267-276. [PMID: 33096522 DOI: 10.3171/2020.6.spine20861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study evaluated a large cohort of patients treated with stereotactic body radiation therapy for spinal metastases and investigated predictive factors for local control, local progression-free survival (LPFS), overall survival, and pain response between the different spinal regions. METHODS The study was undertaken via retrospective review at a single institution. Patients with a tumor metastatic to the spine were included, while patients with benign tumors or primary spinal cord cancers were excluded. Statistical analysis involved univariate analysis, Cox proportional hazards analysis, the Kaplan-Meier method, and machine learning techniques (decision-tree analysis). RESULTS A total of 165 patients with 190 distinct lesions met all inclusion criteria for the study. Lesions were distributed throughout the cervical (19%), thoracic (43%), lumbar (19%), and sacral (18%) spines. The most common treatment regimen was 24 Gy in 3 fractions (44%). Via the Kaplan-Meier method, the 24-month local control was 80%. Sacral spine lesions demonstrated decreased local control (p = 0.01) and LPFS (p < 0.005) compared with those of the thoracolumbar spine. The cervical spine cases had improved local control (p < 0.005) and LPFS (p < 0.005) compared with the sacral spine and trended toward improvement relative to the thoracolumbar spine. The 36-month local control rates for cervical, thoracolumbar, and sacral tumors were 86%, 73%, and 44%, respectively. Comparably, the 36-month LPFS rates for cervical, thoracolumbar, and sacral tumors were 85%, 67%, and 35%, respectively. A planning target volume (PTV) > 50 cm3 was also predictive of local failure (p = 0.04). Fewer cervical spine cases had disease with PTV > 50 cm3 than the thoracolumbar (p = 5.87 × 10-8) and sacral (p = 3.9 × 10-3) cases. Using decision-tree analysis, the highest-fidelity models for predicting pain-free status and local failure demonstrated the first splits as being cervical and sacral location, respectively. CONCLUSIONS This study presents a novel risk stratification for local failure and LPFS by spinal region. Patients with metastases to the sacral spine may have decreased local control due to increased PTV, especially with a PTV of > 50 cm3. Multidisciplinary care should be emphasized in these patients, and both surgical intervention and radiotherapy should be strongly considered.
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Affiliation(s)
- Roman O Kowalchuk
- 1Radiosurgery Center, Riverside Regional Medical Center (in partnership with University of Virginia Health System), Newport News
| | - Michael R Waters
- 1Radiosurgery Center, Riverside Regional Medical Center (in partnership with University of Virginia Health System), Newport News
| | - K Martin Richardson
- 1Radiosurgery Center, Riverside Regional Medical Center (in partnership with University of Virginia Health System), Newport News
| | - Kelly Spencer
- 1Radiosurgery Center, Riverside Regional Medical Center (in partnership with University of Virginia Health System), Newport News
| | | | - William H McAllister
- 3Department of Neurosurgery, Riverside Regional Medical Center, Newport News, Virginia
| | - Jason P Sheehan
- 4Neurosurgery, University of Virginia Health System, Charlottesville; and
| | - Charles R Kersh
- 1Radiosurgery Center, Riverside Regional Medical Center (in partnership with University of Virginia Health System), Newport News
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Clinical outcomes of sacroplasty for metastatic sacral tumours: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3116-3122. [PMID: 32772170 DOI: 10.1007/s00586-020-06562-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 04/30/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The purpose of this study was to evaluate the clinical outcome and safety of sacroplasty for patients with secondary metastatic lesions to the sacrum. METHODS Several databases, including the Cochrane library, PubMed and EMBASE, were systematically searched to identify potentially eligible articles in English language. All the above databases were searched until December 2019. The search strategy was based on the combination of the following keywords: sacroplasty AND secondary tumours OR metastasis OR metastases. The reference list of the selected literature was also reviewed and a standard PRISMA template utilised. RESULTS From a total of 102 articles initially identified, a final seven studies were identified as meeting the inclusion criteria. A total of 107 patients from these studies were included. The follow-up ranged from immediate post-operatively to 30.5 months. The mean preoperative VAS was 8.38 (range 6.9-9.3), which improved significantly to 3.01 (range 1.12-4.7) post-operatively (p < 0.001). The most frequent complication reported was cement leakage, which occurred in 26 patients (25.4%), but without any neurological or other adverse sequelae. CONCLUSIONS Sacroplasty in the management of secondary sacral tumours is a safe procedure that can achieve a significant reduction in pain, as quantified by VAS scores, and low complication rate.
