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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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2
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Quraishi NA, Palliyil N, Hassanin MA, D'Aquino D, Shetaiwi A, Walker D. Malignant spinal cord compression in the paediatric population-a systematic review, meta-analysis. 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 2023; 32:4306-4313. [PMID: 37338630 DOI: 10.1007/s00586-023-07820-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Malignant spinal cord compression (MSCC) has been noted in 3-5% of children with primary tumours. MSCC can be associated with permanent neurological deficits and prompt treatment is necessary. Our aim was to perform a systematic review on MSCC in children < 18 years to help formulate national guidelines. METHODS A systematic review of the English language was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search criteria included 'MSCC in children, paediatric and metastases' for papers published between January1999 and December 2022. Isolated case reports/case series with < 10 patients were excluded. RESULTS From a total of 17 articles identified, a final 7 were analysed (Level III/IV). Neuroblastoma constituted the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%). Soft tissue sarcomas were the most frequent cause of MSCC in children > 5 years old, while for neuroblastomas, the mean age of presentation was 20 months. The median age at time of diagnosis for the entire cohort of patients was 50.9 months (14.8-139). The median follow-up duration was 50.7 months (0.5-204). Motor deficits were the presenting symptom in 95.6% of children followed by pain in 65.4% and sphincter disturbance in 24%. There was a delay of about 26.05 days (7-600) between the onset of symptoms and diagnosis. A multimodality approach to treatment was utilised depending on the primary tumour. The prognosis for neurological recovery was found to be inversely proportional to the degree of neurological deficits and duration of symptoms in four studies. CONCLUSION Neuroblastoma is the most common cause for MSCC in children (62.7%) followed by sarcoma (14.2%), whilst soft tissue sarcomas constituted the most frequent cause of MSCC in children > 5 years old. The majority of patients presented with motor deficit, followed by pain. In children with neuroblastoma /lymphoma, chemotherapy was the primary treatment. Early surgery should be a consideration with rapid deterioration of neurology despite chemotherapy. A multimodality approach including chemo-radiotherapy and surgery should be the treatment of choice in metastatic sarcomas. It is worth noting that multi-level laminectomy/decompression and asymmetrical radiation to the spine can lead to spinal column deformity in the future.
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Affiliation(s)
- N A Quraishi
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - N Palliyil
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Mohamed A Hassanin
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
- Department of Orthopaedic Surgery, Assiut University, Assiut, Egypt.
| | - D D'Aquino
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - A Shetaiwi
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - D Walker
- Department of Paediatric Oncology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
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Huang Z, Tong Y, Kong Q. Construction of a Tool to Predict Overall Survival of Patients With Primary Spinal Tumors After Surgical Resection: A Real-World Analysis Based on the Surveillance, Epidemiology, and End Results Database. Global Spine J 2023; 13:2422-2431. [PMID: 35341359 PMCID: PMC10538349 DOI: 10.1177/21925682221086539] [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: 02/05/2023] Open
Abstract
BACKGROUND We aim to construct a practical clinical prediction model to accurately evaluate the overall survival (OS) of patients with primary spinal tumors after primary tumor resection, thereby aiding clinical decision-making. METHODS A total of 695 patients diagnosed with a primary spinal tumor, selected from the Surveillance, Epidemiology, and End Results (SEER) database, were included in this study. The Cox regression algorithm was applied to the training cohort to build the prognostic nomogram model. The nomogram's performance in terms of discrimination, calibration, and clinical usefulness was also assessed in the internal SEER validation cohort. The fitted prognostic nomogram was then used to create a web-based calculator. RESULTS Four independent prognostic factors were identified to establish a nomogram model for patients with primary spinal tumors who had undergone surgical resection. The C-index (.757 for the training cohort and .681 for the validation cohort) and the area under the curve values over time (both >.68) showed that the model exhibited satisfactory discrimination in both the SEER cohort. The calibration curve revealed that the projected and actual survival rates are very similar. The decision curve analysis also revealed that the model is clinically valuable and capable of identifying high-risk patients. CONCLUSIONS After developing a nomogram and a web-based calculator, we were able to reliably forecast the postoperative OS of patients with primary spinal tumors. These tools are expected to play an important role in clinical practice, informing clinicians in making decisions about patient care after surgery.
