1
|
González-Kusjanovic N, Delgado Ochoa B, Vidal C, Campos M. Post-operative complications affect survival in surgically treated metastatic spinal cord compression. INTERNATIONAL ORTHOPAEDICS 2024; 48:1341-1350. [PMID: 38472466 DOI: 10.1007/s00264-024-06120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients. METHODS Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups. RESULTS Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence. CONCLUSION In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.
Collapse
Affiliation(s)
- Nicolás González-Kusjanovic
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Byron Delgado Ochoa
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Catalina Vidal
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Mauricio Campos
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile.
| |
Collapse
|
2
|
Farid AR, Liu DS, Morcos MM, Hogue GD. Spinal osteoid osteoma in the pediatric population: A management algorithm and systematic review. J Child Orthop 2023; 17:428-441. [PMID: 37799321 PMCID: PMC10549702 DOI: 10.1177/18632521231192477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose The purpose of this study is to develop an accessible step-wise management algorithm for the management of pediatric spinal osteoid osteomas (OOs) based on a systematic review of the published literature regarding the diagnostic evaluation, treatment, and outcomes following surgical resection. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on the management of pediatric spinal OOs. Data extraction of clinical presentation, management strategies and imaging, and treatment outcomes were performed. Results Ten studies reporting on 85 patients under the age of 18 years presenting with OOs were identified. Back pain was the most common presenting symptom, and scoliosis was described in 8 out of 10 studies, and radicular pain in 7 out of 10 studies. Diagnostic, intraoperative, and postoperative assessment included radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), bone scans, and frozen section. Treatment options varied, including conservative management, open surgical resection with or without intraoperative imaging, and percutaneous image-guided treatment. All included studies described partial or complete resolution of pain in the immediate postoperative period. Conclusions The proposed algorithm provides a suggested framework for management of pediatric spinal OOs based on the available evidence (levels of evidence: 3, 4). This review of the literature indicated that a step-wise approach should be utilized in the management of pediatric spinal OOs.
Collapse
Affiliation(s)
| | - David S Liu
- Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Mary M Morcos
- Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA
| | - Grant D Hogue
- Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| |
Collapse
|
3
|
Karabacak M, Margetis K. A Machine Learning-Based Online Prediction Tool for Predicting Short-Term Postoperative Outcomes Following Spinal Tumor Resections. Cancers (Basel) 2023; 15:cancers15030812. [PMID: 36765771 PMCID: PMC9913622 DOI: 10.3390/cancers15030812] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Background: Preoperative prediction of short-term postoperative outcomes in spinal tumor patients can lead to more precise patient care plans that reduce the likelihood of negative outcomes. With this study, we aimed to develop machine learning algorithms for predicting short-term postoperative outcomes and implement these models in an open-source web application. Methods: Patients who underwent surgical resection of spinal tumors were identified using the American College of Surgeons, National Surgical Quality Improvement Program. Three outcomes were predicted: prolonged length of stay (LOS), nonhome discharges, and major complications. Four machine learning algorithms were developed and integrated into an open access web application to predict these outcomes. Results: A total of 3073 patients that underwent spinal tumor resection were included in the analysis. The most accurately predicted outcomes in terms of the area under the receiver operating characteristic curve (AUROC) was the prolonged LOS with a mean AUROC of 0.745 The most accurately predicting algorithm in terms of AUROC was random forest, with a mean AUROC of 0.743. An open access web application was developed for getting predictions for individual patients based on their characteristics and this web application can be accessed here: huggingface.co/spaces/MSHS-Neurosurgery-Research/NSQIP-ST. Conclusion: Machine learning approaches carry significant potential for the purpose of predicting postoperative outcomes following spinal tumor resections. Development of predictive models as clinically useful decision-making tools may considerably enhance risk assessment and prognosis as the amount of data in spinal tumor surgery continues to rise.
