1
|
Diabira S, Akhaddar A, Lebhar J, Breitel D, Bacon P, Blamoutier A. Metastasi spinali degli adulti. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
2
|
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
|
3
|
Ishida Y, Shigematsu H, Tsukamoto S, Morimoto Y, Iwata E, Okuda A, Kawasaki S, Tanaka M, Fujii H, Tanaka Y, Kido A. Impairment-driven cancer rehabilitation in patients with neoplastic spinal cord compression using minimally invasive spine stabilization. World J Surg Oncol 2020; 18:187. [PMID: 32711537 PMCID: PMC7382795 DOI: 10.1186/s12957-020-01964-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neoplastic spinal cord compression is a cause of severe disability in cancer patients. To prevent irreversible paraplegia, a structured strategy is required to address the various impairments present in cancer patients. In this study, we aimed to identify the status where rehabilitation with minimally invasive spine stabilization (MISt) effectively improves ADL. METHODS We retrospectively reviewed 27 consecutive patients with neoplastic spinal compression who were treated with MISt. We classified the impairments of patients through our multidisciplinary tumor board based on spine-specific factors, skeletal instability, and tumor growth. The neurological deficits, progress of pathological fracture, incidence of vertebral collapse, and postoperative implant failure were examined. Changes of the Barthel index (BI) scores before and after surgery were investigated throughout the clinical courses. RESULTS The average duration to ambulation was 7.19 ± 11 days, and we observed no collapse or progression of paralysis except in four cases of complete motor paraplegia before the surgery. Neurological deficiency was improved to or maintained at Frankel's grade E in 16 patients, remained unchanged in 6 patients (in grades B, C, D), and worsened in 5 patients. BI score comparisons before and after surgery in all patients showed statistically significant increments (p < 0.05). On further analysis, we noted good functional prognosis in patients capable of ambulation within 7 days (p < 0.05) and in patients who could survive longer than 3 months after the surgery (p < 0.05). CONCLUSIONS In various cancer patients with neoplastic spinal cord compression, skeletal instability as the primary impairment is a good indication for MISt, as the patients showed early ambulation with improved BI scores.
Collapse
Affiliation(s)
- Yukako Ishida
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Shinji Tsukamoto
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhiko Morimoto
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Eiichiro Iwata
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Akinori Okuda
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Hiromasa Fujii
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| |
Collapse
|
4
|
Barzilai O, Boriani S, Fisher CG, Sahgal A, Verlaan JJ, Gokaslan ZL, Lazary A, Bettegowda C, Rhines LD, Laufer I. Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice. Global Spine J 2019; 9:98S-107S. [PMID: 31157152 PMCID: PMC6512191 DOI: 10.1177/2192568219830323] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVE To provide an overview of the recent advances in spinal oncology, emphasizing the key role of the surgeon in the treatment of patients with spinal metastatic tumors. METHODS Literature review. RESULTS Therapeutic advances led to longer survival times among cancer patients, placing significant emphasis on durable local control, optimization of quality of life, and daily function for patients with spinal metastatic tumors. Recent integration of modern diagnostic tools, precision oncologic treatment, and widespread use of new technologies has transformed the treatment of spinal metastases. Currently, multidisciplinary spinal oncology teams include spinal surgeons, radiation and medical oncologists, pain and rehabilitation specialists, and interventional radiologists. Consistent use of common language facilitates communication, definition of treatment indications and outcomes, alongside comparative clinical research. The main parameters used to characterize patients with spinal metastases include functional status and health-related quality of life, the spinal instability neoplastic score, the epidural spinal cord compression scale, tumor histology, and genomic profile. CONCLUSIONS Stereotactic body radiotherapy revolutionized spinal oncology through delivery of durable local tumor control regardless of tumor histology. Currently, the major surgical indications include mechanical instability and high-grade spinal cord compression, when applicable, with surgery providing notable improvement in the quality of life and functional status for appropriately selected patients. Surgical trends include less invasive surgery with emphasis on durable local control and spinal stabilization.
Collapse
Affiliation(s)
- Ori Barzilai
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Charles G. Fisher
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Arjun Sahgal
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Aron Lazary
- National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | | | | | - Ilya Laufer
- Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
5
|
Sayari AJ, Pardo C, Basques BA, Colman MW. Review of robotic-assisted surgery: what the future looks like through a spine oncology lens. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:224. [PMID: 31297389 DOI: 10.21037/atm.2019.04.69] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advancements in medical technology have led to the emergence of robotic-assisted surgery with the hope of creating a safer and more efficient surgical environment for the patient and surgical team. Spine surgery and spine tumor surgery involve challenging anatomy and demand highly precise surgical maneuvers, creating an important niche for robotic systems. While still in its infancy, robotics in spine surgery have proven successful in pedicle screw placement. Similarly, robotics has begun to be used for accurate resections and surgical planning in tumor surgery. As future studies are published and robotics systems continue to evolve, we can expect more tactile haptic feedback and implementation of useful instruments to improve preoperative planning, resection guidance, and reconstruction during spine tumor surgery.