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Affiliation(s)
- Zhangheng Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuexin Tong
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Qingquan Kong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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4
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Marsiolo M, Aulisa AG. Editorial: Case reports in paediatric orthopaedics 2022. Front Pediatr 2023; 11:1211236. [PMID: 37342534 PMCID: PMC10277796 DOI: 10.3389/fped.2023.1211236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Martina Marsiolo
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angelo Gabriele Aulisa
- U.O.C Traumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Human, Social and Health Sciences, University of Cassino, Cassino, Italy
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5
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Zacharia B. Tumors of the Posterior Elements of the Spine in Children—an Overview. Indian J Surg Oncol 2023. [DOI: 10.1007/s13193-023-01729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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6
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Moscinksi N, Sullivan PZ, Gokaslan ZL. Benign primary bone tumors, long-term management into adulthood. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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7
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Disch AC, Boriani S, Luzzati A, Rhines LD, Fisher CG, Lazary A, Gokaslan ZL, Chou D, Clarke MJ, Fehlings MG, Schaser KD, Germscheid NM, Reynolds JJ. Extradural Primary Malignant Spinal Tumors in a Population Younger than 25 Years: An Ambispective International Multicenter Study on Onco-Surgical Outcomes. Cancers (Basel) 2023; 15:cancers15030845. [PMID: 36765803 PMCID: PMC9913243 DOI: 10.3390/cancers15030845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Extradural malignant primary spinal tumors are rare and outcome data, especially for younger patients, is limited. In a worldwide (11 centers) study (Predictors of Mortality and Morbidity in the Surgical Management of Primary Tumors of the Spine study; ClinicalTrials.gov Identifier NCT01643174) by the AO Spine Knowledge Forum Tumor, patients surgically treated for primary tumors of the spine between 1992 and 2012, were retrospectively analyzed from a prospective database of their medical history. Medical history, tumor characteristics, diagnostics, treatments, cross-sectional survival, and local recurrences were analyzed. Sixty-eight cases (32 f; 36 m), at an average age of 18.6 ± 4.7 years at the time of diagnosis, were identified (median follow-up 2.9 years). The most common entities were Ewing's sarcoma (42.6%). Of the patients, 28% had undergone previous spine tumor surgery in another center (84% with intralesional margins). Resection was considered "Enneking appropriate" (EA) in 47.8% of the cases. Of the patients, 77.9% underwent chemotherapy and 50% radiotherapy. A local recurrence occurred in 36.4%. Over a third of patients died within a 10-year follow-up period. Kaplan-Meier-analysis demonstrated statistically significant overall survival (p = 0.007) and local recurrence rates (p = 0.042) for tumors treated with EA surgery versus Enneking inappropriate surgery. Aggressive resection of extradural primary malignant spinal tumors combined with adjuvant therapy reveals low local recurrence rates and better outcomes overall in younger patients.
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Affiliation(s)
- Alexander C. Disch
- University Center for Orthopedics, Trauma & Plastic Surgery, University Comprehensive Spine Center (UCSC), University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany
- Correspondence:
| | | | | | - Laurence D. Rhines
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles G. Fisher
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Aron Lazary
- National Center for Spinal Disorders, 1126 Budapest, Hungary
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI 02903, USA
| | - Dean Chou
- Department of Neurosurgery, The UCSF Spine Center, University of California, San Francisco, CA 94143, USA
| | | | - Michael G. Fehlings
- Department of Surgery Halbert Chair, Spinal Program University of Toronto, Toronto Western Hospital University Health Network, Toronto, ON M5T 2S8, Canada
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma & Plastic Surgery, University Comprehensive Spine Center (UCSC), University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany
| | | | - Jeremy J. Reynolds
- Oxford Spinal Surgery Unit, Oxford University Hospitals, Oxford OX3 7LE, UK
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8
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Disch AC, Boriani S, Lazary A, Rhines LD, Luzzati A, Gokaslan ZL, Fisher CG, Fehlings MG, Clarke MJ, Chou D, Germscheid NM, Schaser KD, Reynolds JJ. Outcomes of Surgical Treatment for Extradural Benign Primary Spinal Tumors in Patients Younger than 25 Years: An Ambispective International Multicenter Study. Cancers (Basel) 2023; 15:cancers15030650. [PMID: 36765605 PMCID: PMC9913733 DOI: 10.3390/cancers15030650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/19/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
Extradural primary spinal tumors were retrospectively analyzed from a prospective database of 1495 cases. All subjects with benign primary tumors under the age of 25 years, who were enrolled between 1990 and 2012 (Median FU was 2.4 years), were identified. Patient- and case-related characteristics were collected and statistically analyzed. Results: 161 patients (66f;95m; age 17.0 ± 4.7 years at time of diagnosis) were identified. The most common tumors were osteoblastomas n = 53 (32.9%), osteoid osteomas n = 45 (28.0%), and aneurysmal bone cysts n = 32 (19.9%). The tumor grade, according to the Enneking Classification S1/S2/S3, was 14/73/74 (8.7/45.3/46.0%), respectively. Tumor-related pain was present in 156 (96.9%) patients. Diagnosis was achieved by biopsies in 2/3 of the cases. Spinal fixation was used in >50% of the cases. Resection was Enneking appropriate in n = 100 (62.1%) of cases. Local recurrence occurred in 21 (13.1%) patients. Two patients died within a 10-year follow-up period. Conclusion: This is one of the largest international multicenter cohorts of young patients surgically treated for benign spinal tumors. The heterogenic young patient cohort presented at a mid-term follow-up without a correlation between the grade of aggressiveness in resection and local recurrence rates. Further prospective data are required to identify prognostic factors that determine oncological and functional outcomes for young patients suffering from these rare tumors.