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Prospective analysis of health-related quality of life after surgery for spinal metastases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3163-3169. [DOI: 10.1007/s00586-020-06396-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
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Tian QH, Liu HF, Wang T, Wu CG, Cheng YS. Fluoroscopy-Guided Percutaneous Sacroplasty for Painful Metastases at the Sacral Ala. J Pain Res 2020; 13:151-156. [PMID: 32021404 PMCID: PMC6970629 DOI: 10.2147/jpr.s193866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/09/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Percutaneous sacroplasty (PSP) is widely used in the clinic for osteoporotic sacral insufficiency fractures; however, few reports have described the safety and effectiveness of PSP for painful sacral metastases at the sacral ala under fluoroscopy alone. We aimed to evaluate the safety and efficacy of fluoroscopy-guided PSP for painful metastases at the sacral ala. Patients and Methods Thirty-five consecutive patients (median age, 60.74 ± 12.74 years), with a total of 41 metastatic lesions at the sacral ala, were treated with PSP. The patients were followed up for periods ranging from 1 month to 30 months (average, 8.23 ± 6.75 months). The visual analog scale (VAS), Oswestry Disability Index (ODI), and Karnofsky Performance Scale (KPS) were used to evaluate pain, mobility, and quality of life before the procedure and at 3 days and 1, 3, 6, 12, and 18 months after the procedure. Results Technical success was achieved in all patients. The minimum follow-up duration was 1 month. The mean VAS scores declined significantly from 7.20 ± 0.93 before the procedure to 3.43 ± 1.38 by day 3 after the procedure, and was 3.13 ± 1.07 at 1 month, 3.17 ± 1.15 at 3 months, 2.91± 1.38 at 6 months, and 2.57 ± 1.51 at 12 months after the procedure (P < 0.001). After PSP, analgesic drug administration had been discontinued in 31 of 35 patients (88.57%). The ODI and KPS also changed after PSP, with significant differences between the baseline scores and those at each follow-up examination (P < 0.001). Extraosseous cement leakage occurred in 12 cases without any major clinical complications. Conclusion PSP is a safe and effective technique for the palliative treatment of painful metastases involving the sacral ala under fluoroscopic guidance alone. It can relieve pain, reduce disability, and improve function, and is associated with minimal complications.
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Affiliation(s)
- Qing-Hua Tian
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, People's Republic of China
| | - He-Fei Liu
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, People's Republic of China
| | - Tao Wang
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, People's Republic of China
| | - Chun-Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, People's Republic of China
| | - Ying-Sheng Cheng
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, People's Republic of China
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Freiburg Neuropathology Case Conference: a Hemorrhagic Intraspinal Tumor Extending from L3 to S1. Clin Neuroradiol 2020; 29:383-389. [PMID: 31119325 DOI: 10.1007/s00062-019-00791-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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12
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Charest-Morin R, Fisher CG, Versteeg AL, Sahgal A, Varga PP, Sciubba DM, Schuster JM, Weber MH, Clarke MJ, Rhines LD, Boriani S, Bettegowda C, Fehlings MG, Arnold PM, Gokaslan ZL, Dea N. Clinical presentation, management and outcomes of sacral metastases: a multicenter, retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:214. [PMID: 31297379 DOI: 10.21037/atm.2019.04.