Collapse
Affiliation(s)
- Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Coralie Pardo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
6
|
Li X, Huang Z, Deng Y, Fan H, Sui W, Wang C, Yang J. Three-dimensional translations following posterior three-column spinal osteotomies for the correction of severe and stiff kyphoscoliosis. Spine J 2017; 17:1803-1811. [PMID: 28602981 DOI: 10.1016/j.spinee.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/07/2017] [Accepted: 06/05/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature. PURPOSE This study aimed to evaluate the three-dimensional (3D) translations at the three-column osteotomy site and their effects on neurologic outcome in the surgical correction of severe and stiff kyphoscoliosis. STUDY DESIGN/SETTING A retrospective study was carried out. PATIENT SAMPLE Sixty-nine patients treated by posterior three-column spinal osteotomy for severe kyphoscoliosis of idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis origin were included. OUTCOME MEASURES General, coronal, and sagittal translations were graded three-dimensionally according to the theory of Meyerding. METHODS The charts of 69 clinical patients with severe and stiff kyphoscoliosis treated by posterior three-column osteotomy from January 2013 to June 2015 were reviewed. There were 35 male patients with an average age of 21.5 years and 34 female patients with an average age of 22.5 years. The etiologies of these spinal deformities were idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis. According to our classification system of spinal cord neurologic function, there were 41 type A, 13 type B, and 15 type C cases. The 3D spine models were reconstructed from thin-sliced computed tomography (CT) scan, and the 3D translations at the three-column osteotomy site were graded and analyzed. RESULTS The incidences of general translation (GT), frontal translation (FT), and sagittal translation (ST) were 62.3%, 52.2%, and 26.1%. The incidence of evoked potential (EP) change in cases with GT/FT being or more than grade II (GT, 42.9%; FT, 50.0%) was significantly higher than that with GT/FT being less than grade II (GT, 16.7%; FT, 18.2%), whereas the incidence of EP change in cases with ST being or more than grade I (33.3%) was significantly higher than that with ST being less than grade I (9.8%). No linear correlations were found between spine shortening distance, deformity correction rate, and the degree of translation. CONCLUSIONS The 3D translations are common in posterior three-column spinal osteotomies regardless of anterior strut graft placement. The increase of translation will increase neurologic risks, with GT or FT less than grade II and ST less than grade I being relatively safe.
Collapse
Affiliation(s)
- Xueshi Li
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China
| | - Zifang Huang
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China
| | - Yaolong Deng
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China
| | - Hengwei Fan
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China
| | - Wenyuan Sui
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China
| | - Chongwen Wang
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China
| | - Junlin Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China.
| |
Collapse
|
7
|
Janssen SJ, Teunis T, van Dijk E, Ferrone ML, Shin JH, Hornicek F, Schwab JH. Validation of the Spine Oncology Study Group-Outcomes Questionnaire to assess quality of life in patients with metastatic spine disease. Spine J 2017; 17:768-776. [PMID: 26254565 DOI: 10.1016/j.spinee.2015.07.456] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/22/2015] [Accepted: 07/23/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT General questionnaires are often used to assess quality of life in patients with spine metastases, although a disease-specific survey did not exist until recently. The Spine Oncology Study Group has developed an outcomes questionnaire (SOSG-OQ) to measure quality of life in these patients. However, a scoring system was not developed, and the questionnaire was not validated in a group of patients, nor was it compared with other general quality of life questionnaires such as the EuroQol 5 Dimensions (EQ-5D) questionnaire. PURPOSE Our primary null hypothesis is that there is no association between the SOSG-OQ and EQ-5D. Our secondary null hypothesis is that there is no difference in coverage and internal consistency between the SOSG-OQ and EQ-5D. We also assess coverage, consistency, and validity of the domains within the SOSG-OQ. STUDY DESIGN/SETTING A survey study from a tertiary care spine referral center was used for this study. PATIENT SAMPLE The patient sample consisted of 82 patients with spine metastases, myeloma, or lymphoma. OUTCOME MEASURES The SOSG-OQ (27 questions, 6 domains) score ranges from 0 to 80, with a higher score indicating worse quality of life. The EQ-5D (5 questions, 5 domains) index score ranges from 0 to 1, with a higher score indicating better quality of life. METHODS The association between the SOSG-OQ and EQ-5D index score was assessed using the Spearman rank correlation. Instrument coverage and precision were assessed by determining item completion rate, median score with range, and floor and ceiling effect. Internal consistency was assessed using Cronbach alpha. Multitrait analysis and exploratory factor analysis were used to analyze properties of the individual domains in the SOSG-OQ. RESULTS The Spearman rank correlation between the SOSG-OQ and EQ-5D questionnaire was high (r=-0.83, p<.001). Internal consistency of the SOSG-OQ (0.92, 95% CI: 0.89-0.94) was higher as compared to the internal consistency of the EQ-5D (0.73, 95% CI: 0.63-0.84; p<.001). The SOSG-OQ score had no floor or ceiling effect indicating good coverage (median 30, range 3-64), whereas the EQ-5D had a ceiling effect of 10% (median 0.71, range 0.05-1). CONCLUSIONS In conclusion, our study proposes a scoring methodology-after reversing four inversely scored items-for the SOSG-OQ and shows that the questionnaire is a valid tool for the assessment of quality of life in patients with metastatic spine disease. The SOSG-OQ is superior to the EQ-5D in terms of coverage and internal consistency but consists of more questions.