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Affiliation(s)
- Alexander C. Disch
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, University Comprehensive Spine Center, University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany
- Correspondence:
| | | | - Aron Lazary
- National Center for Spinal Disorders, 1126 Budapest, Hungary
| | - Laurence D. Rhines
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI 02903, USA
| | - Charles G. Fisher
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Michael G. Fehlings
- Department of Surgery Halbert Chair, Spinal Program University of Toronto, Toronto Western Hospital University Health Network, Toronto, ON M5T 2S8, Canada
| | | | - Dean Chou
- Department of Neurosurgery, The UCSF Spine Center, University of California, San Francisco, CA 94143, USA
| | | | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma Surgery and Plastic Surgery, University Comprehensive Spine Center, University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany
| | - Jeremy J. Reynolds
- Oxford Spinal Surgery Unit, Oxford University Hospitals, Oxford OX3 7LE, UK
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Minimally Invasive Resection of Benign Osseous Tumors of the Spinal Column: 10 Years' Experience and Long-Term Outcomes of a Specialized Center. Medicina (B Aires) 2022; 58:medicina58121840. [PMID: 36557042 PMCID: PMC9786891 DOI: 10.3390/medicina58121840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022] Open
Abstract
Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on minimally invasive resection of these lesions are rare. We report a series of patients managed by total resection of benign osseous spine tumors using MIS techniques. Surgical decisions and technical considerations are discussed. Materials and Methods: A retrospective evaluation of prospectively collected data of patients who underwent minimally invasive surgery for removal of benign osseous vertebral tumors. Demographic, clinical and radiographic features, operative details and final pathological reports were summarized. Primary outcomes were completeness of tumor resection and pain relief assessed by VAS for back and leg pain. Secondary outcome measures were recurrence of tumor on repeat post-operative MRI and postoperative unstable deformity on standing scoliosis X-rays. Results: This series included 32 cases of primary osseous spine tumors resected by minimally invasive techniques. There were 17 males and 15 females aged 5-68 years (mean 23.3). The follow-up period was 8-90 months (mean 32 months) and the preoperative symptoms duration was 9-96 months. Axial spinal pain was the presenting symptom in all the patients. Five patients also complained about radicular pain and four patients had antalgic scoliosis. The tumor involved the thoracic spine in 12 cases, the lumbar segment in 11, the cervical in 5 and the sacral area in 4 cases. Complete tumor removal was performed in all patients. No procedure-related complications were encountered. Histopathology showed osteoid osteoma in 24 patients, osteoblastoma in 5 patients, and fibrous dysplasia, fibroadenoma and eosinophilic granuloma in one case each. All patients experienced significant pain relief after surgery, and had stopped pain medications by 12 months postoperatively. No patient suffered from tumor recurrence or spinal deformity. Conclusions: Minimally invasive surgery is feasible for total removal of selected benign vertebral tumors and may have some advantages over conventional surgical techniques.
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10
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von Brandis E, Zadig PK, Avenarius DFM, Flatø B, Kristian Knudsen P, Lilleby V, Nguyen B, Rosendahl K, Ording Müller LS. Whole body magnetic resonance imaging in healthy children and adolescents. Bone marrow appearances of the axial skeleton. Eur J Radiol 2022; 154:110425. [PMID: 35843014 DOI: 10.1016/j.ejrad.2022.110425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the findings of focal high signal on T2 weighted (T2W) images of the bone marrow in the axial skeleton as assessed by whole-body MRI in healthy and asymptomatic children and adolescents. MATERIAL AND METHODS We assessed the bone marrow of the mandible, shoulder girdle, thorax, spine, and pelvis on water-only Dixon T2W sequences as part of a whole-body MRI protocol in 196 healthy and asymptomatic children aged 5-19 years. Intensity (0-2 scale) and extension (1-4 scale) of focal high signal areas in the bone marrow were scored and divided into minor or major findings, based on intensity and extension to identify the potentially conspicuous lesions in a clinical setting. RESULTS We registered 415 areas of increased signal in the axial skeleton whereof 75 (38.3%) were major findings. Fifty-eight (29.6%) individuals had at least one major finding, mainly located in the pelvis (54, 72%). We found no differences according to gender. The number of minor findings increased with age (p = 0.020), but there were no significant differences in the number of major findings. The most conspicuous findings were in the pelvis, spine and sternum. CONCLUSION Non-specific bone marrow T2W hyperintensities in the axial skeleton are frequently detected on whole-body MRI in healthy, asymptomatic children. Awareness of this is important as some findings may resemble clinically silent lesions in children with suspected multifocal skeletal disease.
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Affiliation(s)
- Elisabeth von Brandis
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Pia K Zadig
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway; Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Derk F M Avenarius
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway; Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Berit Flatø
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Knudsen
- Department of Pediatric Medicine, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Vibke Lilleby
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Bac Nguyen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway; Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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11
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Cardarelli-Leite L, Rassekh SR, D'Ortenzio R, Heran MKS. Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors. Pediatr Blood Cancer 2021; 68:e29307. [PMID: 34453400 DOI: 10.1002/pbc.29307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022]
Abstract
Primary and secondary malignant tumors of the spine are relatively uncommon in the pediatric population but are associated with high morbidity and significantly decreased quality of life due to pain. Local management of these tumors is often challenging due to the importance of maintaining vertebral mechanical integrity as well as the spinal growth potential. Typically, surgery and/or radiation therapy have been used in the primary management of these tumors. However, treatment options become more limited when there is relapse or refractory disease, with re-resection or additional radiotherapy often not being viable therapies. Vertebroplasty is a currently underutilized modality that might provide significant pain palliation in cases of relapsed cancer in the spine.
