Adjunct and Minimally Invasive Techniques for the Diagnosis and Treatment of Vertebral Tumors

Overview of the management of primary tumors of the spine

STUDY DESIGN

Narrative review.

OBJECTIVE

To provide a narrative review for diagnosis and management of Primary spine tumors.

METHODS

A detailed review of literature was done to identify relevant and well cited manuscripts to construct this narrative review.

RESULTS

Primary tumors of the spine are rare with some racial differences reported. There are numerous adjuvant technologies and developments that influence the way we currently manage these tumors. Collimated radiation allows for heavy dosage to be delivered and have been reported to give good local control both as an adjuvant and neoadjuvant setting. These have made surgical decision making even more intricate needing a multicentric approach. Dedicated care has been shown to significantly improve health quality of life measures and survival.

CONCLUSION

While, it is beyond the scope of this paper to discuss all primary tumors subtypes individually, this review highlights the developments and approach to primary spine tumors.

Craniocervical junction diseases treatment with a minimally invasive approach

Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess(r) surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.

Aggressive "benign" primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor

STUDY DESIGN

Clinically based systematic review.

OBJECTIVE

To define optimal clinical care for primary spinal aggressive "benign" osseous neoplasms using a systematic review with expert opinion.

METHODS

Predefined focused questions on treatment of osteoblastomas, aneurysmal bone cysts and giant cell tumors were refined by a panel of spine oncology surgeons, medical and radiation oncologist. Keywords were searched through Medline and pertinent abstracts and articles obtained. The quality of literature was rated as high, moderate, low or very low. Based on literature review and expert opinion recommendations were composed through the GRADE system and rated as either strong or weak.

RESULTS

The literature searches revealed very low quality evidence with no prospective or randomized studies. There are a limited number of patients with aggressive primary osseous tumors. The osteoblastoma initial search identified 211 articles of which 17 were pertinent to the spinal questions. The aneurysmal bone cysts initial search revealed 482 articles initially of which 6 were pertinent; and the search on giant cell tumors identified 178 articles of which only 8 were focused on the predefined treatment questions.

CONCLUSION

Spinal aggressive benign osseous neoplasms have varying histology. Despite these differences surgical treatment should be directed at gross resection of the tumor, understanding that this may be limited by anatomic confines and the potential for morbidity.