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Zhang Y, Chen W, Cao S, He S, Wei H. Surgical Treatments and Long-Term Outcomes for Pediatric Patients With Lumbar Spinal Tumors. Global Spine J 2023:21925682231212863. [PMID: 38060695 DOI: 10.1177/21925682231212863] [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] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN Retrospective case‒control study. OBJECTIVES This study aimed to report the effects of surgical intervention on spinal stability recovery and to assess the long-term outcomes of children and adolescents with lumbar tumors. METHODS From January 2016 to June 2021, 42 pediatric patients with lumbar tumors were selected and separated into different groups based on the surgical method used (total en bloc resection (TER) group, n = 21; piecemeal resection (PR) group, n = 21; titanium mesh (TM) group n = 23; artificial vertebrae (AV) group n = 19). The clinicopathological characteristics, treatments and related outcomes were described in detail and compared between groups, with P value ≤.05 indicating statistically significant differences. RESULTS The average follow-up duration was 24.89 months, and the mean age was 14.89 ± 2.41 years. There were no significant differences in the mean operation time, average blood loss, complication rate, or length of hospital stay between the groups. The ODI, VAS and JOA scores at the final follow-up (FF) were elevated after surgery in all groups. The FF local angular drift (LOD) and lumbar angular drift (LUD) were greater in the TM group than in the AV group (P = .03, P = .001). CONCLUSIONS After surgery, pediatric patients with lumbar tumors can obtain satisfactory spinal stability, effective relief of pain symptoms and substantial improvements in neurological function. There was no significant difference in the invasiveness, safety or timeliness between the 2 surgical methods, so TER is recommended due to its low postoperative recurrence rate and good local control. Spinal fusion in the AV group resulted in better spinal stability.
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Affiliation(s)
- Yue Zhang
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Wenjun Chen
- Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu, Shanghai, China
| | - Shuang Cao
- Department of orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaohui He
- Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu, Shanghai, China
| | - Haifeng Wei
- Department of orthopedic oncology, Changzheng Hospital, Second Military Medical University, Huangpu, Shanghai, China
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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"The eye sees only what the mind is prepared to comprehend": Unrecognized incidental findings on intraoperative computed tomography during spine instrumentation surgery. Clin Imaging 2020; 72:64-69. [PMID: 33217672 DOI: 10.1016/j.clinimag.2020.11.034] [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: 07/31/2020] [Revised: 09/20/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intraoperative computed tomography (CT) is becoming more widely utilized in spine fusion surgeries. The use of CT-based image guidance has been shown to increase the accuracy in instrumentation placement and to reduce the rate of reoperation. However, incidental findings that are obvious in retrospect are still missed in spinal fusion surgeries due to the concept of inattentional blindness and surgeons' preoccupation with the main objective of intraoperative CT (i.e. instrumentation accuracy). CASE DESCRIPTION The first case describes a 60-year-old male who underwent posterior spinal laminectomy and interbody fusions from L2-L5. Intraoperative CT confirmed appropriate placement of hardware. However, when he was transferred out to the care unit and extubated, he developed a severe headache for which the source was confirmed to be a pneumocephalus from durotomy and cerebrospinal fluid leakage on repeat CT. A retrospective review of his intraoperative CT demonstrated the intrathecal air at L5-S1 interlaminar space that was missed on evaluation during surgery. The second case describes a 68-year-old female who was treated with a successful T4 to pelvis instrumentation and fusion with vertebral column resection at T10 confirmed with imaging. Postoperatively, she developed rapidly progressive oxygen desaturation and was found to have a pneumothorax which had been present on the intraoperative imaging. CONCLUSION This case report of two patients with missed intraoperative findings demonstrates the importance of looking beyond instrumentation placement and evaluating the entire intraoperative CT imaging to find abnormalities that could complicate the patients' postoperative recovery and overall hospital stay.
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Nguyen TT, Thelen JC, Bhatt AA. Bone up on spinal osseous lesions: a case review series. Insights Imaging 2020; 11:80. [PMID: 32601958 PMCID: PMC7324468 DOI: 10.1186/s13244-020-00883-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
Spinal osseous neoplasms are frequently encountered and can be challenging when present as solitary lesions. Familiarity with the range of benign and malignant spinal pathology can help the radiologist formulate a comprehensive differential diagnosis. This article focuses on the spectrum of extradural spinal tumors, accounting for the majority of primary spinal tumors, by comparing the epidemiology, pathophysiology, clinical presentation, and characteristic imaging appearance of these lesions. The discussion includes the commonly encountered benign lesions, such as vertebral venous vascular malformation and enostosis, as well as malignant lesions including metastases and lymphoma. The article also includes other less-encountered primary spinal tumors such as plasmacytoma, osteoid osteoma, osteoblastoma, giant cell tumor, eosinophilic granuloma, chordoma, chondrosarcoma, osteosarcoma, Ewing’s sarcoma, and angiosarcoma. Familiarity with the characteristic imaging features can help the radiologist reach an accurate diagnosis and obviate the need for unnecessary invasive procedures such as biopsy and surgery.
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Affiliation(s)
- Trinh T Nguyen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Jarett C Thelen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Boaro A, Wells M, Chi J, Lu Y, Smith TR, Groff MW, Zaidi H. A National Surgical Quality Improvement Program Analysis of Postoperative Major and Minor Complications in Patients with Spinal Metastatic Disease. World Neurosurg 2020; 140:e203-e211. [PMID: 32389869 DOI: 10.1016/j.wneu.2020.04.225] [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: 02/07/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Major complications after spine metastasis surgery are prioritized in the literature with little consideration of the more frequent minor events such as pneumonia or urinary tract infection. We analyzed incidence and risk factors of postsurgical complications in patients with spinal metastasis extracted from the National Surgical Quality Improvement Program (NSQIP). We also developed a useful predictive model to estimate the probability of occurrence of complications. METHODS A total of 1176 patients diagnosed with spinal metastasis were extracted from NSQIP. Variables screened included age, sex, tumor location, patient's functional status, comorbidities, laboratory values, and case urgency. Two multivariate logistic regression models were designed to evaluate risk factors and likelihood of event occurrence. RESULTS Minor events occurred twice as frequently compared with major complications (36% vs. 18% of patients). The most common major event was death (10%); the most frequent minor event was need for postoperative transfusion (29.4%). In the multivariate analysis, elderly age, emergency case, preoperative leukocytosis, and smoking status retained significance for major complications; American Society of Anesthesiologists classes 4-5, low hematocrit levels, and intradural extramedullary location of the tumor retained significance for minor complications. The predictive models designed explained 72% of the variability in major complications occurrence and 67% for minor events. CONCLUSIONS Smoking status and emergent surgery were found to be the strongest independent predictors of major complications, whereas higher American Society of Anesthesiologists class showed a greater association with minor events. The predictive models produced can be a useful aid for surgeons to identify those patients who are at greater risk of developing postoperative adverse events.