Collapse
|
4
|
Shiber M, Kimchi G, Knoller N, Harel R. The Evolution of Minimally Invasive Spine Tumor Resection and Stabilization: From K-Wires to Navigated One-Step Screws. J Clin Med 2023; 12:jcm12020536. [PMID: 36675466 PMCID: PMC9865379 DOI: 10.3390/jcm12020536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
Minimization of the surgical approaches to spinal extradural metastases resection and stabilization was advocated by the 2012 Oncological Guidelines for Spinal Metastases Management. Minimally invasive approaches to spine oncology surgery (MISS) are continually advancing. This paper will describe the evolution of minimally invasive surgical techniques for the resection of metastatic spinal lesions and stabilization in a single institute. A retrospective analysis of patients who underwent minimally invasive extradural spinal metastases resection during the years 2013-2019 by a single surgeon was performed. Medical records, imaging studies, operative reports, rates of screw misplacement, operative time and estimated blood loss were reviewed. Detailed description of the surgical technique is provided. Of 138 patients operated for extradural spinal tumors during the study years, 19 patients were treated in a minimally invasive approach and met the inclusion criteria for this study. The mortality rate was significantly improved over the years with accordance of improve selection criteria to better prognosis patients. The surgical technique has evolved over the study years from fluoroscopy to intraoperative 3D imaging and navigation guidance and from k-wire screw insertion technique to one-step screws. Minimally invasive spinal tumor surgery is an evolving technique. The adoption of assistive devices such as intraoperative 3D imaging and one-step screw insertion systems was safe and efficient. Oncologic patients may particularly benefit from the minimization of surgical decompression and fusion in light of the frailty of this population and the mitigated postoperative outcomes associated with MIS oncological procedures.
Collapse
Affiliation(s)
- Mai Shiber
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Gil Kimchi
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Nachshon Knoller
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Ran Harel
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +972-3-5302650
| |
Collapse
|
5
|
Minimally Invasive Resection of Benign Osseous Tumors of the Spinal Column: 10 Years' Experience and Long-Term Outcomes of a Specialized Center. Medicina (B Aires) 2022; 58:medicina58121840. [PMID: 36557042 PMCID: PMC9786891 DOI: 10.3390/medicina58121840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022] Open
Abstract
Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on minimally invasive resection of these lesions are rare. We report a series of patients managed by total resection of benign osseous spine tumors using MIS techniques. Surgical decisions and technical considerations are discussed. Materials and Methods: A retrospective evaluation of prospectively collected data of patients who underwent minimally invasive surgery for removal of benign osseous vertebral tumors. Demographic, clinical and radiographic features, operative details and final pathological reports were summarized. Primary outcomes were completeness of tumor resection and pain relief assessed by VAS for back and leg pain. Secondary outcome measures were recurrence of tumor on repeat post-operative MRI and postoperative unstable deformity on standing scoliosis X-rays. Results: This series included 32 cases of primary osseous spine tumors resected by minimally invasive techniques. There were 17 males and 15 females aged 5-68 years (mean 23.3). The follow-up period was 8-90 months (mean 32 months) and the preoperative symptoms duration was 9-96 months. Axial spinal pain was the presenting symptom in all the patients. Five patients also complained about radicular pain and four patients had antalgic scoliosis. The tumor involved the thoracic spine in 12 cases, the lumbar segment in 11, the cervical in 5 and the sacral area in 4 cases. Complete tumor removal was performed in all patients. No procedure-related complications were encountered. Histopathology showed osteoid osteoma in 24 patients, osteoblastoma in 5 patients, and fibrous dysplasia, fibroadenoma and eosinophilic granuloma in one case each. All patients experienced significant pain relief after surgery, and had stopped pain medications by 12 months postoperatively. No patient suffered from tumor recurrence or spinal deformity. Conclusions: Minimally invasive surgery is feasible for total removal of selected benign vertebral tumors and may have some advantages over conventional surgical techniques.
Collapse
|
6
|
Current and Emerging Approaches for Spine Tumor Treatment. Int J Mol Sci 2022; 23:ijms232415680. [PMID: 36555324 PMCID: PMC9779730 DOI: 10.3390/ijms232415680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Spine tumors represent a significant social and medical problem, affecting the quality of life of thousands of patients and imposing a burden on healthcare systems worldwide. Encompassing a wide range of diseases, spine tumors require prompt multidisciplinary treatment strategies, being mainly approached through chemotherapy, radiotherapy, and surgical interventions, either alone or in various combinations. However, these conventional tactics exhibit a series of drawbacks (e.g., multidrug resistance, tumor recurrence, systemic adverse effects, invasiveness, formation of large bone defects) which limit their application and efficacy. Therefore, recent research focused on finding better treatment alternatives by utilizing modern technologies to overcome the challenges associated with conventional treatments. In this context, the present paper aims to describe the types of spine tumors and the most common current treatment alternatives, further detailing the recent developments in anticancer nanoformulations, personalized implants, and enhanced surgical techniques.