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Sacral metastases are rare and literature regarding their management is sparse. This multicenter, prospective, observational study aimed to determine health related-quality of life (HRQOL) and pain in patients treated for sacral metastases with surgery and/or radiation therapy (RT). The secondary objectives were to describe the adverse event (AE) profile and change in neurologic function in this population. Methods Twenty-three patients presenting with symptomatic sacral metastases were identified from the Epidemiology, Process and Outcomes of Spine Oncology (EPOSO) dataset, a prospective multicenter study on spinal metastases. Patients requiring surgery and/or RT between August 2013 and February 2017 were prospectively enrolled. HRQOL, assessed by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQv2.0), the Short Form-36 version 2 (SF-36v2), and the EuroQol-5Dimension (EQ-5D) was documented at baseline, 6 weeks, 3 and 6 months post-treatment. Pain numeric rating scale (NRS), AEs, lower extremities motor score (ASIA), and bowel and bladder function were also recorded. Results Eight patients underwent surgery ± RT and 15 patients underwent RT alone. Mean age was 59.3 (SD 11.7) years and 13 patients were female. At 6 months, 3 (37.5%) surgical patients and 2 (13.3%) RT patients were deceased. There was a trend showing that surgical patients had worse baseline HRQOL and pain. Pain NRS, EQ-5D, SOSGOQv2.0, and the mental component of the SF-36v2 showed improvement, irrespective of treatment (P>0.05). Ten AEs occurred in the surgical cohort, dominated by wound complications (n=3). Bowel and bladder function improved at 6 weeks in both groups. Conclusions Surgical treatment and RT are both valid treatment options for symptomatic sacral metastases. Improvement in HRQOL can be expected with an acceptable AE rate.
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Affiliation(s)
- Raphaële Charest-Morin
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
| | - Charles G Fisher
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
| | - Ann L Versteeg
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Peter Pal Varga
- National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James M Schuster
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael H Weber
- Department of Orthopaedic Surgery, McGill University, Montreal, Qc, Canada
| | | | - Laurence D Rhines
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | | | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicolas Dea
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
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13
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Affiliation(s)
- Aleksander Mika
- Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
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14
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Full Endoscopic Interlaminar Approach for Nerve Root Decompression of Sacral Metastatic Tumor. World Neurosurg 2018; 112:57-63. [DOI: 10.1016/j.wneu.2018.01.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 12/20/2022]
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15
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Hutson N, Hung JC, Puttanniah V, Lis E, Laufer I, Gulati A. Interventional Pain Management for Sacroiliac Tumors in the Oncologic Population: A Case Series and Paradigm Approach. PAIN MEDICINE 2018; 18:959-968. [PMID: 28339540 DOI: 10.1093/pm/pnw211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Tumors invading the sacrum and/or ilium often represent incurable metastatic disease, and treatment is targeted toward palliation of symptoms and control of pain. As systemic opioid therapy is frequently inadequate and limited by side effects, a variety of interventional techniques are available to better optimize analgesia. Using six patients as a paradigm for interventional approaches to pain relief, we present a therapeutic algorithm for treating sacroiliac tumor-related pain in the oncologic population. Methods We describe the use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, and implantable neuraxial drug delivery devices to treat malignant sacroiliac pain in six patients. Pre- and postprocedure numerical rating scale (NRS) pain scores, duration of pain relief, and postprocedure pain medication requirements were studied for each patient. Results Each patient had marked improvement in their pain based on an average postprocedure NRS difference of six points. The average duration of pain relief was eight months. In all cases, opioid requirements decreased after the intervention. Discussion Depending on tumor location, burden of disease, and patient preference, patients suffering from metastatic disease to the sacrum may find benefit from use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, dorsal column stimulator leads, and/or implantable neuraxial drug delivery devices. We provide a paradigm for treatment in this patient population.