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Affiliation(s)
- Alessandro Boaro
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA.
| | - Michael Wells
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - John Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Hasan Zaidi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
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Macki M, Hamilton T, Pawloski J, Chang V. Occipital fixation techniques and complications. JOURNAL OF SPINE SURGERY 2020; 6:145-155. [PMID: 32309653 DOI: 10.21037/jss.2019.12.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Occipitocervical fusions in the adult population are most commonly indicated for neoplastic tumors invading the craniocervical junction (CCJ), rheumatological deformities compromising the foramen magnum, and traumatic dislocations resulting in occiput-C1 instability. Appropriate preoperative imaging will not only assist in identifying the pathology but also determine a treatment regimen for the diseased junction. A treatment algorithm for craniocervical disease is proposed. Lesions must first be identified as irreducible versus reducible: restore extension and/or distraction of the craniovertebral junction without injuring the neural elements. Irreducible lesions require decompression only, while reducible lesions require an added fusion. Techniques in fusion are broadly divided into external immobilization versus internal fixation. The former entails halo rings and tongs for a prolonged duration. Fixation surgeries vary from wiring to screw fixation of the occiput-C1 segment. Details of the operation as well as potential complications are discussed.
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Affiliation(s)
- Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Travis Hamilton
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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Quality of life, pain, and psychological factors in patients undergoing surgery for primary tumors of the spine. Support Care Cancer 2019; 28:1385-1393. [PMID: 31264185 DOI: 10.1007/s00520-019-04965-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/26/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Knowledge about quality of life (QOL), pain, and psychological factors in patients with primary tumors of the spine is limited, but is important in planning rehabilitation after surgery. Aims of this study were to assess the preoperative levels and improvement after surgery of these factors, and to identify the predictors of postoperative pain and QOL. METHODS Patients with primary tumors undergoing spine surgery were matched for sex and age with patients with metastatic tumors. QOL was measured at baseline and three months after surgery with the physical (PCS) and mental (MCS) components SF-12 subscales, pain intensity with a numeric rating scale (NRS), depression with the Beck Depression Inventory (BDI). Preoperative SF-12, NRS, and BDI levels and differences in follow-up improvement in SF-12 and NRS were compared across samples. LASSO regressions were performed to find predictors of follow-up SF-12 and NRS. RESULTS Patients with primary tumors showed better PCS and NRS, and similar BDI and MCS than patients with metastatic tumors. At follow-up, they showed stronger improvement in the MCS and no improvement in the PCS. All QOL scores were below those of the general population. Follow-up PCS was predicted by baseline PCS and BDI; MCS by baseline MCS; pain intensity by baseline pain intensity and BDI. CONCLUSION Patients with primary tumors of the spine suffer from moderate levels of physical and mental impairment. Depression influences surgical outcomes.
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Osborn VW, Lee A, Yamada Y. Stereotactic Body Radiation Therapy for Spinal Malignancies. Technol Cancer Res Treat 2019; 17:1533033818802304. [PMID: 30343661 PMCID: PMC6198394 DOI: 10.1177/1533033818802304] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Stereotactic body radiation therapy and stereotactic radiosurgery have become important treatment options for the treatment of spinal malignancies. A better understanding of dose tolerances with more conformal technology have allowed administration of higher and more ablative doses. In this review, the framework for approaching a patient with spinal metastases and primary tumors will be discussed as well as details on the delivery of this treatment.
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Affiliation(s)
- Virginia W Osborn
- 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,2 Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anna Lee
- 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,2 Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Yoshiya Yamada
- 1 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Malik AT, Jain N, Scharschmidt TJ, Mayerson JL, Khan SN. Factors associated with post-operative sepsis following surgery for spinal tumors: An analysis of the ACS-NSQIP database. Clin Neurol Neurosurg 2018; 172:1-7. [DOI: 10.1016/j.clineuro.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
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Yokogawa N, Murakami H, Demura S, Kato S, Yoshioka K, Tsuchiya H. Incidental durotomy during total en bloc spondylectomy. Spine J 2018; 18:381-386. [PMID: 28735765 DOI: 10.1016/j.spinee.2017.07.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The incidence of incidental durotomy (ID) during total en bloc spondylectomy (TES) tends to be higher than that during other spinal surgeries because of the peculiarities of TES, including its highly invasive nature, epidural tumor extension, and use in patients who often have complicated medical backgrounds. However, there have been no detailed reports on ID associated with TES. PURPOSE The study aimed to investigate ID during TES in detail. STUDY DESIGN This is a retrospective review of prospectively collected data. PATIENT SAMPLE The study included 105 consecutive patients with spinal tumor who underwent TES between May 2010 and February 2015 (59 men, 46 women; mean age, 54.0 years [range, 14-75 years] at the time of surgery). OUTCOME MEASURES Outcome measures included the incidence, risk factors, anatomical location, intraoperative maneuvers, and postoperative course of ID associated with TES. MATERIALS AND METHODS Medical and operative records and imaging findings were reviewed. Univariate analysis and multivariable stepwise logistic regression models were used to identify independent risk factors for ID. RESULTS Incidental durotomy occurred in 18 (17.1%) of the 105 patients. The univariate and multivariate analyses demonstrated that older age (adjusted odds ratio [aOR], 6.09; 95% confidence interval [CI], 1.17-31.76; p=.03), radiotherapy (RT) history (aOR, 5.31; 95% CI, 1.46-19.49; p=.01), and revision surgery (aOR, 19.42; 95% CI, 3.46-109.14; p<.01) were independent risk factors for ID. Incidental durotomy was more likely to occur during dissection of tumor tissues in proximity to the nerve root. Although all of the ID cases were primarily sutured and covered with polyglycolic acid mesh and fibrin glue spray, eight cases required additional intervention because of intractable postoperative cerebrospinal fluid leakage. Six of these eight had a history of RT. CONCLUSIONS Our results may help better identify high-risk patients for ID during TES, which may aid surgeons with optimal surgical decision making and in counseling patients on perioperative complications.