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Affiliation(s)
- Leandro Cardarelli-Leite
- Division of Interventional Radiology, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Hematology, Oncology and BMT, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert D'Ortenzio
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Basma J, Rangarajan SV, Michael LM, Magnuson JS, Muhlbauer MS, Gleysteen JP. Robotic-Assisted Tubular Transoral Parapharyngeal Approach to the Ventral Craniovertebral Junction. Oper Neurosurg (Hagerstown) 2021; 21:14-19. [PMID: 33647934 DOI: 10.1093/ons/opab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) has become a routine technique for treating benign and malignant lesions of the oropharynx with the advantage of reducing morbidity compared to open surgical techniques. However, TORS has not been used routinely for accessing lesions of the spine. OBJECTIVE To describe how TORS can be used to access spinal lesions. METHODS We describe our technique of accessing the parapharyngeal space using the robotic technique, and then dissecting the prevertebral muscles to expose the ventral craniovertebral junction. Tubular retraction with endoscopic visualization is then employed for surgical resection. We then report a case of a 14-yr-old competitive athlete who presented with an osseous lesion of C1, which underwent resection using this novel TORS approach. RESULTS Our patient underwent successful resection of a lateral C1 osteoid osteoma utilizing a combined TORS/endoscopic approach. She tolerated soft diet immediately and was discharged on postoperative day 2. Postoperative imaging revealed complete resection of the lesion, and she returned to competitive athletics within 6 wk. CONCLUSION Utilizing this novel, robotic-assisted approach can definitively treat osseous cervical spine lesions while reducing morbidity, allowing for early return to normal diet and minimizing overall length of hospital stay.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet V Rangarajan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - J Scott Magnuson
- Head and Neck Surgery Program, Advent Health Orlando, Orlando, Florida, USA.,Department of Otolaryngology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michael S Muhlbauer
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - John P Gleysteen
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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13
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Lidar Z, Khashan M, Ofir D, Regev GJ, Salame K. Resection of Benign Osseous Spine Tumors in Pediatric Patients by Minimally Invasive Techniques. World Neurosurg 2021; 152:e758-e764. [PMID: 34166825 DOI: 10.1016/j.wneu.2021.06.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Benign osseous tumors of the spine in children are a rare cause for surgery. The aim of this study is to describe our experience with resection of pediatric benign osseous spine tumors using a minimally invasive technique through a variety of surgical approaches. METHODS A retrospective review of prospectively collected data of pediatric patients who underwent minimally invasive resection of a benign osseous vertebral tumor from May 2013 through November 2018 was performed. Primary outcome measures included the extent of resection and pain resolution. Secondary outcomes included postoperative spinal instability evaluated by standing scoliosis x-rays and tumor recurrence evaluated by periodic follow-up magnetic resonance imaging scans. RESULTS Our study group comprised 8 children, 3 males and 5 females, with a mean age of 12.2 years. The average follow-up period was 4.3 years. Complete removal of tumors was achieved in all cases and was verified by follow-up magnetic resonance imaging scans. There were no procedure-related complications. The average duration of surgery was 70 minutes, and the blood loss was less than 20 cc in all cases. The average inpatient length of stay was 1.6 days. Histopathology revealed osteoid osteoma in 6 patients and osteoblastoma in 2 patients. Average improvement of the pain scores was from 8 to 0.8. At the time of this report, no tumor recurrence was evident in all 8 patients and none of the cases developed spinal deformity. CONCLUSION Our limited experience suggests that the minimally invasive technique is a valuable option for the surgical management of selected benign osseous spinal tumors in children.
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Affiliation(s)
- Zvi Lidar
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Morsi Khashan
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Ofir
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad J Regev
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khalil Salame
- Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Colafati GS, Marrazzo A, Cirillo M, d'Angelo P, Barbuti D, Tanturri de Horatio L, Tomà P, Bartoloni A. The Pediatric Spine. Semin Musculoskelet Radiol 2021; 25:137-154. [PMID: 34020474 DOI: 10.1055/s-0041-1727095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The spine, a frequently investigated site in children, has a complex development in relation to both nervous and bone/cartilaginous structures and shows several particular features in children compared with adults. We report the main normal variants and pathologies of the pediatric spine, from the prenatal period to adolescence, focusing on a multimodality imaging approach.
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Affiliation(s)
| | - Antonio Marrazzo
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Cirillo
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola d'Angelo
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Domenico Barbuti
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Paolo Tomà
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Fowler J, Takayanagi A, Fiani B, Cathel A, Sarhadi KJ, Arshad M, Lau S, Siddiqi I, Ghanchi H, Wolberg A, Hariri O. Diagnosis, Management, and Treatment Options: A Cervical Spine Osteochondroma Meta-Analysis. World Neurosurg 2021; 149:215-225.e6. [PMID: 33561553 DOI: 10.1016/j.wneu.2021.01.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. Although osteochondromas most often involve the appendicular skeleton, many involve the spine, with many cases located in the cervical spine. When osteochondromas involve the spine, they can present with a variety of symptoms, including pain, radiculopathy, and myelopathy, which may necessitate surgical treatment. Spinal osteochondromas can be classified into 2 types: multiple osteochondromas in the context of patients with multiple hereditary exostosis (MHE) and solitary osteochondroma or solitary exostosis (SE). Previous reviews have captured only some of the available literature on cervical osteochondromas and have generally focused on either SE or those associated with MHE. The purpose of our review was to provide an extensive review of all previously reported cervical osteochondromas and to compare osteochondroma characteristics, clinical presentation, and outcomes in the context of MHE and SE.