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Affiliation(s)
- Nathan Hutson
- Department of Anesthesiology, Weill Medical College, Cornell University, New York, USA
| | - Joseph C Hung
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, U.S.A
| | - Vinay Puttanniah
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, U.S.A
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, U.S.A
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Buraimoh MA, Yu CC, Mott MP, Graziano GP. Sacroiliac stabilization for sacral metastasis: A case series. Surg Neurol Int 2017; 8:287. [PMID: 29285403 PMCID: PMC5735436 DOI: 10.4103/sni.sni_324_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/17/2023] Open
Abstract
Background: The sacrum is a rare location for spinal metastasis. These lesions are typically large and destructive by the time of diagnosis, making treatment difficult. When indicated, surgical stabilization offers pain relief and preserves independence in patients with impending and acute pathological sacral fractures. Case Description: Three consecutive patients presented with sacral metastases. After either failing radiation therapy or presenting with acute fracture and instability, the patients underwent intralesional excision, bilateral L4 to ilium fusion with instrumentation, and sacroiliac (SI) screw fixation. Pain improved after surgery, and there were no wound healing complications. Two patients could continue walking without any assistive device, while one patient required a walker. Conclusion: Stabilization with combined modified Galveston fixation and SI screw fixation relieves pain and allows maintenance of independence in patients with sacral metastasis.
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Affiliation(s)
| | - Charles C Yu
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Michael P Mott
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Gregory P Graziano
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
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What Is the Value of Surgical Intervention for Sacral Metastases? PLoS One 2016; 11:e0168313. [PMID: 27992502 PMCID: PMC5167270 DOI: 10.1371/journal.pone.0168313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were acceptable. Methods Curettage for metastatic lesions of the sacrum was performed in 154 patients with obvious sacral nerve compression symptoms between July 1997 and July 2014. Potential risk factors were evaluated in univariate analysis for associations with local control; multivariate conditional logistic regression was used to identify the combined effects. Complications were recorded. The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery. Results The cumulative survival rates were 71.8%, 41.1%, and 22.5% and the local control rates were 95.4%, 90.9%, and 79.4% at 6, 12, and 24 months, respectively. Tumors with rapid growth, the lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control. There were 29 (18.8%) complications related to surgery. The mean pain scores were 7.04 preoperatively, 1.66 at 1 month postoperatively (p = 0.003), and 1.51 at 3 months postoperatively (p = 0.002). The mean ECOG scores were 2.82 preoperatively and 1.47 3 months postoperatively (p < 0.001). There were significant improvements from preoperatively to 3 months postoperatively in global health status (43.3 vs. 52.1), pain (62.0 vs. 33.2), and constipation (51.4 vs. 30.3) (p < 0.001). Conclusions Surgery for sacral metastasis is effective to palliate pain rapidly and improve constipation and quality of life and has a low rate of complications.
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Mulholland RC, Clamp JC, Boszczyk BM. A short history of spinal training and outlook on spine speciality development in the UK 1948-2013. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22 Suppl 1:S1-4. [PMID: 23328876 DOI: 10.1007/s00586-013-2667-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weitao Y, Qiqing C, Songtao G, Jiaqiang W. Use of gluteus maximus adipomuscular sliding flaps in the reconstruction of sacral defects after tumor resection. World J Surg Oncol 2013; 11:110. [PMID: 23701700 PMCID: PMC3664623 DOI: 10.1186/1477-7819-11-110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/16/2013] [Indexed: 12/15/2022] Open
Abstract
Background While performing sacrectomy from a posterior approach enables the en bloc resection of sacral tumors, it can result in deep posterior peritoneal defects and postoperative complications. We investigated whether defect reconstruction with gluteus maximus (GLM) adipomuscular sliding flaps would improve patient outcomes. Methods Between February 2007 and February 2012, 48 sacrectomies were performed at He Nan Cancer Hospital, Zhengzhou City, China. We retrospectively examined the medical records of each patient to obtain the following information: demographic characteristics, tumor location and pathology, oncological resection, postoperative drainage and complications. Based on the date of the operation, patients were assigned to two groups on the basis of closure type: simple midline closure (group 1) or GLM adipomuscular sliding reconstruction (group 2). Results We assessed 21 patients in group 1 and 27 in group 2. They did not differ with regards to gender, age, tumor location, pathology or size, or fixation methods. The mean time to last drainage was significantly longer in group 1 compared to group 2 (28.41 days (range 17–43 days) vs. 16.82 days (range 13–21 days, P < 0.05)) and the mean amount of fluid drained was higher (2,370 mL (range 2,000–4,000 mL) vs. 1,733 mL (range 1,500–2,800 mL)). The overall wound infection rate (eight (38.10%) vs. four (14.81%), P < 0.05) and dehiscence rate (four (19.05%)] vs. three (11.11%), P < 0.05) were significantly higher in group 1 than in group 2. The rate of wound margin necrosis was lower in group 1 than in group 2 (two (9.82%) vs. three (11.11%), P < 0.05). Conclusions The use of GLM adipomuscular sliding flaps for reconstruction after posterior sacrectomy can significantly reduce the risk of infection and improve outcomes.