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Affiliation(s)
- Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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He J, Xiao J, Peng X, Duan B, Li Y, Ai P, Yao M, Chen N. Dose escalation by image-guided intensity-modulated radiotherapy leads to an increase in pain relief for spinal metastases: a comparison study with a regimen of 30 Gy in 10 fractions. Oncotarget 2017; 8:112330-112340. [PMID: 29348828 PMCID: PMC5762513 DOI: 10.18632/oncotarget.18979] [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: 12/15/2016] [Accepted: 06/18/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Under the existing condition that the optimum radiotherapy regimen for spinal metastases is controversial, this study investigates the benefits of dose escalation by image-guided intensity-modulated radiotherapy (IG-IMRT) with 60-66 Gy in 20-30 fractions for spinal metastases. RESULTS In the dose-escalation group, each D50 of planning gross tumor volume (PGTV) was above 60 Gy and each Dmax of spinal cord planning organ at risk volume (PRV) was below 48 Gy. The median biological effective dose (BED) of Dmax of spinal cord was lower in the dose-escalation group compared with that in the 30-Gy group (69.70 Gy vs. 83.16 Gy, p < 0.001). After one month and three months of the radiotherapy, pain responses were better in the dose-escalation group than those in the 30-Gy group (p = 0.005 and p = 0.024), and the complete pain relief rates were respectively 73.69% and 34.29% (p = 0.006), 73.69% and 41.38% (p = 0.028) in two compared groups. In the dose-escalation group, there is a trend of a longer duration of pain relief, a longer overall survival and a lower incidence of acute radiation toxicities. No late radiation toxicities were observed in both groups. MATERIALS AND METHODS Dosimetric parameters and clinical outcomes, including pain response, duration of pain relief, radiation toxicities and overall survival, were compared among twenty-five metastatic spinal lesions irradiated with the dose-escalation regimen and among forty-four lesions treated with the 30-Gy regimen. CONCLUSIONS Conventionally-fractionated IG-IMRT for spinal metastases could escalate dose to the vertebral lesions while sparing the spinal cord, achieving a better pain relief without increasing radiation complications.
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Affiliation(s)
- Jinlan He
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xingchen Peng
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Baofeng Duan
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ping Ai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Min Yao
- Department of Radiation Oncology, Case Comprehensive Cancer Center, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Nianyong Chen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Bettaswamy G, Ambesh P, Kumar R, Sahu RN, Das KK, Jaiswal AK, Srivastava AK, Behari S. Multicompartmental Primary Spinal Extramedullary Tumors: Value of an Interdisciplinary Approach. Asian J Neurosurg 2017; 12:674-680. [PMID: 29114282 PMCID: PMC5652094 DOI: 10.4103/ajns.ajns_54_13] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Primary extramedullary tumors involving multiple compartments around the spine are a technically demanding group of tumors whose extent traverses beyond the normal confines of those anatomical regions which fall in the common domain of neurosurgeons. In the following series, we present 12 patients who were diagnosed with primary spinal extramedullary tumors with multicompartmental extension, and whose surgical management was facilitated by a combined multidisciplinary approach involving surgeons of other superspecialties. This multidisciplinary assistance from the inception to the culmination of surgical management helped in achieving a better surgical removal, thereby resulting in better surgical outcomes. Materials and Methods: Twelve consecutive patients who fulfilled the inclusion criteria in the 5-year period (January 2010 to January 2015) were included in the series based on the radiological and pathological characteristics of the tumor. Depending on the site of the spine involved by the lesion, radiologists and surgeons were involved from the planning phase of the surgical management, and their assistance in procedures such as preoperative embolization/ureteric stenting was sought whenever was deemed necessary. The extent of resection and total blood loss was recorded meticulously. Regular follow-up (3, 6, and 12 months and 2 and 5 years) of the patients was done after the initial follow-up at 6 weeks and their disability scores were recorded. Results: Of the 12 cases (6 males and 6 females), sacrum was the most common location of the tumors (6). Histopathologically, giant-cell tumors, schwannomas, and chondrosarcomas (3 each) were most common followed by Ewing's sarcoma (2) and malignant peripheral nerve sheath tumor (1). Eight patients had functional status of McCormick scale 1 and two patients had a functional status of 2. One patient was lost to follow-up and one patient died during surgery. Conclusion: Judicious involvement of access surgeons and adjunct therapies along with careful preoperative planning can help in improving surgical outcome in multicompartmental spinal tumors.
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Affiliation(s)
- Guruprasad Bettaswamy
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Paurush Ambesh
- Department of Internal Medicine, Maimonides Medical Center, New York City, USA
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rabi Narayan Sahu
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery. World Neurosurg 2016; 95:548-555.e4. [DOI: 10.1016/j.wneu.2016.08.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023]
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Percutaneous Selective Vertebroplasty: State of the Art Management in Well-Confined Metastatic Vertebral Lesions. Asian Spine J 2016; 10:869-876. [PMID: 27790314 PMCID: PMC5081321 DOI: 10.4184/asj.2016.10.5.869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/17/2015] [Accepted: 01/10/2016] [Indexed: 11/17/2022] Open
Abstract
Study Design Prospective cohort study. Purpose To evaluate the clinical and radiological results of percutaneous selective vertebroplasty (PSV) as first-line treatment options in the setting of well-confined spinal metastases. Overview of Literature Recent technological advances combined with innovative interventional techniques enable an alternative less invasive treatment option for many patients with malignant vertebral body infiltration. Percutaneous vertebral augmentation procedures offer less invasive but effective pain relief to many patients with symptomatic spinal metastatic disease. Methods Eleven patients with 21 well-confined metastatic vertebral lesions that had been treated with PSV were included. Pain was evaluated one week, one month, 3 months and 6 months post-procedure using a 10-point visual analogue scale (VAS). A statistical analysis including repeated measures analysis of variance test was used to collectively indicate the presence of any significant differences between different time sequences. Medication usage and range of mobility were also evaluated. Results The 11 patients had an average age of 42 years and 54.5% were male. Highly significant improvements in VAS scores at rest and with activity (p<0.001) were evident. There was a significant decrease in rate of medication consumption post-procedure (p<0.05). Conclusions PSV can be used successfully as the first-line treatment for well-confined metastatic vertebral lesions. It is also an effective method to decrease pain, increase mobility, and decrease narcotic administration in such patients.
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Kandwal P, Vijayaraghavan G, Goswami A, Jayaswal A. Back Pain in Children- How Sinister? Indian J Pediatr 2016; 83:834-43. [PMID: 26411731 DOI: 10.1007/s12098-015-1886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/13/2015] [Indexed: 12/27/2022]
Abstract
Incidence of back pain among children and adolescents is gradually increasing. Children undergo extensive diagnostic workup that ultimately results in a nonconfirmative diagnosis. A good history and clinical examination can, to a large extent help differentiate non-specific from organic causes of backache. Diagnostic workup may be initiated if symptoms are severe and/or persistant. The authors review some of the common causes of back pain in pediatric population, clinical presentations, and the relevant investigations along with their management.