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Affiliation(s)
- James Fowler
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA.
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | | | - Mohammad Arshad
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Sean Lau
- Department of Pathology, Kaiser Permanente, Anaheim, California, USA
| | - Imran Siddiqi
- Western University of Health Sciences College of Osteopathic Medicine, Pomona, California, USA
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | - Adam Wolberg
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Omid Hariri
- Department of Neurosurgery, Kaiser Permanente Orange County, Anaheim, California, USA
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Sheinberg DL, Bryant JP, Perez-Roman RJ, Niazi TN. Indeterminate Cell Histiocytosis of the Spine: A Case Report. Pediatr Neurosurg 2021; 56:465-470. [PMID: 34274927 DOI: 10.1159/000517331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Indeterminate cell histiocytosis is a rare neoplastic disease characterized by proliferation of dendritic cells that share morphologic and immunophenotypic features of Langerhans cells and non-Langerhans histiocytes. ICH lesions are typically restricted to the skin; however, there have been rare reports of extracutaneous and systemic involvement. CASE PRESENTATION We describe a case of a 13-year-old female presenting with complaints of worsening lower back pain for 1 year. CT and MRI of the lumbar spine demonstrated a well-defined bony, lytic, expansile lesion of the posterior and mid-endplate of the L4 vertebra with mass effect on the thecal sac. The patient underwent L3-L5 decompression and fusion with surgical excision of the vertebral body tumor. Microscopic examination of the lesion showed benign fibrohistiocytic proliferation with giant cells, and immunohistochemical staining revealed a phenotype consistent with indeterminate cell histiocytosis (S100+ CD1a+ langerin-). DISCUSSION/CONCLUSION ICH is an extraordinarily rare neoplastic disease of dendritic cells that has a poorly understood pathogenesis. This case expands the spectrum of potential ICH extracutaneous involvement to now include the spine, a location previously undocumented in the literature in the pediatric population.
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Affiliation(s)
- Dallas Louis Sheinberg
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jean-Paul Bryant
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA,
| | - Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Toba N Niazi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Division of Pediatric Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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Distinction and Potential Prediction of Lung Metastasis in Patients with Malignant Primary Osseous Spinal Neoplasms. Spine (Phila Pa 1976) 2020; 45:921-929. [PMID: 32049934 DOI: 10.1097/brs.0000000000003421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The aim of this study was to develop and validate a nomogram for the prediction of lung metastasis in patients with malignant primary spinal tumors. SUMMARY OF BACKGROUND DATA In patients with malignant primary spinal tumors, lung metastasis is usually found by computed tomography (CT) and is considered to be an essential factor affecting the prognosis and survival. METHODS We retrospectively collected 580 malignant primary osseous spinal neoplasms patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic analysis were used to identify independent factors. These prognostic factors were included in the nomograms. The nomograms were validated based on its calibration, discrimination, and clinical utility. The overall survival of the patients was analyzed using the Kaplan-Meier method and the survival differences were tested by the log-rank test. RESULTS We randomly divided all these patients (n = 580) into a training cohort (n = 408) and a validation cohort (n = 172). The results showed that the risk of lung metastasis was independently influenced by histologic type, use of surgery, clinical T stage, clinical N stage, and tumor extension (all P < 0.05). The nomogram consisted of five clinical features and provided good calibration and discrimination in the training and validation cohort, with an area under the curve of 0.858 and 0.811, respectively. Decision curve analysis showed that the nomogram was clinically useful. The Kaplan-Meier curves showed a significant difference between the higher and lower risk of lung metastasis groups (P < 0.001). CONCLUSION Nomograms were developed to predict the risk of lung metastasis in patients with malignant primary spinal tumors. The nomogram showed favorable discrimination and calibration values, which may help optimize treatment decision-making for patients. LEVEL OF EVIDENCE 4.
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Brunette-Clément T, Lavergne P, Shedid D, Weil AG. Minimally Invasive Resection of a Pediatric Lumbar Osteoblastoma: Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E236-E243. [DOI: 10.1093/ons/opaa150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/19/2020] [Indexed: 01/02/2023] Open
Abstract
Abstract
BACKGROUND
Osteoblastomas are locally aggressive bone tumors typically affecting the posterior elements of the vertebral column. The treatment of choice is total surgical resection, traditionally through an open laminectomy, often with facetectomy and fusion when the lesion is in the foramen.
OBJECTIVE
To seek an alternative to open surgery, allowing quick and full functional recovery, to meet the youth and athlete population's specific surgical goals. In this population especially, open surgery can be associated with significant impairment and morbidity.