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Affiliation(s)
- Yao Weitao
- Bone and soft tumor department, He Nan Cancer Hospital, The Affiliated Hospital of Zheng Zhou University, 127 Dong Ming Road, Zheng Zhou City 450000, China.
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Pereira LP, Clarençon F, Cormier É, Rose M, Jean B, Le Jean L, Chiras J. Safety and effectiveness of percutaneous sacroplasty: a single-centre experience in 58 consecutive patients with tumours or osteoporotic insufficient fractures treated under fluoroscopic guidance. Eur Radiol 2013; 23:2764-72. [DOI: 10.1007/s00330-013-2881-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/21/2013] [Accepted: 04/10/2013] [Indexed: 12/13/2022]
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal 2012. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:250-9. [PMID: 23314840 PMCID: PMC3555631 DOI: 10.1007/s00586-012-2630-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
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Surgical treatment of cauda equina compression as a result of metastatic tumours of the lumbo-sacral junction and sacrum. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 1:S33-7. [PMID: 23247862 DOI: 10.1007/s00586-012-2615-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 11/21/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We performed a retrospective analysis of all cases of lumbo-sacral or sacral metastases presenting with compression of the cauda equina who underwent urgent surgery at our institution. Our objective was to report our experience on the clinical presentation, management and finally the surgical outcome of this cohort of patients. METHODS We reviewed medical notes and images of all patients with compression of the cauda equina as a result of lumbo-sacral or sacral metastases during the study period (2004-2011). The collected clinical data consisted of time of onset of symptoms, neurology (Frankel grade), ambulatory status and continence. Operative data analysed were details of surgical procedure and complications. Post-operatively, we reviewed neurological outcome, ambulation, continence, destination of discharge and survival. RESULTS During the 8-year study period, 20 patients [11 males, 9 females; mean age 61.8 years (29-87)] had received urgent surgery for metastatic spinal cauda compression caused by lumbo-sacral or sacral metastases. The majority of patients presented with symptoms of pain and neurological deterioration (n = 14) with onset of pain considerably longer than neurology symptoms [197 days (3-1,825) vs. 46 days (1-540)]; all patients were Frankel C (n = 2, both non-ambulatory), D (n = 13) or E (n = 5) at presentation and three patients were incontinent of urine. Operative procedures performed were posterior decompression with (out) fusion (n = 12), posterior decompression with sacroplasty (n = 1), decompression with lumbo-pelvic stabilisation with (out) kyphoplasty/sacroplasty (n = 7) and posterior decompression/reconstruction with anterior corpectomy/stabilisation (n = 2). Post-operatively, 5/20 (20 %) patients improved one Frankel grade, 1/20 (5 %) improved two grades, 13/20 (65 %) remained stable (8 D, 5 E) and 1/20 (5 %) deteriorated. All patients were ambulatory and 19/20 were continent on discharge. The mean length of stay was 7 days (4-22). There were 6/20 (30 %) complications: three major (PE, deep wound infection, implant failure) and three minor (superficial wound infection, incidental durotomy, chest infection). All patients returned back to their own home (n = 14/20, 70 %) or a nursing home (n = 6/20, 35 %). Thirteen patients are deceased (mean survival 367 days (120-603) and seven are still alive [mean survival 719 days (160-1,719)]. CONCLUSION Surgical intervention for MSCC involving the lumbo-sacral junction or sacral spine has a high but acceptable complication rate (6/20, 30 %), and can be important in restoring/preserving neurological function, assisting with ambulatory function and allowing patients to return to their previous residence.
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