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Affiliation(s)
- Pankaj Kandwal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India.
| | - G Vijayaraghavan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goswami
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Jayaswal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Yang P, He X, Li H, Zang Q, Wang G. Therapy for thoracic lumbar and sacral vertebrae tumors using total spondylectomy and spine reconstruction through posterior or combined anterior-posterior approaches. Oncol Lett 2016; 11:1778-1782. [PMID: 26998076 DOI: 10.3892/ol.2016.4126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/08/2015] [Indexed: 12/29/2022] Open
Abstract
The present study aimed to analyze the indications, feasibility, safety and clinical effects of total spondylectomy and spine reconstruction through posterior or combined anterior-posterior approaches for thoracic lumbar and sacral vertebrae tumors. Between December 2009 and May 2012, 10 patients with thoracic lumbar and sacral vertebrae tumors were retrospectively analyzed. Different surgical indications and approaches were used according to the affected segments, the extent of lesion involvement and the specific pathology results. One-stage posterior or combined anterior-posterior total spondylectomy and reconstruction was used for the treatment of complicated thoracic lumbar and sacral vertebral malignant tumors and invasive benign tumors. The duration of surgery, levels of intraoperative blood loss and transfusions, and the clinical effects were observed. The average surgical duration was 6.8 h (range, 4.8-12 h), with an average blood loss level of 3,200 ml (range, 1,500-10,000 ml) and an average transfusion level of 2,500 ml. During the average 15 months (range, 3-29 months) follow up, two patients succumbed and one patient experienced tumor recurrence. Neither tumor reoccurrence nor metastasis was observed in all other patients. Personalized surgical indications and approaches according to the affected segments, the extent of lesion involvement and the specific pathology results would aid in the reduction of pain, the improvement of nerve function and the reduction of tumor recurrence.
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Affiliation(s)
- Pinglin Yang
- Second Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University Medical School, Xi'an, Shaanxi 710004, P.R. China
| | - Xijing He
- Second Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University Medical School, Xi'an, Shaanxi 710004, P.R. China
| | - Haopeng Li
- Second Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University Medical School, Xi'an, Shaanxi 710004, P.R. China
| | - Quanjin Zang
- Second Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University Medical School, Xi'an, Shaanxi 710004, P.R. China
| | - Guoyu Wang
- Second Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University Medical School, Xi'an, Shaanxi 710004, P.R. China
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Zhang L, Lu J, Wang Z, Cheng Y, Teng G, Chen K. Clinical efficacy of computed tomography-guided iodine-125 seed implantation therapy in patients with advanced spinal metastatic tumors. Onco Targets Ther 2016; 9:7-12. [PMID: 26719712 PMCID: PMC4690646 DOI: 10.2147/ott.s95410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The purpose of this study was to examine the safety and clinical efficacy of computed tomography (CT)-guided radioactive iodine-125 (125I) seed implantation treatment in patients with spinal metastatic tumors. Methods We retrospectively analyzed 20 cases of spinal metastatic tumors, including nine men and eleven women aged 50–79 years (mean age: 61.1 years). We used treatment planning system (TPS) to construct three-dimensional images of the spinal metastatic tumors and to determine what number and dose rate distribution to use for the 125I seeds. The matched peripheral dose of the 125I seed implantation was 90–130 Gy. Twenty-four spinal metastatic tumors were treated by CT-guided radioactive 125I seed implantation. A median of 19 (range: 4–43) 125I seeds were implanted. Results Twenty cases were followed for a median of 15.3 months (range: 7–32 months). The rate of pain relief was 95%. The median control time for all of the patients was 12.5 months. The 3-, 6-, and 12-month cumulative local control rates were 100%, 95%, and 60%, respectively. The median survival time for all of the patients was 16 months. The cumulative 6- and 12-month survival rates were 100% and 78.81%, respectively. No major complications were observed. No 125I seeds were lost or migrated to other tissues or organs. Conclusion CT-guided radioactive 125I seed implantation is a safe, effective, and minimally invasive method for the treatment of patients with spinal metastatic tumors. It is a possible alternative therapy for the treatment of spinal metastases.
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Affiliation(s)
- Liyun Zhang
- Medical College of Soochow University, Suzhou, People's Republic of China ; Department of Radiology, Shanghai Ruijin Hospital Luwan Branch, Shanghai, People's Republic of China
| | - Jian Lu
- Department of Radiology, Shanghai Ruijin Hospital Luwan Branch, Shanghai, People's Republic of China
| | - Zhongmin Wang
- Department of Radiology, Shanghai Ruijin Hospital, Shanghai, People's Republic of China
| | - Yingsheng Cheng
- Department of Radiology, Shanghai the Sixth People Hospital, Shanghai, People's Republic of China
| | - Gaojun Teng
- Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School, Southeast University, Nanjing, People's Republic of China
| | - Kemin Chen
- Department of Radiology, Shanghai the Sixth People Hospital, Shanghai, People's Republic of China
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Abstract
STUDY DESIGN Preliminary report of new antitumor treatment. OBJECTIVE To evaluate the effectiveness of electrochemotherapy as a novel treatment of spinal metastasis. SUMMARY OF BACKGROUND DATA Electrochemotherapy is a new antitumor treatment that combines systemic bleomycin with electric pulses delivered locally at the tumor site. These electric pulses permeabilize cell membranes in the tissue, allow bleomycin delivery diffusion inside the cells, and increase bleomycin cytotoxicity. Previous clinical studies have demonstrated the effectiveness of electrochemotherapy in the treatment of several primary and metastatic solid tumors. METHODS Treatment planning for electrode positioning and electrical pulse parameters was prepared for 4 needle electrodes. Mini-open surgery with a left L5 laminectomy was performed to introduce the eletrodes. The patient was treated according to the established Electrochemotherapy Protocol with Bleomycin. Clinical efficacy of electrochemotherapy was evaluated according to a visual analog scale of pain, Oswestry Disability Index 2.0, the Karnofsky Performance Scale, and Response Evaluation Criteria in Solid Tumors. RESULTS The assessed follow-up period was 48 months after the electrochemotherapy procedure. Neither serious electrochemotherapy-related adverse events, nor bleomycin toxicity were reported. Overall improvement in pain according to Oswestry Disability Index 2.0 and Karnofsky Performance Scale outcomes was better. CONCLUSION Our case represents, to our knowledge, the first one to test the potential role of electrochemotherapy as treatment of spinal metastasis. Electrochemotherapy allowed a successful treatment of metastatic spinal melanoma. However, we believe that there is a strong scientific rationale to support the potential utility of electrochemotherapy as a novel treatment of spinal metastasis, regardless of the histological types. LEVEL OF EVIDENCE 5.
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Qu LL, Qin HF, Gao HJ, Liu XQ. Combination of icotinib, surgery, and internal-radiotherapy of a patient with lung cancer severely metastasized to the vertebrae bones with EGFR mutation: a case report. Onco Targets Ther 2015; 8:1271-6. [PMID: 26082644 PMCID: PMC4459626 DOI: 10.2147/ott.s80012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 48-year-old Chinese female was referred to us regarding EGFR-mutated advanced non-small cell lung cancer, and metastasis to left scapula and vertebrae bones which caused pathological fracture at T8 and T10 thoracic vertebrae. An aggressive combined therapy with icotinib, vertebrae operation, and radioactive particle implantation and immunotherapy was proposed to prevent paraplegia, relieve pain, and control the overall and local tumor lesions. No postoperative symptoms were seen after surgery, and the pain was significantly relieved. Icotinib merited a 31-month partial response with grade 1 diarrhea as its drug-related adverse event. High dose of icotinib was administered after pelvis lesion progression for 3 months with good tolerance. Combination therapy of icotinib, surgery, and internal radiation for metastases of the vertebrae bones from non-small cell lung cancer seems to be a very promising technique both for sufficient pain relief and for local control of the tumor, vertebrae operation can be an encouraging option for patients with EFGR positive mutation and good prognosis indicator.