Collapse
|
7
|
Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers (Basel) 2022; 14:cancers14143480. [PMID: 35884541 PMCID: PMC9317366 DOI: 10.3390/cancers14143480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023] Open
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.
Collapse
|
8
|
Duff JM, Omoumi P, Bobinski L, Belouaer A, Plaza Wuthrich S, Zanchi F, Maduri R. Transtubular image-guided surgery for spinal intradural lesions: techniques, results, and complications in a consecutive series of 60 patients. J Neurosurg Spine 2022; 37:121-129. [PMID: 35171825 DOI: 10.3171/2021.10.spine211168] [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: 09/01/2021] [Accepted: 10/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors previously described the image merge tailored access resection (IMTAR) technique for resection of spinal intradural lesions (SIDLs). The authors reported their updated experience with the IMTAR technique and compared surgical results between patients who underwent operations with 2D or 3D fluoroscopic guidance. METHODS The authors reviewed 60 patients who underwent SIDL resection with transtubular techniques over a 14-year period. The earlier patients in the series underwent operations with 2D fluoroscopic image guidance. The latter patients underwent operations with the IMTAR technique based on 3D image guidance. The results of both techniques were analyzed. RESULTS Sixty patients were included: 27 females (45%) and 33 males (55%). The median (range) age was 50.5 (19-92) years. Gross-total resection (GTR) was achieved in 52 patients (86.7%). Subtotal resection was accomplished in 5 patients (8.3%). Neurological complications occurred in 3 patients (5%), and tumor recurrence occurred in 1 patient (1.7%). The non-IMTAR and IMTAR cohorts showed similar postoperative Nurick scale scores and rates of neurological complications and GTR. The median (interquartile range) bone resection surface area at the index level was 89.5 (51-147) mm2 in the non-IMTAR cohort and 35.5 (11-71) mm2 in the IMTAR cohort, with a statistically significant difference (p = 0.0112). CONCLUSIONS Surgery for SIDLs may be challenging, and meticulous surgical planning is crucial to optimize tumor access, maximize resection, and minimize risk of complications. Image-guided transtubular resection is an additional surgical technique for SIDLs and facilitates microsurgical tumor removal of ventrally located lesions with a posterolateral approach, without requiring potentially destabilizing bone resection.
Collapse
Affiliation(s)
- John Michael Duff
- 1Avaton Surgical Group, Genolier Spine Care Center, Clinique de Genolier, Genolier, Switzerland
| | - Patrick Omoumi
- 2Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Lukas Bobinski
- 3Department of Orthopedics, University Hospital, Umëa, Sweden
| | - Amani Belouaer
- 4Neurosurgical Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Sonia Plaza Wuthrich
- 5Centre Leenaards de la Memoire, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabio Zanchi
- 2Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Rodolfo Maduri
- 1Avaton Surgical Group, Genolier Spine Care Center, Clinique de Genolier, Genolier, Switzerland
| |
Collapse
|
9
|
Tang J, White CA, Arvind V, Cho S, Kim JS, Steinberger J. What Are Patients Saying About Minimally Invasive Spine Surgeons Online: A Sentiment Analysis of 2,235 Physician Review Website Reviews. Cureus 2022; 14:e24113. [PMID: 35573577 PMCID: PMC9106264 DOI: 10.7759/cureus.24113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Physician review websites are becoming increasingly popular for patients to find and review healthcare providers. The goal of this study was to utilize quantitative analyses to understand trends in ratings and written comments on physician review websites for Society of Minimally Invasive Spine Surgery (SMISS) members. Methods This is a cross-sectional study. The reviews of SMISS surgeons were obtained from healthgrades.com, and sentiment analysis was used to obtain compound scores of each physicians' reviews. SMISS surgeons who were international or had fewer than three written reviews, often consisting of residents and fellows, were excluded. Inferential statistics were utilized, and word frequency analysis reported the phrases used to characterize reviews. Results One hundred sixty-nine surgeons met the inclusion criteria. 98.6% were males and the mean age was 51.7 years old. A total of 2,235 written reviews were analyzed. Younger surgeons were significantly more likely to receive higher star ratings (p<0.01). Positive behavioral characteristics, such as “kind” and “bedside manner,” conferred significantly improved odds of receiving positive reviews (p<0.01). Ancillary “staff” conferred a 2x greater odds of receiving a positive review whereas a comment on “wait” times halved a surgeon’s odds (p<0.01). Sentences describing pain drove down the odds of positive reviews whereas those describing pain relief produced greater odds of positive reviews (p<0.01). Conclusion Physicians who were younger, personable, provided sufficient pain relief, and who worked in favorable offices received the most positive reviews. This study informs SMISS members on the traits deemed important by patients who ultimately review surgeons online.