Collapse
Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Teun Teunis
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Eva van Dijk
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Spine Service, Brigham and Women's Hospital-Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Francis Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| |
Collapse
|
8
|
Maugeri R, Graziano F, Basile L, Gulì C, Giugno A, Giammalva GR, Visocchi M, Iacopino DG. Reconstruction of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients. ACTA NEUROCHIRURGICA SUPPLEMENT 2017; 124:81-86. [DOI: 10.1007/978-3-319-39546-3_13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
|
9
|
When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease. Spine (Phila Pa 1976) 2016; 41 Suppl 20:S246-S253. [PMID: 27753784 PMCID: PMC5551976 DOI: 10.1097/brs.0000000000001824] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic spine disease. SUMMARY OF BACKGROUND DATA The utilization of MIS techniques in patients with spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. METHODS PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic spine disease. PRISMA guidelines were followed. RESULTS Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. CONCLUSIONS Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic spine disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery. LEVEL OF EVIDENCE N/A.
Collapse
|
10
|
Yang JL, Huang ZF, Yin JQ, Deng YL, Xie XB, Li FB, Yang JF. A proposed classification system for guiding surgical strategy in cases of severe spinal deformity based on spinal cord function. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1821-9. [PMID: 26769035 DOI: 10.1007/s00586-015-4367-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 12/26/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Spinal cord function classification systems are not useful for guiding surgery in patients with severe spinal deformities. The aim of this study is to propose a classification system for determining a surgical strategy that minimizes the risk of neurological dysfunction in patients with severe spinal deformities. METHODS The records of 89 patients with severe spinal deformities treated with vertebral column reconstruction from 2008 to 2013 were retrospectively analyzed. Based on neurophysiological monitoring, magnetic resonance imaging, and neurological symptoms patients were categorized into three groups: group A, normal spinal cord, normal evoked potentials and no neurological symptoms; group B, spinal cord abnormalities and/or abnormal evoked potentials but no neurological symptoms; group C, neurological symptoms with or without spinal cord abnormalities/abnormal evoked potentials. Outcomes and complications were compared between the groups. RESULTS A total of 89 patients (51 male, 38 female) were included with 47 (52.8 %), 16 (18.0 %), and 26 (29.2 %) patients in groups A, B and C, respectively, and a mean follow-up 34.5 months. There were no differences in age, gender, average preoperative scoliosis, and kyphosis among three groups, but there were differences with respect to the causes of severe spinal deformity and the corrective rate of scoliosis and kyphosis. Changes in intraoperative evoked potentials were different in these three types according to this new classification, and the recovery rates of changes in the three groups were 71.1, 50.0, and 14.1 %, respectively. Postoperative spinal cord injury was positively related to intraoperative changes of evoked potentials. CONCLUSION The classification system may be useful for guiding surgical decisions in patients with severe spinal deformities to minimize the risk of neurological complications.
Collapse
Affiliation(s)
- Jun-Lin Yang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China.
| | - Zi-Fang Huang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jun-Qiang Yin
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Yao-Long Deng
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Xian-Biao Xie
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Fo-Bao Li
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jing-Fan Yang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China
| |
Collapse
|
11
|
Sharifudin MA, Zakaria Z, Awang MS, Mohamed Amin MA, Abd Aziz A. A Rare Case of Monostotic Spinal Fibrous Dysplasia Mimicking Solitary Metastatic Lesion of Thyroid Carcinoma. Malays J Med Sci 2016; 23:82-86. [PMID: 27540330 PMCID: PMC4975581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/10/2015] [Indexed: 06/06/2023] Open
Abstract
Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.
Collapse
Affiliation(s)
- Mohd Ariff Sharifudin
- Musculoskeletal Oncology Unit, Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Zamzuri Zakaria
- Spine Unit, Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Awang
- Neurosurgery Unit, Department of Surgery, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Mohamed Azril Mohamed Amin
- Musculoskeletal Oncology Unit, Department of Orthopaedics, Traumatology and Rehabilitation, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Azian Abd Aziz
- Department of Radiology, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| |
Collapse
|
12
|
Accuracy of Tokuhashi score system in predicting survival of lung cancer patients with vertebral metastasis. J Neurooncol 2015; 125:427-33. [DOI: 10.1007/s11060-015-1934-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
|
13
|
Park HY, Lee SH, Park SJ, Kim ES, Lee CS, Eoh W. Minimally invasive option using percutaneous pedicle screw for instability of metastasis involving thoracolumbar and lumbar spine : a case series in a single center. J Korean Neurosurg Soc 2015; 57:100-7. [PMID: 25733990 PMCID: PMC4345186 DOI: 10.3340/jkns.2015.57.2.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/21/2014] [Accepted: 08/13/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.