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Affiliation(s)
- Li-Li Qu
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Science, Beijing, People's Republic of China
| | - Hai-Feng Qin
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Science, Beijing, People's Republic of China
| | - Hong-Jun Gao
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Science, Beijing, People's Republic of China
| | - Xiao-Qing Liu
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Science, Beijing, People's Republic of China
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Liu W, Zhou S, Wang S. Application of percutaneous vertebroplasty in the treatment of multiple thoracic metastases. Oncol Lett 2015; 9:2775-2780. [PMID: 26137145 DOI: 10.3892/ol.2015.3145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 01/29/2015] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to explore the clinical implications of percutaneous vertebroplasty (PVP) in the treatment of multiple thoracic metastases. A total of 104 involved vertebrae of 28 patients with multiple thoracic metastases underwent PVP and the injection of bone cement. The pain relief rate and activity of daily life were assessed, and the morphological changes of the involved vertebral bodies and the invasiveness of the intraspinal tumor were also observed at 1 week, and 3, 6 and 12 months post-surgery, respectively. The pain relief rate increased at each time-point following PVP. The quality of life scores were also significantly higher than the pre-operative scores. After 12 months of follow-up, the post-operative heights of the anterior border, center and posterior border of the vertebral bodies were not noted to be statistically different from those prior to PVP (P>0.05). The present study concluded that PVP has a good analgesic effect on multiple thoracic metastases. PVP not only improves the quality of life of patients significantly, but also prevents further vertebral collapse and the invasiveness of intraspinal tumors, avoiding the nerve dysfunction caused by spinal cord compression.
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Affiliation(s)
- Wenhua Liu
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Shijun Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Shaofeng Wang
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong 261031, P.R. China
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Primary tumors of the spine: a review of clinical features in 438 patients. J Neurooncol 2015; 121:513-20. [PMID: 25637321 DOI: 10.1007/s11060-014-1650-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/26/2014] [Indexed: 12/14/2022]
Abstract
Primary spinal tumors are rare. Current knowledge on this subject is therefore limited due to the lack of study with large cohort. This study is prompted to share our data on clinical profiles of primary spinal tumors collected from a large series of patients. Clinical manifestations of 438 consecutive patients were summarized retrospectively with statistical analysis. In the spine, benign tumor is more common than malignant. The most prevalent tumor is giant cell tumor. Tumors predominately occur between the age of 18 and 59 and the risk of malignancy increases significantly after 40. Main symptoms include local pain and neurological symptoms with frequent occurrence of neurological deficits and pathological fracture. Pain is caused by tumor expansion, pathological fracture and nerve entrapment. Occurrence of neurological deficits is significantly related to patent's age and the region of involvement. Giant cell tumor is associated with the highest incidence of neurological fracture with significance. Duration of symptom is 6 months on average. The most affected region is the cervical spine, followed by the thoracic and the lumbar spine. Tumors at the sacrum and coccyx are more likely to be malignant. Malignant tumors have significantly higher incidence of involvement at multiple levels than benign tumors. This study contributes by improving our understanding of this rare clinical entity.
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Cao Q, Wang H, Meng N, Jiang Y, Jiang P, Gao Y, Tian S, Liu C, Yang R, Wang J, Zhang K. CT-guidance interstitial (125)Iodine seed brachytherapy as a salvage therapy for recurrent spinal primary tumors. Radiat Oncol 2014; 9:301. [PMID: 25534142 PMCID: PMC4299295 DOI: 10.1186/s13014-014-0301-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/14/2014] [Indexed: 01/09/2023] Open
Abstract
Background Management of spinal neoplasms has relied on open surgery and external beam radiotherapy (EBRT). Although primary spinal tumors are rare, their treatment remains a pervasive problem. This analysis sought to evaluate the safety and efficacy of CT-guided 125I seed brachytherapy for recurrent paraspinous and vertebral primary tumors. Methods From November 2002 to June 2014, 17 patients who met the inclusion criteria were retrospectively reviewed. 14 (82.4%) had previously undergone surgery, 15 (88.2%) had received conventional EBRT and 3 (17.6%) had chosen chemotherapy. The number of 125I seeds implanted ranged from 7 to 122 (median 79) with specific activity of 0.5-0.8 mCi (median 0.7 mCi). The post-plan showed that the actuarial D90 of 125I seeds were 90–183 Gy (median 137 Gy). The follow-up period ranged from 2 to 69 months (median 19 months). The local control rate was calculated by the Kaplan-Meier method. Results For 5 Chondrosarcomas, the 1-, 2-, 3-year local control rates were 75%, 37.5%, and 37.5%, respectively, with a median of 34 months (range, 4–39 months). For 4 chordomas, the local control rate was 50% with a median follow-up of 13 months (range, 3–17 months). For 3 fibromatosis, all of them were survival without local recurrence at the end of follow-up. During the follow-up period, 35.3% (6/17) died from metastases, 17.6% (3/17) developed local recurrence by 8, 14 and 34 months while 64.7% (11/17) remained alive. 100% experienced pain relief and normal or improved ambulation, without more than Frankel grade 3 radiation myelopathy. Conclusions Percutaneous 125I seed implantation can be an alternative or retreatment for recurrent spinal primary tumors.
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Affiliation(s)
- Qianqian Cao
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Hao Wang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Na Meng
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Yuliang Jiang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Ping Jiang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Yang Gao
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Suqing Tian
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Chen Liu
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Ruijie Yang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Junjie Wang
- Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
| | - Kaixian Zhang
- Cancer Center, Tengzhou Central People's Hospital, Tengzhou city, Shangdong Province, 277500, China.
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Bydon M, De la Garza-Ramos R, Gokaslan ZL. Commentary: Spinal instrumentation for mechanical radiculopathy secondary to lumbar metastases. Spine J 2014; 14:2440-1. [PMID: 25256897 DOI: 10.1016/j.spinee.2014.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/16/2014] [Indexed: 02/03/2023]
Abstract
Moliterno J, Veselis CA, Hershey MA, et al. Improvement in pain after lumbar surgery in cancer patients with mechanical radiculopathy. Spine J 2014;14:2434-9 (in this issue).
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Affiliation(s)
- Mohamad Bydon
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-113, Baltimore, MD 21287, USA; Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-113, Baltimore, MD 21287, USA
| | - Rafael De la Garza-Ramos
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-113, Baltimore, MD 21287, USA; Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-113, Baltimore, MD 21287, USA
| | - Ziya L Gokaslan
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-113, Baltimore, MD 21287, USA; Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe St, Meyer 7-113, Baltimore, MD 21287, USA.