Collapse
|
10
|
Sofoluke N, Barber SM, Telfeian AE, Hofstetter CP, Konakondla S. The role of the endoscope in spinal oncology: a systematic review of applications and systematic analysis of patient outcomes. World Neurosurg 2022; 164:33-40. [DOI: 10.1016/j.wneu.2022.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
|
11
|
Radiotherapy with or without Decompressive Surgery for Metastatic Spinal Cord Compression: A Retrospective Matched-Pair Study Including Data from Prospectively Evaluated Patients. Cancers (Basel) 2022; 14:cancers14051260. [PMID: 35267568 PMCID: PMC8909302 DOI: 10.3390/cancers14051260] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary In a retrospective matched-pair study including data of prospectively evaluated patients who were treated for metastatic spinal cord compression, 79 patients assigned to surgery plus radiotherapy were compared to 79 patients receiving radiotherapy alone. Improvement of motor function occurred more significantly often after surgery plus radiotherapy, whereas no significant differences were found for post-treatment ambulatory rates, local progression-free survival, overall survival, and freedom from in-field recurrence. Ten patients died within 30 days after radiotherapy alone and 12 patients within 30 days after surgery. More than one third of surgically treated patients did not complete their radiotherapy due to early death or decreased performance score following surgery. Thus, when selecting a patient for upfront surgery, the individual patient’s prognosis must be considered and weighed against the risk of perioperative complications and 30-day mortality. Abstract In 2005, a randomized trial showed that addition of surgery to radiotherapy improved outcomes in patients with metastatic spinal cord compression (MSCC). Since then, only a few studies compared radiotherapy plus surgery to radiotherapy alone. We performed a retrospective matched-pair study including data from prospective cohorts treated after 2005. Seventy-nine patients receiving radiotherapy alone were matched to 79 patients assigned to surgery plus radiotherapy (propensity score method) for age, gender, performance score, tumor type, affected vertebrae, other bone or visceral metastases, interval tumor diagnosis to MSCC, time developing motor deficits, and ambulatory status. Improvement of motor function by ≥1 Frankel grade occurred more often after surgery plus radiotherapy (39.2% vs. 21.5%, p = 0.015). No significant differences were found for post-treatment ambulatory rates (59.5% vs. 67.1%, p = 0.32), local progression-free survival (p = 0.47), overall survival (p = 0.51), and freedom from in-field recurrence of MSCC (90.1% vs. 76.2% at 12 months, p = 0.58). Ten patients (12.7%) died within 30 days following radiotherapy alone and 12 patients (15.2%) died within 30 days following surgery (p = 0.65); 36.7% of surgically treated patients did not complete radiotherapy as planned. Surgery led to significant early improvement of motor function and non-significantly better long-term control. Patients scheduled for surgery must be carefully selected considering potential benefits and risk of perioperative complications.