Collapse
Affiliation(s)
- Ho-Young Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong-Suh Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Li K, Yan J, Yang Q, Li Z, Li J. The effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in cadaveric spines with simulated metastases. J Orthop Surg Res 2015; 10:20. [PMID: 25626462 PMCID: PMC4338624 DOI: 10.1186/s13018-015-0160-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
Background For osteoporosis or spinal metastases, percutaneous vertebroplasty is effective in pain relief and improvement of mobility. However, the complication rate (cement extravasation and fat embolisms) is relatively higher in the treatment of spinal metastases. The presence of tumor tissue plays a significant role in intravertebral pressure and cement distribution and thereby affects the occurrence of complications. We investigated the effect of void creation prior to vertebroplasty on intravertebral pressure and cement distribution in spinal metastases. Methods Eighteen vertebrae (T8–L4) from five cadaveric spines were randomly allocated for two groups (group with and without void) of nine vertebrae each. Defect was created by removing a central core of cancellous bone in the vertebral body and then filling it with 30% or 100% fresh muscle paste by volume to simulate void creation or no void creation, respectively. Then, 20% bone cement by volume of the vertebral body was injected into each specimen through a unipedicular approach at a rate of 3 mL/min. The gender of the donor, vertebral body size, bone density, cement volume, and intravertebral pressure were recorded. Then, computed tomography scans and cross sections were taken to evaluate the cement distribution in vertebral bodies. Results No significant difference was found between the two groups in terms of the gender of the donor, vertebral body size, bone density, or bone cement volume. The average maximum intravertebral pressure in the group with void creation was significantly lower than that in the group without void creation (1.20 versus 5.09 kPa, P = 0.001). Especially during the filling of void, the difference was more pronounced. Void creation prior to vertebroplasty allowed the bone cement to infiltrate into the lytic defect. Conclusions In vertebroplasty for spinal metastases, void creation produced lower intravertebral pressure and facilitated cement filling. To reduce the occurrence of complication, it may be an alternative to eliminate the tumor tissue to create a void prior to cement injection.
Collapse
Affiliation(s)
- Ka Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Jun Yan
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Qiang Yang
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Zhenfeng Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Jianmin Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| |
Collapse
|
15
|
Abstract
Primary or metastatic spine tumors can present with pain and/or neurologic compromise depending on their location within the spinal axis. Metastases and multiple myeloma comprise most of these lesions. Management of spinal tumors includes surgical decompression with stabilization (neo), adjuvant chemotherapy and radiation therapy, curettage, bone grafting, bone marrow replacement, and palliative treatment with vertebral augmentation. Pre- and postoperative imaging plays a critical role in the diagnosis and management of patients with spinal tumors. This article reviews postoperative imaging of the spine, including imaging protocols, immediate and long-term routine imaging findings, and emergent findings in symptomatic patients.
Collapse
Affiliation(s)
- Esther E Coronel
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| | - Ruby J Lien
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| | - A Orlando Ortiz
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA.
| |
Collapse
|
16
|
Das A, Pandit S, Das SK, Basuthakur S, Das S. An osteolytic metastasis of humerus from an asymptomatic squamous cell carcinoma of lung: a rare clinical entity. Case Rep Pulmonol 2014; 2014:636017. [PMID: 25184068 PMCID: PMC4145377 DOI: 10.1155/2014/636017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/08/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022] Open
Abstract
Advanced lung cancer is complicated by skeletal metastases either due to direct extension from adjacent primaries or, more commonly, due to haematogenous dissemination of neoplastic cells. Lumber spine is the most common site for bony metastases in bronchogenic carcinoma. Proximal lone bones, especially humerus, are unusual sites for metastases from lung primaries. Small cell and large cell varieties of lung cancer are most commonly associated with skeletal dissemination. It is also unusual that an asymptomatic squamous cell carcinoma of lung presents with painful, soft tissue swelling with osteolytic metastasis of humerus which is reported in our case. Systemic cytotoxic chemotherapy, local palliative radiotherapy, adequate analgesia, and internal fixation of the affected long bone are different modalities of treatment in this advanced stage of disease. But the prognosis is definitely poor in this stage IV disease.