METHODS
We report a pediatric case of posterior L5 osteoblastoma completely removed using a facet-sparing and fusion-avoiding contralateral foraminal minimally invasive approach using a tubular retractor system. A 12-yr-old male competitive tennis player presented with progressive right L5 lumbosciatica. Computed tomography scan and magnetic resonance imaging revealed a lesion of the right L5 pedicle, facet, and vertebral body with significant foraminal soft-tissue extension. Being unfit for percutaneous radiofrequency ablation, the patient underwent a minimally invasive biopsy and resection using an 18-mm-wide METRx nonexpandable tubular retractor (Medtronic) through a contralateral approach, sparing the facet and avoiding fusion surgery.
RESULTS
Postoperative imaging showed residual tumor. The patient was reoperated in a similar fashion with complete tumor removal. His symptoms resolved completely postoperatively. He resumed tennis within 4 mo and remains symptom- and tumor-free at 12-mo follow-up.
CONCLUSION
Minimally invasive contralateral facet-sparing resection of a pediatric lumbar osteoblastoma is an alternative to standard technique and is associated with significant advantages for young athletes, such as quick and full functional recovery, along with avoidance of fusion when the facet joint is involved.
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Affiliation(s)
| | - Pascal Lavergne
- Division of Neurosurgery, CHU de Québec-Université Laval, Quebec, Canada
| | - Daniel Shedid
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte-Justine University Hospital Center, Montreal, Canada
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Chen YL, Jiang WY, Ma WH. Osteoid osteoma: lower back pain combined with scoliosis. J Int Med Res 2020; 48:300060520903873. [PMID: 32046556 PMCID: PMC7254605 DOI: 10.1177/0300060520903873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoid osteoma is a small benign bone tumor that is primarily localized in long bone; lumbar osteoid osteoma combined with scoliosis has rarely been reported. Here, we describe a 9-year-old boy who complained of back pain and scoliosis. He underwent nidus resection and did not experience complications or osteoid osteoma recurrence. His pain and scoliosis were relieved after the operation. The findings in this case indicate that resection of osteoid osteoma is an effective and safe method of treatment. The lumbar spine is the most common location of osteoid osteoma, which causes painful scoliosis. Nidus resection can provide relief of back pain and scoliosis.
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Affiliation(s)
- Yun-lin Chen
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wei-yu Jiang
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wei-hu Ma
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
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Jia Q, Chen G, Cao J, Yang X, Zhou Z, Wei H, Liu T, Xiao J. Clinical features and prognostic factors of pediatric spine giant cell tumors: report of 31 clinical cases in a single center. Spine J 2019; 19:1232-1241. [PMID: 30776487 DOI: 10.1016/j.spinee.2019.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Giant cell tumors (GCTs) of the bone are benign but locally aggressive. Pediatric spine giant-cell tumors (PSGCTs) have been infrequently reported in the literature because of the rarity of the disease. PURPOSE The purpose of this study was to define the overall occurrence rate of PSGCTs among all spinal GCTs in our center and investigate the clinical features and prognostic factors of this rare disease. STUDY DESIGN A retrospective review. PATIENT SAMPLE Thirty-one PSGCT patients, screened from 226 patients with spine GCTs who received treatment in our center between 1998 to 2017. OUTCOME MEASURES The clinical symptoms, neurologic status, radiologic manifestations, treatment, outcome, and complications were recorded and analyzed. METHODS The postoperative recurrence-free survival (RFS) rate was estimated by the Kaplan-Meier method. Factors with p values ≤.1 were subjected to multivariate analysis for RFS by proportional hazard analysis, among which p values ≤.05 were considered statistically significant. RESULTS A total of 31 (31 of 226, 13.7%) PSGCTs patients (9 male and 22 female) were included in the study, with a mean age of 15.9 years and a mean follow-up period of 85.1 (median 84.0; range 12-221) months. The majority of patients (80.6 %) were 14-18 years of age. Recurrence was detected in 12 (38.7%) of the 31 patients. Univariate and multivariate analyses suggested that Jaffe grade II-III was an adverse prognostic factor for RFS, while total spondylectomy and bisphosphonate treatment were positive prognostic factors. CONCLUSIONS Total en bloc spondylectomy (TES) is associated with excellent prognosis for PSGCTs, and total piecemeal spondylectomy is a viable alternative if total en bloc spondylectomy is unfeasible. Long-term bisphosphonate administration could significantly reduce the recurrence risk of PSGCTs. Denosumab treatment is recommended, especially for advanced PSGCTs. Jaffe grade II-III is an adverse prognostic factor for recurrence.
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Affiliation(s)
- Qi Jia
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guanghui Chen
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Jiashi Cao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhenhua Zhou
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haifeng Wei
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tielong Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Heinrich C, Gospodarev V, Kheradpour A, Zuppan C, Douglas CC, Minasian T. Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review. Brain Sci 2019; 9:brainsci9050105. [PMID: 31071908 PMCID: PMC6562483 DOI: 10.3390/brainsci9050105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023] Open
Abstract
Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old patient. A transoral biopsy was performed followed by treatment with denosumab, with definitive management in the form of transoral tumor resection with subsequent occiput-cervical three posterior instrumented fusion. The patient tolerated all of the procedures well, as there were no post-operative complications, discharged home neurologically intact and was eager to return to school when assessed during a follow-up visit in clinic. Osteolytic lesions affecting the cervical spine are rare in the pediatric population. It is of utmost importance to have sufficient background knowledge in order to formulate a differential diagnosis, as well as an understanding of principles underlying surgical techniques required to prevent occipital-cervical instability in this patient population. The information presented will guide surgical decision-making by identifying the patient population that would benefit from neurosurgical interventions to stabilize the atlantoaxial junction, in the context of rare osteolytic conditions affecting the cervical spine.