Collapse
|
12
|
Chin M, Camacho JE, Ye IB, Bruckner JJ, Thomson AE, Jauregui JJ, Buraimoh K, Cavanaugh DL, Koh EY, Gelb DE, Ludwig SC. Postoperative outcomes of minimally invasive pedicle screw fixation for treatment of unstable pathologic neoplastic fractures. J Orthop 2022; 30:72-76. [PMID: 35241892 PMCID: PMC8866487 DOI: 10.1016/j.jor.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022] Open
Abstract
STUDY DESIGN Retrospective Case Series. OBJECTIVES Minimally invasive techniques have emerged as a useful tool in the treatment of neoplastic spine pathology due to decrease in surgical morbidity and earlier adjuvant treatment. The objective of this study was to analyze outcomes and complications in a cohort of unstable, symptomatic pathologic fractures treated with percutaneous pedicle screw fixation (PPSF). METHODS A retrospective review was performed on consecutive patients with spinal stabilization for unstable pathologic neoplastic fractures between 2007 and 2017. Patients who underwent PPSF through a minimally invasive approach were included. Surgical indications included intractable pain, mechanical instability, and neurologic compromise with radiologic visualization of the lesion. RESULTS 20 patients with mean Tomita Score of 6.3 ± 2.1 points [95% CI, 5.3-7.2] were treated with constructs that spanned a mean of 4.7 ± 1.4 [95% CI, 4.0-5.3] instrumented levels. 10 (50%) patients were augmented with vertebroplasty. Majority of patients (65%) had no complications during their hospital stay and were discharged home (60%). Four patients received reoperation: two extracavitary corpectomies, one pathologic fracture at a different level, and one adjacent segment disease. CONCLUSION Minimally invasive PPSF is a safe and effective option when treating unstable neoplastic fractures and may be a viable alternative to the traditional open approach in select cases. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Matthew Chin
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Jael E. Camacho
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Ivan B. Ye
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Jacob J. Bruckner
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Alexandra E. Thomson
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Julio J. Jauregui
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Kendall Buraimoh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Daniel L. Cavanaugh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Eugene Y. Koh
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Daniel E. Gelb
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA
| | - Steven C. Ludwig
- Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, 110 S. Paca Street, 6FL Ste. 300, Baltimore, MD, 21201, USA,Corresponding author. Division of Spine Surgery University of Maryland Department of Orthopaedics, 110 S. Paca Street 6th floor, Ste. 300, Baltimore, MD, 21201, USA.
| |
Collapse
|
13
|
Jaman E, Zhang X, Allen J, Saraiya RG, Tollefson S, Hamilton DK, Amankulor NM. Percutaneous fixation for the treatment of metastatic spinal disease provides effective symptom palliation with low rates of hardware failure. Surg Neurol Int 2022; 13:50. [PMID: 35242416 PMCID: PMC8888300 DOI: 10.25259/sni_1110_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The incidence of survival from metastatic spinal disease (MSD) continues to rise. However, open surgery for MSD is associated with significant perioperative morbidity, while minimally invasive percutaneous pedicle screw fixation (MIPPSF) offers reduced tissue trauma, less blood loss, and a reduction in complications. Lytic bone disease plus perioperative radiation further increase risk for instrument failure, especially in long construct MIPPSF. Here, we compared 6 short construct and 14 long construct outcomes for MIPPSF performed in MSD patients, including multiple myeloma (MM). Methods: For 20 patients undergoing MIPPSF for MSD, we evaluated disease type, location, the extent of surgery, outcomes, and survival rates. Statistical comparisons were performed between long-segment construct and short-segment construct patients utilizing Kaplan–Meier survival curves, Mann–Whitney U, and Chi-squared tests. Results: No instrument failure and comparable symptomatic relief were observed for both short and long MIPPSF constructs. However, long construct patients experienced; a higher incidence of postoperative complications, including screw loosening, but exhibited longer overall survivals (likely related to underlying type of MSD, with MM patients making up the largest portion of long construct patients). Conclusion: Long construct MIPPSF in MSD did not have increased risk of construct failure and offered effective symptomatic relief, including for MM patients, without introducing a greater risk construct instability.