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Direct decompressive surgery followed by radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression: a meta-analysis. Spine (Phila Pa 1976) 2014; 39:E587-92. [PMID: 24503688 DOI: 10.1097/brs.0000000000000258] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systemic review and meta-analysis. OBJECTIVE To compare the ambulatory status and survival for metastatic epidural spinal cord compression (MESCC) in patients treated with direct decompressive surgical resection (DDSR) followed by radiotherapy (RTx) with those in patients treated with RTx alone. SUMMARY OF BACKGROUND DATA Surgical techniques have remarkably evolved from decompressive laminectomy without ventral tumor excision to DDSR, which has displayed favorable outcomes since the 2000s. RTx alone has also evolved and is regarded to have accomplished outcome comparable with that of the surgery. The optimal treatment of MESCC has not been clearly defined yet. METHODS We searched MEDLINE, EMBASE, and the Cochrane library in July 2013. Comparative studies enrolled patients with similar performance, primary cancer, age, and sex at the baseline state were included. Outcome measures included ambulatory status and overall survival rate. We did a fixed-effects meta-analysis of the ambulatory status and survival in patients with MESCC compared with DDSR+RTx and RTx alone. RESULTS Five studies were used to obtain data from 238 and 1137 patients treated with DDSR+RTx and RTx alone, respectively. The DDSR+RTx group displayed substantial improvement in ambulatory status after the treatment that was superior to the improvement in the RTx-alone group (relative risk [RR], 1.43; 95% confidence interval [CI], 1.14-1.78) in a fixed-effects model and significantly lower deterioration after treatment than the RTx group (RR, 0.35; 95% CI, 0.19-0.63). The DDSR+RTx group showed significant improvement in the survival rate at 6 months post-treatment (RR, 1.21; 95% CI, 1.09-1.33). Similar findings were observed at 12 months post-treatment (RR, 1.32; 95% CI, 1.12-1.56). CONCLUSION The meta-analysis indicates that DDSR+RTx may produce better clinical improvement of ambulation status and survival than RTx alone in the treatment of MESCC. Additional prospective studies are warranted to better address this question. LEVEL OF EVIDENCE 1.
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Bhatt AD, Schuler JC, Boakye M, Woo SY. Current and emerging concepts in non-invasive and minimally invasive management of spine metastasis. Cancer Treat Rev 2013; 39:142-52. [DOI: 10.1016/j.ctrv.2012.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 01/31/2023]
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Liang T, Wan Y, Zou X, Peng X, Liu S. Is surgery for spine metastasis reasonable in patients older than 60 years? Clin Orthop Relat Res 2013; 471. [PMID: 23179121 PMCID: PMC3549148 DOI: 10.1007/s11999-012-2699-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Spinal metastases are common in patients older than 60 years with cancer. Because of the uncertainty of survival and the high incidence of fatal complications, however, chemotherapy and radiotherapy generally have been considered preferable and surgery a treatment of last resort for these patients. Further, the selection criteria indicating surgery and reliable prognostic factors for survival remain controversial. QUESTIONS/PURPOSES We therefore assessed surgical complications, postoperative function, and risk factors affecting their overall survival. METHODS We retrospectively reviewed 92 patients 60 years or older (range, 60-81 years) who had surgery for spinal metastases. The surgical complications were recorded and a VAS pain score, Frankel grade, and Karnofsky score were obtained. Statistical analyses were performed to identify factors associated with survival. The minimum followup was 6 months (mean, 22 months; range, 6-78 months). RESULTS Surgical complications occurred in 21 patients. Pain levels decreased postoperatively in 90% of patients and neurologic function improved in 78%. The Karnofsky status improved in 58 patients giving an improvement rate of 63%. The overall survival rates at 1 year and 3 years were 61% and 35% with a median of 15 months. Primary tumor type and Tokuhashi score independently predicted survival in patients with spinal metastases. CONCLUSION Our findings suggest surgery for spinal metastasis can achieve pain relief, neurologic improvement, and restoration of general condition but with a high risk of complications. Primary tumor type and Tokuhashi scoring independently predicted survival in patients with spinal metastases after surgery. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tangzhao Liang
- Department of Orthopaedic Surgery/Orthopaedic Research Institute, The First Hospital Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2nd Road, 510080 Guangzhou, China
| | - Yong Wan
- Department of Orthopaedic Surgery/Orthopaedic Research Institute, The First Hospital Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2nd Road, 510080 Guangzhou, China
| | - Xuenong Zou
- Department of Orthopaedic Surgery/Orthopaedic Research Institute, The First Hospital Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2nd Road, 510080 Guangzhou, China
| | - Xinsheng Peng
- Department of Orthopaedic Surgery/Orthopaedic Research Institute, The First Hospital Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2nd Road, 510080 Guangzhou, China
| | - Shaoyu Liu
- Department of Orthopaedic Surgery/Orthopaedic Research Institute, The First Hospital Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2nd Road, 510080 Guangzhou, China
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Rosales Olivarez LM, Nieto Sandoval HR, Alpízar Aguirre A, Zárate Kalfopulos B, Sánchez Bringas MG, Reyes Sánchez AA. Evaluacion de la biopsia transpedicular guiada por TAC. COLUNA/COLUMNA 2012. [DOI: 10.1590/s1808-18512012000300004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Valorar la utilidad de la biopsia transpedicular percutánea guiada por Tomografía Axial Computarizada en conjunto con la sistematización de estudios como pruebas diagnósticas de la etiología de la destrucción vertebral. MÉTODOS: Estudio de serie de casos prospectivo transversal de 21 pacientes a los que se les realizó biopsia transpedicular percutánea guiada por Tomografía Axial Computarizada y estudios de laboratorio y gabinete de marzo a julio del 2011, para evaluar su utilidad en el diagnóstico de destrucción vertebral. RESULTADOS: Fueron 21 pacientes, 14 hombres y 7 mujeres, con edad media de 59,2 años, cuyos niveles más afectados estuvieron en L1, L2 y L3. El reporte de la biopsia tuvo una precisión diagnóstica del 90,4%. En 2 casos se realizó correlación clínica entre biopsia y sistematización de estudios para obtener el diagnóstico. CONCLUSIÓN: La biopsia guiada por Tomografía Axial Computarizada es una técnica sencilla, útil, de bajo costo y eficaz en el estudio de la destrucción vertebral; la sistematización de estudios permite corroborar el diagnóstico de la biopsia.