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Affiliation(s)
| | - Vadim Gospodarev
- Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University, 11234 Anderson Street, Room 2567, Loma Linda, CA 92354, USA.
| | - Albert Kheradpour
- Department of Pediatric Hematology/Oncology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Craig Zuppan
- Department of Pathology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Clifford C Douglas
- Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2556, Loma Linda, CA 92354, USA.
| | - Tanya Minasian
- Department of Neurosurgery, Loma Linda University Medical Center, 11234 Anderson Street, Room 2556, Loma Linda, CA 92354, USA.
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Socioeconomic Predictors of Surgical Resection and Survival for Patients With Osseous Spinal Neoplasms. Clin Spine Surg 2019; 32:125-131. [PMID: 30531357 DOI: 10.1097/bsd.0000000000000738] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OF BACKGROUND DATA Primary osseous spinal neoplasms (POSNs) include locally aggressive tumors such as osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma. For such tumors, surgical resection is associated with improved survival for patients. Socioeconomic predictors of receiving surgery, however, have not been studied. OBJECTIVE To examine the independent effect of race on receiving surgery and survival probability in patients with POSN. STUDY DESIGN A total of 1904 patients from the SEER program at the National Cancer Institute database, all diagnosed with POSN of the spinal cord, vertebral column, pelvis, or sacrum from 2003 through 2012 were included in the study. Race was reported as white or nonwhite. Treatment included receiving surgery and no surgery. MATERIALS AND METHODS Multivariable logistic regression was used to determine odds of receiving surgery based on race. Survival probability based on and race and surgery status was analyzed by Cox proportional hazards model and Kaplan-Meir curves. Results were adjusted for age at diagnosis, sex, socioeconomic status (composite index), tumor size, and tumor grade. Data were analyzed with SAS version 9.4. RESULTS The study found that white patients were significantly more likely to receive surgery (odds ratio=3.076, P<0.01). Furthermore, nonwhite race was associated with significantly shorter survival time [hazard ratio (HR)=1.744, P<0.05]. Receiving surgery was associated with improved overall survival (HR=2.486, P<0.01). After adjusting for receiving surgery, white race remained significantly associated with higher survival probability (HR=2.061, P<0.05). CONCLUSIONS This national study of patients with typically aggressive POSN found a significant correlation between race and the likelihood of receiving surgery. The study also found race to be a significant predictor of overall survival, regardless of receiving surgical treatment. These findings suggest an effect of race on receiving treatment and survival in patients with POSN, regardless of socioeconomic status. Further studies are required to understand reasons underlying these findings, and how they may be addressed.
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Spinal osteosarcoma in the paediatric age group: Case series and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Egea-Gámez RM, Ponz-Lueza V, Cendrero-Torrado A, Martínez-González C, Certucha-Barragán JA, González-Díaz R. Spinal osteosarcoma in the paediatric age group: case series and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:122-131. [PMID: 30744956 DOI: 10.1016/j.recot.2018.09.001] [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: 03/17/2018] [Revised: 07/28/2018] [Accepted: 09/02/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Osteosarcoma is the most frequent malignant spinal tumour in the paediatric age group. Diagnosis and early treatment of this pathology is essential for a good prognosis. The aim of this study was to present the results of treatment of paediatric patients with lumbar osteosarcoma and conduct a literature review. MATERIAL AND METHODS All the patients with lumbar osteosarcoma who were operated between 2012 and 2014 in the same centre were included. Demographic and radiological data (Enneking, WBB and Tomita classification), as well as anatomopathological (Broders classification) variables were analysed. All the patients were treated by surgical resection associated with adjuvant therapies (chemotherapy and radiotherapy); according to consensus with the tumour committee. The average follow-up was 62.53 months (47-70 months). RESULTS A total of 3 patients were studied, two girls of 9 and 11, with L5 osteosarcoma, and a 15-year-old boy with L4 osteosarcoma. Two of the cases were initially treated as an osteoblastoma, supported by radiological and anatomopathological images. None of the patients had local recurrences or metastases during follow-up. CONCLUSIONS Due to a lack of long series of cases of osteosarcoma in the mobile spine during childhood, the optimal treatment and prognosis in these patients is uncertain. Block resection improves local control of the disease, without demonstrating improvement in overall survival. Intralesional resection is associated with a higher rate of local recurrence. Oncological treatment is essential in the treatment of this pathology. A correct differential diagnosis of the tumour (osteosarcoma vs. osteoblastoma) is vital for its correct treatment.