Collapse
Affiliation(s)
- Emade Jaman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Xiaoran Zhang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Jordan Allen
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Raj G. Saraiya
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Savannah Tollefson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - D. Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Nduka M. Amankulor
- Department of Neurological Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| |
Collapse
|
14
|
Souzanchi-K M, Akbarzadeh-T MR. Brain emotional learning impedance control of uncertain nonlinear systems with time delay: Experiments on a hybrid elastic joint robot in telesurgery. Comput Biol Med 2021; 138:104786. [PMID: 34560502 DOI: 10.1016/j.compbiomed.2021.104786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023]
Abstract
Telesurgical robot control is a significant example of an uncertain nonlinear system, as it involves various complexities, including unknown master/slave dynamics, environmental uncertainties, joint elasticities, and communication time delays. This problem becomes even more complicated when desirable properties such as stability, transparency, rigidity, accuracy, and fine manipulability are considered. We consider an elastic joint telesurgical robot architecture that combines two parallel and serial manipulators to achieve the desired rigidity, accuracy, and fine manipulability. For this purpose, we propose using Brain Emotional Learning (BEL) to estimate the robot's uncertain nonlinear dynamics. In contrast to recent stability analyses of BEL-based systems, we employ Lyapunov theory to achieve the closed-loop system's general stability independent of robot dynamics and chattering. Furthermore, the proposed control architecture implements two reference impedance models for the master and slave robots' trajectory generation and makes a trade-off between transparency and stability by simultaneously considering optimal position synchronization and transparency conditions. In this regard, we extend these two conditions in absolute stability theory and Llewellyn's criterion to obtain the allowable bound of communication time delay. The proposed robot is designed and experimentally implemented at the Robotics Laboratories at FUM and SUT Universities. Along with confirming the theoretical results, simulations and laboratory experiments demonstrate that a reasonable trade-off between stability and transparency is made in four realistic case studies with and without communication time delays.
Collapse
Affiliation(s)
- M Souzanchi-K
- Center of Excellence on Soft Computing and Intelligent Information Processing (SCIIP), Department of Electrical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - M-R Akbarzadeh-T
- Center of Excellence on Soft Computing and Intelligent Information Processing (SCIIP), Department of Electrical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran.
| |
Collapse
|
15
|
Spinal metastasis: The rise of minimally invasive surgery. Surgeon 2021; 20:328-333. [PMID: 34563452 DOI: 10.1016/j.surge.2021.08.007] [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: 01/04/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bone is the third most common site of metastatic cancer, of which the spine is the most frequently involved. As metastatic cancer prevalence rises and surgical techniques advance, operative intervention for spinal metastases is expected to rise. In the first operative cohort of spinal metastasis in Ireland, we describe the move towards less invasive surgery, the causative primary types and post-operative survival. METHODS This is a retrospective cohort study of all operative interventions for spinal metastasis in a tertiary referral centre over eight years. Primary spinal tumours and local invasion to the spine were excluded. Median follow up was 1895 days. RESULTS 225 operative procedures in 196 patients with spinal metastasis were performed over eight years. Average cases per year increased form 20 per year to 29 per year. Percutaneous procedures became more common, accounting for the majority (53%) in the final two years. The most common primary types were breast, myeloma, lung, prostate and renal. Overall survival at 1 year was 51%. Primary type was a major determinant of survival, with breast and the haematological cancers demonstrating good survival, while lung had the worst prognosis. CONCLUSION This is the first descriptive cohort of operative interventions for spinal metastasis in an Irish context. Surgery for spinal metastasis is performed at an increasing rate, especially through minimally-invasive means. The majority of patients survive for at least one year post-operatively. Prudent resource planning is necessary to prepare for this growing need.
Collapse
|
16
|
Lidar Z, Khashan M, Ofir D, Regev GJ, Salame K. Resection of Benign Osseous Spine Tumors in Pediatric Patients by Minimally Invasive Techniques. World Neurosurg 2021; 152:e758-e764. [PMID: 34166825 DOI: 10.1016/j.wneu.2021.06.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Benign osseous tumors of the spine in children are a rare cause for surgery. The aim of this study is to describe our experience with resection of pediatric benign osseous spine tumors using a minimally invasive technique through a variety of surgical approaches. METHODS A retrospective review of prospectively collected data of pediatric patients who underwent minimally invasive resection of a benign osseous vertebral tumor from May 2013 through November 2018 was performed. Primary outcome measures included the extent of resection and pain resolution. Secondary outcomes included postoperative spinal instability evaluated by standing scoliosis x-rays and tumor recurrence evaluated by periodic follow-up magnetic resonance imaging scans. RESULTS Our study group comprised 8 children, 3 males and 5 females, with a mean age of 12.2 years. The average follow-up period was 4.3 years. Complete removal of tumors was achieved in all cases and was verified by follow-up magnetic resonance imaging scans. There were no procedure-related complications. The average duration of surgery was 70 minutes, and the blood loss was less than 20 cc in all cases. The average inpatient length of stay was 1.6 days. Histopathology revealed osteoid osteoma in 6 patients and osteoblastoma in 2 patients. Average improvement of the pain scores was from 8 to 0.8. At the time of this report, no tumor recurrence was evident in all 8 patients and none of the cases developed spinal deformity. CONCLUSION Our limited experience suggests that the minimally invasive technique is a valuable option for the surgical management of selected benign osseous spinal tumors in children.