Collapse
Affiliation(s)
- Anirban Das
- Department of Pulmonary Medicine, Medical College, 88 College Street, Kolkata, West Bengal 700 073, India
| | - Sudipta Pandit
- Department of Pulmonary Medicine, Medical College, 88 College Street, Kolkata, West Bengal 700 073, India
| | - Sibes k. Das
- Department of Pulmonary Medicine, Medical College, 88 College Street, Kolkata, West Bengal 700 073, India
| | - Sumitra Basuthakur
- Department of Pulmonary Medicine, Medical College, 88 College Street, Kolkata, West Bengal 700 073, India
| | - Somnath Das
- Department of Pulmonary Medicine, Medical College, 88 College Street, Kolkata, West Bengal 700 073, India
| |
Collapse
|
17
|
Gerszten PC. Spine Metastases: From Radiotherapy, Surgery, to Radiosurgery. Neurosurgery 2014; 61 Suppl 1:16-25. [DOI: 10.1227/neu.0000000000000375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Peter C. Gerszten
- Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
18
|
Wong ML, Lau HC, Kaye AH. The management of malignant spinal cord compression: a modified technique of spinal reconstruction. Neurol Res 2014; 36:544-9. [DOI: 10.1179/1743132814y.0000000363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
19
|
Operative Management of a Sacral Gunshot Injury via Minimally Invasive Techniques and Instrumentation. Asian Spine J 2013; 7:44-9. [PMID: 23508557 PMCID: PMC3596584 DOI: 10.4184/asj.2013.7.1.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 08/04/2012] [Accepted: 08/20/2012] [Indexed: 01/19/2023] Open
Abstract
Gunshot wounds to the spine account for 13% to 17% of all gunshot injuries and occur predominantly in the thoracic region. Minimally invasive spine surgery procedures implementing serial muscle dilation and the use of a tubular retracting system with a working channel minimize soft tissue trauma, facilitate less bony and soft tissue resection, decrease blood loss, minimize scarring and improve cosmesis, decrease hospitalization, and reduce postoperative pain and narcotic usage in comparison to more open, traditional approaches. Although minimally invasive spine surgery techniques and instrumentation have gained considerable attention, their application in the management of gunshot injuries to the sacrum has not been reported. The following is a brief case report of a 21-year-old male who sustained a gunshot injury to the sacrum who was managed operatively via minimally invasive spine surgery techniques and instrumentation.
Collapse
|
20
|
Dunning EC, Butler JS, Morris S. Complications in the management of metastatic spinal disease. World J Orthop 2012; 3:114-21. [PMID: 22919567 PMCID: PMC3425630 DOI: 10.5312/wjo.v3.i8.114] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/15/2012] [Accepted: 08/07/2012] [Indexed: 02/06/2023] Open
Abstract
Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial spinal pain. No treatment has been proven to increase the life expectancy of patients with spinal metastasis. The goals of therapy are pain control and functional preservation. The most important prognostic indicator for spinal metastases is the initial functional score. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues; neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy is the most commonly used treatment modality for those patients presenting with spinal pain, causative by tumours which are not impinging on neural elements. Operative intervention has, until recently been advocated for establishing a tissue diagnosis, mechanical stabilization and for reduction of tumor burden but not for a curative approach. It is treatment of choice patients with diseaseadvancement despite radiotherapy and in those with known radiotherapy-resistant tumors. Vertebral resection and anterior stabilization with methacrylate or hardware (e.g., cages) has been advocated.Surgical decompression and stabilization, however, along with radiotherapy, may provide the most promising treatment. It stabilizes the metastatic deposited areaand allows ambulation with pain relief. In general, patients who are nonambulatory at diagnosis do poorly, as do patients in whom more than one vertebra is involved. Surgical intervention is indicated in patients with radiation-resistant tumors, spinal instability, spinal compression with bone or disk fragments, progressive neurologic deterioration, previous radiation exposure, and uncertain diagnosis that requires tissue diagnosis. The main goal in the management of spinal metastatic deposits is always palliative rather than curative, with the primary aim being pain relief and improved mobility. This however, does not come without complications, regardless of the surgical intervention technique used. These complication range from the general surgical complications of bleeding, infection, damage to surrounding structures and post operative DT/PE to spinal specific complications of persistent neurologic deficit and paralysis.
