MRI examination of resected malignant bone tumor can be an option for assessment of the osseous surgical margin

A Novel Surgical Technique for the Management of Large-Volume Neurogenic Heterotopic Ossification Following a Spinal Cord Injury: The Sashimi Technique

This case series investigates the efficacy of the "sashimi technique," a novel surgical approach utilizing a curved chisel for the resection of heterotopic ossification (HO). The main focus is on reducing resection margins and preventing excessive bone removal while maintaining optimal functional outcomes and preventing recurrence. Two cases illustrate successful outcomes in patients with spinal cord injuries and severe HO of the hip, emphasizing the precision of using the curved chisel-based technique in improving patient mobility while still achieving a desired resection margin. The study highlights the effectiveness of using a curved chisel in protecting neurovascular structures and maintaining resection precision. Additionally, the integration of postoperative radiotherapy and pharmacological treatment is emphasized as a strategy to prevent recurrence. The goal of this procedure is to improve functional outcomes and patient quality of life.

Surgical margin assessment of bone tumours: A systematic review of current and emerging technologies

Osteosarcoma is the most common malignant tumour of the bone. Complete surgical excision is critical to achieve optimal outcomes and lower recurrence rates. However, accurate assessment of tumour margins remains a challenge and multiple technologies are employed for this purpose. The aim of this study is to highlight current and emerging technologies and their efficacy in detecting clear bone margins intraoperatively, through a systematic review of the literature. The following databases were searched using the OVID platform: Medline, Embase, Global Health and Google Scholar. Studies were screened using predetermined eligibility criteria. Data was extracted based on study and patient characteristics, modes of detection, and commercial availability, followed by quality assessment. A total of 17 studies were included. The primary diagnosis varied, with osteosarcoma being reported by 9 studies. Three studies reported relapse, ranging between 17.6%-48%. Twelve studies reported non-invasive imaging as the mode of detection used, while 4 studies reported the use of frozen section. MRI and CT were found to have an accuracy of up to 93 %. Raman spectroscopy was reported to have an accuracy, sensitivity, and specificity of 69%, 58.8% and 83.3% respectively. CT had a sensitivity and specificity up to 83% and 100%, respectively. In conclusion, there seems to be high potential for the use of multimodal technologies to increase the accuracy of intraoperative margin assessment. Although imaging modalities possess a fair level of accuracy, they carry the risk of radiation exposure, are expensive, and cannot be used in-situ. Future clinical trials are needed to test the effectiveness of these technologies to measure the diagnostic accuracy and overall patient survival.

Analysis of mechanical complications for patients with extremity sarcoma after biological reconstruction

BACKGROUND

Biological reconstruction after tumor resection is significant for restoration of limb integrality. However, it is unclear what risk factors influence mechanical complications of patients after extremity sarcoma resection and biological reconstruction. The objective of study was (1) to compare complications between patients receiving inactivated autograft and allograft, (2) to analyze influence of graft type, nonunion and fixation method on mechanical complications for patients after biological reconstruction.

HYPOTHESIS

We hypothesized allograft, nonunion and fixation method influence occurrence of mechanical complications after biological reconstruction.

MATERIALS AND METHODS

We retrospectively reviewed 71 patients with sarcomas at the extremity receiving biological reconstruction from January 1999 to November 2015. Eight patients were lost at last follow-up. Sixty-three patients with complete clinical data were recruited into the present study. There were 32 males and 31 females with a mean age of 20.5±14.9 years (median, 17 years; range, 2-72 years). Sixty-one cases had tumors at lower extremity and two at upper extremity. Histological diagnosis was confirmed as forty-five with osteosarcoma, thirteen with Ewing sarcoma and five with chondrosarcoma.

RESULTS

Forty-four patients were free of disease, sixteen died of disease and three lived with pulmonary metastasis at last follow-up. Twenty-one out of 63 patients (33.3%) had local recurrence requiring surgical treatment. Reconstruction choice (mechanical complications rates were 38.9% for allograft (14/36) versus 14.8% for inactivated autograft (4/27)) and nonunion occurrence (yes 58.8% (10/17); no 17.4% (8/46)) had the close relationship with mechanical complication in the univariate analysis. The multivariate analysis revealed fixation method (p=0.041) and nonunion (p=0.008) were prognostic factors for mechanical complication of sarcoma resection and biological reconstruction at the extremity. Fourteen of 36 patients receiving massive allograft had a second surgery due to mechanical complication compared to 4 of 27 patients with massive inactivated autograft (38.9%, 14/36 vs. 14.8%, 4/27 (p=0.05)). Time to union for diaphysis and metaphysis was not significantly different between allograft and inactivated autograft groups.

DISCUSSION

Patients receiving massive allograft are prone to suffer from the mechanical complications. Extramedullary plate and nonunion have the tendency of increasing occurrence of mechanical complications of biological reconstruction.

LEVEL OF EVIDENCE

IV; retrospective study.