Collapse
Affiliation(s)
- Zvi Lidar
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Morsi Khashan
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Ofir
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad J Regev
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khalil Salame
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Porras JL, Pennington Z, Hung B, Hersh A, Schilling A, Goodwin CR, Sciubba DM. Radiotherapy and Surgical Advances in the Treatment of Metastatic Spine Tumors: A Narrative Review. World Neurosurg 2021; 151:147-154. [PMID: 34023467 DOI: 10.1016/j.wneu.2021.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
Spine tumors encompass a wide range of diseases with a commensurately broad spectrum of available treatments, ranging from radiation for spinal metastases to highly invasive en bloc resection for primary vertebral column malignancies. This high variability in treatment approaches stems both from variability in the goals of surgery (e.g., oncologic cure vs. symptom palliation) and from the significant advancements in surgical technologies that have been made over the past 2 decades. Among these advancements are improvements in surgical technique, namely minimally invasive approaches, increased availability of focused radiation modalities (e.g., proton therapy and linear accelerator devices), and new surgical technologies, such as carbon fiber-reinforced polyether ether ketone rods. In addition, several groups have described nonsurgical interventions, such as vertebroplasty and kyphoplasty for spinal instability secondary to pathologic fracture, and lesion ablation with spinal laser interstitial thermoablation, radiofrequency ablation, or cryoablation. We provide an overview of the latest technological advancements in spinal oncology and their potential usefulness for modern spinal oncologists.
Collapse
Affiliation(s)
- Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bethany Hung
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
| |
Collapse
|
18
|
Wang R, Chen Y, Liang Z, Yang W, Chen C. Efficacy of One-stage Paravertebral Approach using a Micro-Tubular Technique in Treating Thoracic Dumbbell Tumors. Orthop Surg 2021; 13:1227-1235. [PMID: 33943013 PMCID: PMC8274168 DOI: 10.1111/os.12991] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/24/2021] [Accepted: 02/21/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the feasibility and efficacy of one-stage surgical resection of thoracic dumbbell tumors using a paravertebral approach and a micro-tubular technique. METHODS Clinical data of thoracic dumbbell tumors resected using a paravertebral approach and a micro-tubular technique (14 mm, non-expandable type) in the Department of Neurosurgery at our hospital from July 2014 to July 2019 were retrospectively analyzed. Tumors were found between T1 and T12 vertebrae. Operation time, blood loss, hospitalization, recovery of neurological function, complications, the Japanese Orthopaedic Association (JOA) score, and the visual analogue scale (VAS) score were used to evaluate clinical efficacy. RESULTS In all 31 cases, tumors were completely resected in one operation, with a mean blood loss of 53.23 ± 33.08 mL (20-150 mL) and a mean operation time of 95.16 ± 20.31 min (60-180 min). According to the Eden classification, there were four type II cases, 16 type III cases, and 11 type IV cases. The incidence of tumors in the lower thoracic segment (T8-T12) was 51.6% (16/31 cases), while the incidences in the upper thoracic segment (T1-T4) and middle segment (T5-T8) were 25.8% (8/31 cases) and 22.6% (7/31 cases), respectively. Pathological diagnoses were schwannoma (n = 22), gangliocytoma (n = 4), metastatic tumor (n = 2), neurofibroma (n = 1), granuloma (n = 1), and lipoma (n = 1). After surgery, symptoms were relieved in all patients. VAS and JOA scores significantly improved (P < 0.001). There was no pleural or lung injury, and there were no complications, such as cerebrospinal fluid leakage. The average follow-up duration was 29 months (13-59 months), during which time no tumor recurrence or spinal instability occurred. The group of Eden type II tumors had lower JOA scores at 12 months postoperatively, longer operation times, and more estimated blood loss compared with other groups (P < 0.05). There were no significant influences on VAS scores at 12 months postoperatively and postoperative hospital stay from the different types of tumors. CONCLUSION The paravertebral approach with a micro-tubular technique is a safe and effective minimally invasive surgical approach for thoracic dumbbell tumors that allows one-stage tumor resection using a single incision. Using this approach significantly reduces intraoperative blood loss and postoperative complications, shortens hospital stay, and reduces the rates of postoperative spinal instability.