Collapse
|
21
|
Trilling GM, Cho H, Ugas MA, Saeed S, Katunda A, Jerjes W, Giannoudis P. Spinal metastasis in head and neck cancer. HEAD & NECK ONCOLOGY 2012; 4:36. [PMID: 22716187 PMCID: PMC3448515 DOI: 10.1186/1758-3284-4-36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 11/17/2022]
Abstract
Background The incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia. Notwithstanding advances in surgery and radiotherapy over the past several decades, the 5-year survival rate for head and neck cancer has stagnated and remains at 50–55%. This is due, in large part, to both regional and distant disease spread, including spinal metastasis. Spinal metastasis from head and neck cancer is rare, has a poor prognosis and can significantly impede end-stage quality of life; normally only palliative care is given. This study aims to conduct a systematic review of the evidence available on management of spinal metastasis from head and neck cancer and to use such evidence to draw up guiding principles in the management of the distant spread. Methods Systematic review of the electronic literature was conducted regarding the management of spinal metastasis of head and neck malignancies. Results Due to the exceptional rarity of head and neck cancers metastasizing to the spine, there is a paucity of good randomized controlled trials into the management of spinal metastasis. This review produced only 12 case studies/reports and 2 small retrospective cohort studies that lacked appropriate controls. Conclusion Management should aim to improve end-stage quality of life and maintain neurological function. This review has found that radiotherapy +/− medical adjuvant is considered the principle treatment of spinal metastasis of head and neck cancers. There is an absence of a definitive treatment protocol for head and neck cancer spinal metastasis. Our failure to find and cite high-quality scientific evidence only serves to stress the need for good quality research in this area.
Collapse
Affiliation(s)
- Gregory M Trilling
- Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | | | | | | | | | | | | |
Collapse
|
22
|
Crabtree KL, Anderson KK, Haynes NG, Arnold PM. Surgical treatment of multiple spine metastases from gastrinoma. EVIDENCE-BASED SPINE-CARE JOURNAL 2011; 2:45-50. [PMID: 23230405 PMCID: PMC3506145 DOI: 10.1055/s-0031-1274756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
STUDY DESIGN Case report. CLINICAL QUESTION To report successful surgical therapy for spinal cord compression in a patient with spinal metastases from a pancreatic gastrinoma. METHODS A 43-year-old man presented three times within 4 years with cervical and upper thoracic spinal cord compression because of metastatic gastrinoma. He had two previous spine metastases to the lower thoracic and lumbar spine, a T11 compressive lesion which required a T9L1 fusion, and an L4 lesion that was treated with chemotherapy and stereotactic radiation. The compression was relieved each time by surgery. RESULTS The patient underwent three surgeries in 4 years: (1) debulking and removal of the rib head on the left at T3, and debulking of the tumor at T3 with hemilaminectomy and spinal cord decompression with internal fixation from T1-T5 using posterolateral instrumented fusion and allograft; (2) anterior C7 corpectomy with placement of a cage from C7-T1 with both anterior and posterior fusion of C2C7; and (3) T1-T3 laminectomy, T1-T3 exploration of wound, revision of hardware, T1-T3 removal of spinal tumor, and T3 bilateral transpedicular circumferential decompression. The patient is alive and regained the ability to walk 8 years after initial diagnosis, despite the appearance of spinal metastases 1 year after the diagnosis of liver metastases. CONCLUSION Surgery for spinal cord compression in patients with metastatic neuroendocrine tumors can be effective in relieving radicular pain, weakness and numbness, and while not curative can greatly improve quality of life.
Collapse
Affiliation(s)
| | | | - Neal G. Haynes
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul M. Arnold
- University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
23
|
Actual and predicted survival time of patients with spinal metastases of lung cancer: evaluation of the robustness of the Tokuhashi score. Spine (Phila Pa 1976) 2011; 36:983-9. [PMID: 21217434 DOI: 10.1097/brs.0b013e3181e8f7f8] [Citation(s) in RCA: 57] [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 In a retrospective analysis we evaluated the achieved and the predicted survival times according to the Tokuhashi score for patients with spinal metastases of lung cancer (lc). OBJECTIVE Our aim was to investigate the robustness of the Tokuhashi Score for this group of patients. SUMMARY OF BACKGROUND DATA The decision on operative versus conservative treatment for cancer patients with vertebral metastases depend on their predicted lifespan. Although the score of Tokuhashi is commonly used for prognostic predictions, it's reliability for specific tumor types (e.g., lc), has not been validated. METHODS Seventy-six patients who had undergone spinal surgery for lc metastases between 1999 and 2004 were verified according to the Tokuhashi score and predicted versus achieved survival times were compared. RESULTS The median overall survival (OS) after surgery for all patients was 108 (3-1767) days (102 [5-1767] days for patients with NSCLC [n = 49; 64.5%] and 108 [3-473] days for patients with SCLC [n = 24; 31.6%]). Survival times differed depending on the time period of procedure performance (OS 81 [3-435] days for patients operated between 1999 and 2001 [n = 38], 135 [8-1767] days for patients who received surgery between 2002 and 2004 [n = 38]). Actual and predicted survival were similar in 51 of 76 cases (67.1%), while there was no correlation in 25 of 76 (32.9%) cases. Results were comparable for all histologic subgroups. CONCLUSION Although the survival time of patients with vertebral metastases from lc has increased over the last 10 years, the overall outcome is still poor. For the prediction of an individual prognosis in the group of lc patients the score of Tokuhashi seems to be a suboptimal tool. We conclude that therapeutic decisions for such patients should be made based on interdisciplinary platforms, especially in the light of improved systemic treatment options.