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Affiliation(s)
- R M Egea-Gámez
- Unidad de Raquis, Servicio de Traumatología y Ortopedia Infantil, Hospital Infantil Universitario Niño Jesús, Madrid, España.
| | - V Ponz-Lueza
- Servicio de Ortopedia y Traumatología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - A Cendrero-Torrado
- Servicio de Ortopedia y Traumatología, Hospital Virgen de las Nieves, Granada, España
| | - C Martínez-González
- Unidad de Raquis, Servicio de Traumatología y Ortopedia Infantil, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J A Certucha-Barragán
- Unidad de Raquis, Servicio de Traumatología y Ortopedia Infantil, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - R González-Díaz
- Unidad de Raquis, Servicio de Traumatología y Ortopedia Infantil, Hospital Infantil Universitario Niño Jesús, Madrid, España
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Affiliation(s)
- F. M. D. Henson
- Department of Veterinary Medicine; University of Cambridge; UK
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Erosive effects of a posterior mediastinal mass in a 18th to early 19th c. Spanish child mummy. Forensic Sci Med Pathol 2018; 14:574-578. [PMID: 30145698 DOI: 10.1007/s12024-018-0013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 12/15/2022]
Abstract
During the 2011 restoration works in the central nave of the church of the Assumption of Our Lady, known as "The Piquete", in the village of Quinto (about 50 kms southwest of Zaragoza, Spain), the remains of 70 individuals were uncovered. Of these there were 32 mummified bodies, four of which have been investigated with CT scans. Here we report on the findings in one such individual, namely a child of between 7 and 8 years of age, whose sex is debatable but may well be female. The main pathological finding is the presence of pressure erosion and distortion of the upper thoracic spine, the cause of which is discussed with the conclusion that this may well represent a neurenteric duplication cyst. The possible consequences of such a lesion are considered.
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Liu J, Li M, Liu X, Liu F, Zhu J. miR-27a-3p promotes the malignant phenotypes of osteosarcoma by targeting ten-eleven translocation 1. Int J Oncol 2018; 52:1295-1304. [PMID: 29484426 DOI: 10.3892/ijo.2018.4275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/09/2018] [Indexed: 11/06/2022] Open
Abstract
Osteosarcoma has become one of the most common primary malignant tumors affecting children and adolescents. Although increasing evidence has indicated that microRNAs (miRNAs or miRs) play important roles in the development of osteosarcoma, the expression of miR‑27a‑3p and its effects on osteosarcoma are not yet fully understood. In the present study, our data demonstrated that the expression of miR‑27a‑3p in osteosarcoma cell lines was significantly higher than that in the normal human osteoblastic cell line, hFOB 1.19 cell (P<0.01). In order to explore the role of miR‑27a‑3p in the development and progression of osteosarcoma, the expression of miR‑27a‑3p was inhibited by transfection of the MG-63 cells with miR‑27a‑3p inhibitor. The results revealed that the cell proliferative ability significantly decreased (P<0.01), the number of apoptotic cells significantly increased (P<0.01) and the number of cells passing through the Transwell membrane was significantly reduced in the group transfected with the miR‑27a‑3p inhibitor (P<0.01). At the same time, the expression of E-cadherin and α-catenin was significantly upregulated (P<0.01), while the expression of vimentin was significantly downregulated in the group transfected with the miR‑27a‑3p inhibitor (P<0.01). Our results also revealed that the mRNA expression of ten-eleven translocation 1 (TET1) in the osteosarcoma cells was significantly downregulated compared with that in the hFOB 1.19 cells (P<0.01). Luciferase reporter system analysis indicated that miR‑27a‑3p recognized the TET1 3'-UTR. The protein expression of TET1 significantly increased in the group transfected with the miR‑27a‑3p inhibitor. The results from CCK-8 assay, flow cytometric assay and Transwell invasion analysis revealed that TET1 knockdown inhibited the biological effects induced by the downregulation of miR‑27a‑3p. Taken together, the findings of this study indicate that miR‑27a‑3p is upregulated, while TET1 is downregulated in human osteosarcoma cells. miR‑27a‑3p inhibition suppresses the proliferation and invasion of osteosarcoma cells, and promotes cell apoptosis via the negative regulation of TET1. miR‑27a‑3p/TET1 may thus be a potential target for the treatment of osteosarcoma.
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Affiliation(s)
- Jin Liu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Mingpeng Li
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xiancheng Liu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Fan Liu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Jianwei Zhu
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
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Pediatric Emergency MRI: What You Need to Know to Make It Through the Night. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lehner B, Rehnitz C, Geisbüsch A, Akbar M, Omlor GW. [Diagnostics and treatment of benign spinal tumors]. DER ORTHOPADE 2017; 46:505-509. [PMID: 28477060 DOI: 10.1007/s00132-017-3432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Benign tumors of the spine are rare and may lead to unspecific back pain. The classification of the lesion is typically achieved with a combination of imaging techniques (MRI and CT scans) and, in some cases, a histological sampling to allow differentiation from malignant processes. Both open and interventional (CT guided) biopsies are possible, depending on the localization of the tumor. Treatment strategies are diverse, require an interdisciplinary approach, and include operative and interventional procedures. The following article gives an overview of the most important benign tumors of the spine, the typical features in imaging, and treatment strategies.
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Affiliation(s)
- B Lehner
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - C Rehnitz
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - A Geisbüsch
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Akbar
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - G W Omlor
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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