Collapse
Affiliation(s)
- Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yan Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zeyan Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Yang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
19
|
Baldassarre BM, Penner F, Bertero L, Di Perna G, Ajello M, Marengo N, Zenga F, Garbossa D. Solitary late spinal metastasis from apocrine salivary duct carcinoma: Case report. Surg Neurol Int 2021; 12:122. [PMID: 33880227 PMCID: PMC8053463 DOI: 10.25259/sni_903_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background The salivary duct carcinomas (SDCs) are rare, high-grade neoplasms involving major salivary glands. Parotid is the most frequently involved gland (85%). Apocrine phenotype (histological presence of decapitation secretions) and androgen reception expression define SDC. The clinical course of these tumors is characterized by aggressive local behavior with extraglandular extension, high recurrence rates, early metastases, and poor prognoses. Despite aggressive surgical/radiation therapy management, the rates of locoregional and metastatic relapses are high, and the mortality rates over 48 months approach 65%. Notably, there is no treatment algorithm available for managing vertebral metastases from apocrine SDC. Case Description An elderly male presented with MR/CT findings of an isolated T11 vertebral metastasis attributed to a previously treated parotid SDC. On both CT/MR, it was an osteolytic lesion and demonstrated spinal canal infiltration. The patient underwent surgical biopsy/decompression/resection, following which the lesion histopathologically proved to be a SDC. The patient was subsequently treated with 30 Gy in 10 fractions within 2 weeks of discharge. One-month later, the MRI confirmed adequate epidural decompression without recurrence, and 9 months post-operatively, patient remained disease free. Conclusion Isolated metastasis attributed to parotid SDC followed by radiation therapy may result in tumor control.
Collapse
Affiliation(s)
| | - Federica Penner
- Department of Neuroscience, Neurosurgery Unit, Città Della Scienza e Della Salute, Italy
| | - Luca Bertero
- Department of Pathologic, Città Della Scienza e Della Salute, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience, Neurosurgery Unit, Città Della Scienza e Della Salute, Italy
| | - Marco Ajello
- Department of Neuroscience, Neurosurgery Unit, Città Della Scienza e Della Salute, Italy
| | - Nicola Marengo
- Department of Neuroscience, Neurosurgery Unit, Città Della Scienza e Della Salute, Italy
| | - Francesco Zenga
- Department of Neuroscience, Neurosurgery Unit, Città Della Scienza e Della Salute, Italy
| | - Diego Garbossa
- Department of Neuroscience, Neurosurgery Unit, Città Della Scienza e Della Salute, Italy
| |
Collapse
|
20
|
Shao MM, Rubino S, DiRisio DJ, German JW. The History of Neurosurgical Spinal Oncology: From Inception to Modern-Day Practices. World Neurosurg 2021; 150:101-109. [PMID: 33771747 DOI: 10.1016/j.wneu.2021.03.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023]
Abstract
The neurosurgical management of spinal neoplasms has undergone immense development in parallel with advancements made in general spine surgery. Laminectomies were performed as the first surgical procedures used to treat spinal neoplasms. Since then, neurosurgical spinal oncology has started to incorporate techniques that have developed from recent advances in minimally invasive spine surgery. Neurosurgery has also integrated radiotherapy into the treatment of spine tumors. In this historical vignette, we present a vast timeline spanning from the Byzantine period to the current day and recount the major advancements in the management of spinal neoplasms.
Collapse
Affiliation(s)
- Miriam M Shao
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
| | - Sebastian Rubino
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Darryl J DiRisio
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - John W German
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| |
Collapse
|