Collapse
|
24
|
Spinal extradural arachnoid cyst following percutaneous vertebroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20 Suppl 2:S206-10. [PMID: 20835874 DOI: 10.1007/s00586-010-1569-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 08/14/2010] [Accepted: 08/29/2010] [Indexed: 12/11/2022]
Abstract
We report a rare complication of extradural arachnoid cyst following percutaneous vertebroplasty in a spinal metastasis patient. Percutaneous vertebroplasty has been established as a safe and effective treatment for osteoporotic vertebral fractures and vertebral metastatic lesions. To our knowledge, extradural arachnoid cyst following vertebroplasty has not been reported in literature. A 48-year-old woman diagnosed with adenocarcinoma underwent percutaneous vertebroplasty at the L3 vertebral level due to painful solitary spinal metastasis. At 5 months after surgery, the patient complained of low back pain radiating to the left lower extremity. MRI showed a large cystic lesion in the spinal canal at the L2-L3 level with compression to adjacent dura sac. On T1- and T2-weighted images, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent laminectomy for excision of the extradural cyst. Intraoperatively, a small communication between the cyst and the subarachnoid space was seen at the level of the L3 pedicle. Pathological examination revealed that the cyst wall was composed of non-specific fibrous connective tissue and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the patient's symptom was relieved immediately. The iatrogenic dural injury produced by puncture of the pedicle during vertebroplasty may be the cause of formation of the extradural arachnoid cyst.
Collapse
|
25
|
Gerszten PC, Monaco EA. Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique. Neurosurg Focus 2009; 27:E9. [DOI: 10.3171/2009.9.focus09184] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and radiation therapy for the underlying malignant process. Spinal radiosurgery provides excellent long-term radiographic control for vertebral metastases. Percutaneous cement augmentation using polymethylmethacrylate (PMMA) may be contraindicated in lesions with spinal canal compromise due to the risk of displacement of tumor resulting in spinal cord or cauda equina injury. However, there is also significant morbidity associated with open corpectomy procedures in patients with metastatic cancer, especially in those who subsequently require adjuvant radiotherapy. This study evaluated a treatment paradigm for malignant vertebral compression fractures consisting of transpedicular coblation corpectomy combined with closed fracture reduction and fixation, followed by spinal radiosurgery.
Methods
Eleven patients (6 men and 5 women, mean age 58 years) with symptomatic vertebral body metastatic tumors associated with moderate spinal canal compromise were included in this study (8 thoracic levels, 3 lumbar levels). Primary histologies included 4 lung, 2 breast, 2 renal, and 1 each of thyroid, bladder, and hepatocellular carcinomas. All patients underwent percutaneous transpedicular coblation corpectomy immediately followed by balloon kyphoplasty through the same 8-gauge cannula under fluoroscopic guidance. Patients subsequently underwent radiosurgery to the affected vertebral body (mean time to treatment 14 days). Postoperatively, patients were assessed for pain reduction and neurological morbidity.
Results
There were no complications associated with any part of the procedure. Adequate cement augmentation within the vertebral body was achieved in all cases. The mean radiosurgical tumor dose was 19 Gy covering the entire vertebral body. The procedure provided long-term pain improvement and radiographic tumor control in all patients (follow-up range 7–44 months). No patient later required open surgery. No radiation-induced toxicity or new neurological deficit occurred during the follow-up period.
Conclusions
This treatment paradigm for pathological fractures of percutaneous transpedicular corpectomy combined with cement augmentation followed by radiosurgery was found to be safe and clinically effective. This technique combines minimally invasive procedures that avoid the morbidity associated with open surgery while providing spinal canal decompression and immediate fracture stabilization, and then administering a single-fraction tumoricidal radiation dose.
Collapse
|
26
|
Katonis P, Pasku D, Alpantaki K, Bano A, Tzanakakis G, Karantanas A. Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty. World J Surg Oncol 2009; 7:90. [PMID: 19917114 PMCID: PMC2779796 DOI: 10.1186/1477-7819-7-90] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 11/16/2009] [Indexed: 02/01/2023] Open
Abstract
Background In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function. The combination of fluoroscopic guided radiofrequency ablation (RFA) and kyphoplasty may fulfill these criteria. Methods We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic hepatocellular carcinoma, and a 71-year-old man with a Th12 and L1 pathological fracture from multiple myeloma. Results The choice of patients was carried out according to the classification of Tomita. Visual analog score (VAS) and Oswestry disability index (ODI) were used for the evaluation of the functional outcomes. The treatment was successful in all patients and no complications were reported. The mean follow-up was 6 months. Marked pain relief and functional restoration was observed. Conclusion In our experience the treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty is safe and effective for immediate pain relief in painful spinal lesions in neurologically intact patients.