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Management der Wirbelsäulenmetastasen, Strategien und operative Indikationen. DER ORTHOPADE 2012; 41:632-9. [DOI: 10.1007/s00132-012-1910-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aguirre AA, Olivares LMR, Bringas GS, Kalfopulos BZ, García JGE, Sánchez AR. Evaluación de una nueva sistematización de estudios para el diagnóstico del síndrome de destrucción vertebral. COLUNA/COLUMNA 2012. [DOI: 10.1590/s1808-18512012000200013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Explorar la efectividad de un conjunto de pruebas de diagnósticos, sistematizadas en hoja de protocolo, para la determinación del Síndrome de Destrucción Vertebral en pacientes de nuestro servicio. MÉTODOS: Analizamos una propuesta de sistematización mediante un estudio piloto de 20 pacientes a quienes se realizaron 10 diferentes pruebas de laboratorio y gabinete, además del estudio histopatológico de biopsia percutánea. Se describieron las características demográficas y clínicas, con los resultados obtenidos mediante estadística descriptiva, media y desviación estándar para las variables cuantitativas y porcentajes para las cualitativas. RESULTADOS: Edad promedio de 53,3 años ± 16,56 años; 10 hombres y 10 mujeres. 30 vértebras afectadas en los 20 pacientes, 8 de ellos tuvieron afección de dos o más vértebras. El nivel más afectado fue el Lumbar en 18 casos, seguido por el Torácico en 12. El Mal de Pott se diagnosticó en 7 casos (35%), Osteomielitis en 4 (20%), Mieloma Múltiple en 2 (10%), y Espondilodiscitis, Metástasis de Adenocarcinoma, Linfoma y Osteoporosis en un caso respectivamente (5%). En 3 casos (15%) no se obtuvo un diagnóstico específico. CONCLUSIONES: Esta propuesta de sistematización fue útil para llegar al diagnóstico etiológico definitivo del SDV en 85% de los casos, con la reducción en la cantidad de estudios realizados. Es necesario mayor número de pacientes para aumentar la evidencia de su utilidad.
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Abu-Hegazy M, Wahba HA. Single-versus multi-fraction radiation treatment for metastatic spinal cord compression: functional outcome study. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10330-011-0832-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pilge H, Holzapfel B, Prodinger P, Hadjamu M, Gollwitzer H, Rechl H. Diagnostik und Therapie von Wirbelsäulenmetastasen. DER ORTHOPADE 2011; 40:185-93; quiz 194-5. [DOI: 10.1007/s00132-010-1738-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Primary bone lymphoma: polyostotic disease presenting as a cauda equina syndrome. J Clin Rheumatol 2010; 16:392-4. [PMID: 21085013 DOI: 10.1097/rhu.0b013e3182005370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a patient with B-cell primary bone lymphoma with involvement of multiple vertebrae at presentation and rapid development of cauda equina syndrome. The patient presented subacute low-back pain, initially with good response to corticosteroid treatment.Primary bone lymphoma is a very unusual disease, commonly affecting only 1 vertebra. Despite this, our case involved multiple levels at the onset; furthermore, there were no adenopathies. Because of the information of the magnetic resonance imaging, an open biopsy of the vertebrae was performed for diagnosis. The reported cases of radicular syndromes secondary to a lymphoma as an initial symptom are extremely infrequently reported in the literature, above all for a B-cell lymphoma.
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Aggressive "benign" primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor. Spine (Phila Pa 1976) 2009; 34:S39-47. [PMID: 19829276 DOI: 10.1097/brs.0b013e3181ba0024] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Pecherstorfer M. Treatment Options for Breast Cancer and Bone Metastases. WOMENS HEALTH 2009; 5:149-63. [DOI: 10.2217/17455057.5.2.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The most common destination for breast cancer metastases is bone. If bone metastases are detected, treatment algorithms should include the continuation of cytoreductive therapy with the addition of treatment to counter skeletal-related events, including bone pain. The range of current treatment options includes bisphosphonates, surgical intervention to improve structural integrity and palliative focal radiotherapy. This article focuses on the role of bisphosphonate therapy in metastatic breast cancer. Bisphosphonate therapy significantly reduces the impact of skeletal-related events, reduces bone pain and increases patient quality of life. Our current understanding is that bisphosphonates may also disrupt the metastatic process and reduce the development of bone lesions. Ultimately, this may lead to further expansion of bisphosphonate-based therapy in the future.
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Affiliation(s)
- Martin Pecherstorfer
- Martin Pecherstorfer, Hematologic–Oncologic Service, Landesklinikum Krems, A-3500 Krems, Austria, Tel.: +43 2732 804 4425, Fax: +43 2732 804 6708,
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Jang KU, Lee JS, Jang HS. Incidental diagnosis of multiple myeloma during the treatment of low back pain - A case report -. Korean J Anesthesiol 2009; 56:120-123. [DOI: 10.4097/kjae.2009.56.1.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kwang Uk Jang
- Department of Anesthesiology and Pain Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Jung Sam Lee
- Department of Anesthesiology and Pain Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Hyun Soo Jang
- Department of Anesthesiology and Pain Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
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Abstract
More than one-third of patients with cancer have vertebral metastases found at autopsy. Primary and metastatic tumors to the spinal column can lead to pain, instability, and neurologic deficit. Symptomatic lesions are most prevalent in the thoracic spine (70%), followed by the lumbar spine (20%) and cervical spine (10%). Lesions in larger vertebral bodies tend to be asymptomatic given the increased ratio between the diameter of the spinal canal and the traversing nerve roots.
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Affiliation(s)
- Todd Alamin
- Stanford University Department of Orthopaedic Surgery, Spinal Surgery Section, Stanford University School of Medicine, 300 Pasteur Drive, Stanford University Hospitals and Clinics, Room R171, Stanford, CA 94305, USA.
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Abstract
As survival time increases for many cancers, it is likely that the incidence and prevalence of spinal metastases will increase also. Given that most patients first present with solitary lesions in the spine, proper initial diagnosis and management are of paramount importance in minimizing pain, improving neurologic function, and potentially lengthening survival. Although pain control and standard radiation are still used, spinal stereotactic radiosurgery, vertebroplasty and kyphoplasty, and spinal cord decompression and fusion are now consistently used in aggressive management and offer exciting preliminary results.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
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Pandiyan MS, Kavunkal AM, Cherian VK. An unusual cause for mediastinal mass. Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-007-0054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gottfried ON, Dailey AT, Schmidt MH. Adjunct and Minimally Invasive Techniques for the Diagnosis and Treatment of Vertebral Tumors. Neurosurg Clin N Am 2008; 19:125-38. [DOI: 10.1016/j.nec.2007.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chi JH, Acosta FL, Aryan HE, Chou D, Ames CP. Partial spondylectomy: modification for lateralized malignant spinal column tumors of the cervical or lumbosacral spine. J Clin Neurosci 2007; 15:43-8. [PMID: 18037295 DOI: 10.1016/j.jocn.2006.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 12/05/2006] [Accepted: 12/06/2006] [Indexed: 10/22/2022]
Abstract
Total en bloc spondylectomy is a useful technique in treating primary and secondary spinal malignancies, but requires extensive instrumentation to achieve difficult fusions, and requires extensive exposure of neurovascular structures that poses additional risk of nerve root and vascular injury. More limited resections may reduce these risks, especially in the cervical or lumbosacral spine. We report a technique used in two patients with lateralized primary vertebral tumors of the cervical or lumbosacral spine where tumor removal was achieved through a partial spondylectomy. The advantages of a partial spondylectomy included: (i) avoidance of injuring contralateral neurovascular structures during exposure; and (ii) supplementation of instrumentation by additional fixation at the level of spondylectomy. Partial spondylectomy can be an alternative to total en bloc spondylectomy in properly selected patients with lateralized encapsulated malignant spinal tumors and may be performed in the cervical or lumbosacral spinal regions.