Collapse
Affiliation(s)
- Pavlos Katonis
- Department of Orthopaedic and Traumatology, University Hospital of Heraklion, Crete, Greece.
| | | | | | | | | | | |
Collapse
|
27
|
Fürstenberg CH, Wiedenhöfer B, Gerner HJ, Putz C. The effect of early surgical treatment on recovery in patients with metastatic compression of the spinal cord. ACTA ACUST UNITED AC 2009; 91:240-4. [DOI: 10.1302/0301-620x.91b2.20894] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analysed the influence of the timing of surgery (< 48 hours, group 1, 21 patients vs > 48 hours, group 2, 14 patients) on the neurological outcome and restoration of mobility in 35 incomplete tetra- and paraplegic patients with metastatic spinal-cord compression. Pain and neurological symptoms were assessed using the American Spinal Injury Association impairment scale. More improvement was found in group 1 than in group 2 when comparing the pre-operative findings with those both immediately post-operatively (p = 0.021) and those at follow-up at four to six weeks (p = 0.010). In group 1 the number of pre-operatively mobile patients increased from 17 (81%) to 19 patients (90%) whereas the number of mobile patients in group 2 changed from nine (64%) to ten (71%). These results suggest that early surgical treatment in patients with metastatic spinal-cord compression gives a better neurological outcome even in a palliative situation.
Collapse
Affiliation(s)
- C. H. Fürstenberg
- Orthopaedic University Hospital Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - B. Wiedenhöfer
- Orthopaedic University Hospital Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - H. J. Gerner
- Orthopaedic University Hospital Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - C. Putz
- Orthopaedic University Hospital Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| |
Collapse
|
28
|
Abstract
In most patients who have spinal metastases, treatment is mainly palliative. The conventional surgical methods carry higher risks of complications and postoperative morbidity. Minimally invasive spinal interventions seem to be reasonable alternatives to treat spinal metastatic disease. These procedures can result in less soft tissue trauma, lower blood loss, shorter hospitalization time and are better tolerated by the patients. In this review, the techniques and results of minimally invasive management in spinal metastasis, including percutaneous image-guided interventions (vertebroplasty, kyphoplasty, and radiofrequency ablation) and minimally invasive surgical techniques (endoscopic and minimal access operations), are presented.
Collapse
|
29
|
Sohn MJ, Lee DJ. Radiosurgery for Spinal Lesions. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Moon-Jun Sohn
- Department of Neurosurgery, Inje University College of Medicine, Korea.
| | - Dong Joon Lee
- Department of Neurosurgery, Inje University College of Medicine, Korea.
| |
Collapse
|
30
|
Abstract
Hundreds of thousands of Americans are affected every year by skeletal complications of oncologic disease. Recent developments in medical oncology, radiation oncology and radiology, particularly with respect to the use of bisphosphonate medication and radiofrequency techniques, have served to greatly lessen the morbidity associated with metastatic skeletal disease. Similarly, there has been significant advancement in the field of orthopaedic oncology in the areas of internal fixation, endoprosthetic implant design, and minimally invasive kyphoplasty technology. Given the palliative intent of intervention in this patient population, the goal of treatment of skeletal metastases must be optimization of limb function and ultimately, quality of life.
Collapse
Affiliation(s)
- Pamela M Aubert
- UCSF Comprehensive Cancer Center, Orthopaedic Oncology Service, 1600 Divisadero Street, San Francisco, CA 94115-1939, USA
| | | |
Collapse
|
31
|
Gerszten PC. The role of minimally invasive techniques in the management of spine tumors: percutaneous bone cement augmentation, radiosurgery, and microendoscopic approaches. Orthop Clin North Am 2007; 38:441-50; abstract viii. [PMID: 17629991 DOI: 10.1016/j.ocl.2007.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In a similar manner to which patients with degenerative spinal disorders have benefited from advances in minimally invasive spine surgery techniques, patients with spine tumors may benefit from the option of less invasive techniques for tumor ablation, resection, reconstruction, and stabilization. Percutaneous bone cement augmentation, radiosurgery, and microendoscopic approaches for the treatment of spine tumors have allowed for improved clinical outcomes while limiting procedure-related morbidity in this unique patient population.
Collapse
Affiliation(s)
- Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| |
Collapse
|
32
|
Samartzis D, Shen FH, Perez-Cruet MJ, Anderson DG. Minimally invasive spine surgery: a historical perspective. Orthop Clin North Am 2007; 38:305-26; abstract v. [PMID: 17629980 DOI: 10.1016/j.ocl.2007.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Minimally invasive spine surgery has gained considerable momentum and increased acceptance among spine surgeons throughout the years. An understanding and awareness of the development of minimally invasive spine surgery and its role in the operative treatment of various spine conditions is imperative. This article provides a succinct historical perspective of the development of spine surgery from the more traditional, open procedures to the use of more "minimal access" or minimally invasive spine surgery procedures.
Collapse
Affiliation(s)
- Dino Samartzis
- Graduate Division, Harvard University, Cambridge, MA 12138-3722, USA.
| | | | | | | |
Collapse
|