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Affiliation(s)
- John H Chi
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue M779, Box 0112, San Francisco, CA 94143, USA
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Street J, Fisher C, Sparkes J, Boyd M, Kwon B, Paquette S, Dvorak M. Single-stage Posterolateral Vertebrectomy for the Management of Metastatic Disease of the Thoracic and Lumbar Spine. ACTA ACUST UNITED AC 2007; 20:509-20. [PMID: 17912128 DOI: 10.1097/bsd.0b013e3180335bf7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Appropriate surgical management of spinal metastases combines maximal neural decompression with simultaneous immediate spinal column stabilization in the context of a paliative operation undertaken to improve patients' quality of life. We have used a single-stage posterolateral vertebrectomy (SPLV) for disease of the lumbar spine, combined with bilateral costotransversectomies in the thoracic spine, for these challenging cases. In this prospective cohort study of 96 consecutive patients with metastatic disease of the spinal column for we describe our surgical technique in detail, we examine our learning curve in its use and we analyze the long-term surgical and "quality of life" results in 42 patients who underwent SPLV. The mean and maximum operative blood loss was significantly lower for the SPLV group when compared with combined approaches. All patients either remained neurologically stable or had improved with surgery. Both the mean and the range visual analog scale scores were significantly improved after the SPLV. The SPLV was the only surgical approach to demonstrate a statistically significant improvement in Eastern Cooperative Oncology Group scores at 3 months after the surgery. Seventy-five percent of patients were alive at 6 months and 50% of patients survived for more than 12 months after the surgery. Eleven patients had a major complication (26%) with 9 (21%) patients required early reoperation, 7 of them for wound failure. Our data demonstrates that the SPLV represents a technically achievable improvement in surgical approach to spinal metastases when key parameters are examined. On the basis of these results, we recommend that the SPLV should be considered in all cases where resection of thoracic or lumbar spinal metastatic disease and reconstruction is contemplated.
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Affiliation(s)
- John Street
- Vancouver Hospital and Health Services Center, Spine Program, Vancouver, BC, Canada.
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Abstract
Surgery on the cervical spine runs the gamut from minor interventions done in a minimally invasive fashion on a short-stay or ambulatory basis, to major surgical undertakings of a high-risk, high-threat nature done to stabilize a degraded skeletal structure to preserve and protect neural elements. Planning for optimum airway management and anesthesia care is facilitated by an appreciation of the disease processes that affect the cervical spine and their biomechanical implications and an understanding of the imaging and operative techniques used to evaluate and treat these conditions. This article provides background information and evidence to allow the anesthesia practitioner to develop a conceptual framework within which to develop strategies for care when a patient is presented for surgery on the cervical spine.
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Affiliation(s)
- Edward T Crosby
- Department of Anesthesiology, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, Ontario K1H 8L6, Canada.
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Schaser KD, Melcher I, Mittlmeier T, Schulz A, Seemann JH, Haas NP, Disch AC. Chirurgisches Management von Wirbelsäulenmetastasen. Unfallchirurg 2007; 110:137-59; quiz 160-1. [PMID: 17287967 DOI: 10.1007/s00113-007-1232-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The spine is the most frequent site of skeletal metastases. Among all spinal malignancies metastatic disease is most frequent and indicative of disseminating tumor disease. Depending on primary tumor entity, estimated survival time, general health status of the patient, presence of spinal instability and neurological deficits an oncological useful and patient-specific therapeutic intervention should be performed. New anterior approaches, resections and reconstruction techniques are making surgery a preferred method over radiation therapy. For differential indication of the multiple surgical treatment modalities prognostic scores are available to assist individual decision making. Indications for surgery include survival prognosis of minimum 3 months, intractable pain, progress of myelon compression and/or neurological deficits under radiochemotherapy, spinal instability and necessity for histological diagnosis. Resulting quality of life depends on efficient decompression of the spinal cord and restoration of spinal stability. To achieve these ultimate goals there are different anterior and posterior approaches, instrumentations and vertebral body replacement implants available. Preoperative embolization should be performed in hypervascular tumors, e.g., renal cell cancer. Vertebro-/Kyphoplasty as a percutaneous intervention should be considered for painful multisegmental disease and symptomatic osteolysis without epidural tumor compression to reach analgesia and stability. A multidisciplinary approach in patient selection, decision making and management is an essential precondition for complication avoidance and acceptable quality of life.
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Affiliation(s)
- K-D Schaser
- Centrum für Muskuloskeletale Chirurgie, Sektion Muskuloskeletale Tumorchirurgie, Charité-Universitätsmedizin Berlin, Klinik für Unfall- & Wiederherstellungschirurgie, Klinik für Orthopädie, 13353 Berlin.
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Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME. Part II: Spinal-cord neoplasms—primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol 2007; 8:137-47. [PMID: 17267328 DOI: 10.1016/s1470-2045(07)70033-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Primary tumours of the bony spine and adjacent soft tissues most frequently present with pain although neurological deficits and spinal deformity can be present too. Knowledge of the spectrum of lesions that can affect the bony spine and the surrounding soft tissues is crucial in directing appropriate investigation and treatment. Patients need individualised approaches and treatment plans in view of the variations in tumour aggressiveness, spinal level, location within the vertebral body or posterior elements, involvement of soft tissues and structures surrounding the vertebral column, neurological deficits, and spinal instability.
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Affiliation(s)
- Charles A Sansur
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA 22908, USA
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O'Toole JE, Eichholz KM, Fessler RG. Minimally Invasive Approaches to Vertebral Column and Spinal Cord Tumors. Neurosurg Clin N Am 2006; 17:491-506. [PMID: 17010899 DOI: 10.1016/j.nec.2006.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Minimally invasive approaches to spinal tumors have evolved rapidly over the past 15 to 20 years as clinicians seek to avoid the morbidity and long-term dysfunction associated with traditional open surgical procedures. We review the noninvasive, percutaneous, and minimally invasive surgical techniques currently available for the treatment of spinal column and intradural spinal tumors, including minimal access thoracic corpectomy and minimal access intradural tumor surgery. The various advantages and limitations of these approaches as well as their appropriate indications and uses are also presented here. A measured understanding of surgical objectives and iatrogenic effects on patients' quality of life allows the surgeon to implement such minimally invasive approaches in the design of individualized treatment plans that range from pure palliation to definitive cure.
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Affiliation(s)
- John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison Street, Suite 970, Chicago, IL 60612, USA.
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