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MERELES MAXIMILIANOE, ESTEFAN MARTÍNM, PETRACCHI MATÍASG, BASSANI JULIOE, GRUENBERG MARCELO, SOLÁ CARLOSA. EN BLOC VERTEBRAL RESECTION FOR PRIMARY AND METASTATIC SPINE TUMORS. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201901222788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective Primary and secondary spine tumors occur frequently and treating them surgically has gained prominence. The objective of this study was to evaluate the outcomes and complications in a series of patients with primary and secondary vertebral tumors treated by en bloc vertebral resection. Methods A retrospective review of the patients who underwent en bloc vertebral resection between 2004 and 2017 was conducted. Results During the study period, 16 patients underwent en bloc vertebral resection. They were divided into primary tumor and metastatic tumor groups, 11 being primary tumors and 5 metastatic tumors. The average follow-up period was 95 months (3-156 months). The patients were treated by the same surgical team and the analysis was carried out by an independent observer. Conclusion In this case series, the results where comparable to those reported in the literature in terms of complications, survival, recurrence and neurological status. It is a demanding surgical technique, with a high percentage of morbidity and mortality, nevertheless, it allows local control and recurrence of the lesion. Level of evidence I; Case Series.
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Affiliation(s)
- MAXIMILIANO E MERELES
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - MARTÍN M ESTEFAN
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - MATÍAS G PETRACCHI
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - JULIO E BASSANI
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - MARCELO GRUENBERG
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - CARLOS A SOLÁ
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
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Sankey EW, Park C, Howell EP, Pennington Z, Abd-El-Barr M, Karikari IO, Shaffrey CI, Gokaslan ZL, Sciubba D, Goodwin CR. Importance of Spinal Alignment in Primary and Metastatic Spine Tumors. World Neurosurg 2019; 132:118-128. [PMID: 31476476 DOI: 10.1016/j.wneu.2019.08.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022]
Abstract
Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.
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Affiliation(s)
- Eric W Sankey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christine Park
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth P Howell
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad Abd-El-Barr
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA.
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Pipola V, Terzi S, Tedesco G, Bandiera S, Bròdano GB, Ghermandi R, Evangelisti G, Girolami M, Gasbarrini A. Metastatic epidural spinal cord compression: does timing of surgery influence the chance of neurological recovery? An observational case-control study. Support Care Cancer 2018; 26:3181-3186. [PMID: 29600414 DOI: 10.1007/s00520-018-4176-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/21/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Metastatic epidural spinal cord compression (MESCC) is radiologically defined as an epidural metastatic lesion causing the displacement of the spinal cord from its normal position in the vertebral canal. The purpose of this paper is the evaluation of the influence of timing of surgery on the chance of neurological recovery. METHODS This is a retrospective observational case-control study performed on patients with MESCC from solid tumors surgically treated at our institute from January 2010 to December 2016. Patients included were divided in two groups depending on surgery that was performed within or after 24 h the admission to the hospital. Neurological status was assessed with American Spine Injury Association (ASIA) Impairment Scale. RESULTS No statistically significant difference was observed in the variation of ASIA if surgery is performed within or after 24 h from the admission to the hospital. A statistically significant difference was observed after surgery in each group in the improvement of neurological status. A statistically significant difference was reported in the early post-operative complications in patients surgically treated within 24 h. CONCLUSION MESCC management is challenge for spine surgeons and may represent an oncologic emergency and if not promptly diagnosed can lead to a permanent neurological damage. According to this study, there is no difference in the chance of neurological recovery if surgery is performed within or after 24 h the admission to hospital, but there is a greater rate of early post-operative complications when surgery is performed within 24 h from the admission to the hospital.
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Affiliation(s)
- Valerio Pipola
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Silvia Terzi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Stefano Bandiera
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Barbanti Bròdano
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Riccardo Ghermandi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Girolami
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Mansoorinasab M, Abdolhoseinpour H. A review and update of vertebral fractures due to metastatic tumors of various sites to the spine: Percutaneous vertebroplasty. Interv Med Appl Sci 2018; 10:1-6. [PMID: 30363329 PMCID: PMC6167632 DOI: 10.1556/1646.10.2018.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Vertebral fractures (VFs) are the most usual convolution of metastatic tumors and the vertebral column is the third most ordinary site for painful bone metastases and remains a chief factor of morbidity in cancer patients. Methods In this paper, we investigated the previous literature on the status of clinical and prospects for the use of percutaneous vertebroplasty (PVP) with polymethylmethacrylate as a remedial alternative for the therapy of refractory pain resulting from malignant vertebral compression and pathologic fractures associated with metastatic tumors of various sites in numerous studies. The scientific document for this remedy, containing safety, immediate and long-term efficacy, and outcome measures, and also the risks of complications, was analyzed in detail. Results PVP is a safe, feasible, reliable, effective, and useful procedure, a minimally invasive treatment, and a significant tool for reduction of pain and the relief of pain symptoms. Conclusions This method can be employed as a further or narcotic remedy in elected patients. The techniques of PVP present a novel alternative therapy for diverse metastases with potentially large application.
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Affiliation(s)
| | - Hesam Abdolhoseinpour
- Department of Neurosurgery, Bou Ali Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Cho JH, Ha JK, Hwang CJ, Lee DH, Lee CS. Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The Efficacy of Each Treatment Modality. Clin Orthop Surg 2015; 7:476-82. [PMID: 26640631 PMCID: PMC4667116 DOI: 10.4055/cios.2015.7.4.476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/23/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Metastatic pathological fractures of the spine are a major problem for cancer patients; however, there is no consensus on treatment strategy. The purpose of this study was to evaluate various treatment options by analyzing their patterns for metastatic pathological fractures of the spine. METHODS In this study, 54 patients (male:female = 36:18) who were diagnosed with metastatic pathological fractures of spine were recruited. Demographic data, origin of cancer, type of treatment, and results were obtained from electronic medical records. Treatment options were divided into radiotherapy (RT), vertebroplasty (VP) or kyphoplasty (KP), operation (OP), and other treatments. Treatment results were defined as aggravation, no response, fair response, good response, and unknown. The survival time after detection of pathologic fractures was analyzed with the Kaplan-Meier method. RESULTS The mean age of the patients was 62.3 years. Hepatocellular carcinoma was the most common cancer of primary origin (n = 9), followed by multiple myeloma (n = 8). RT was the most common primary choice of treatment (n = 29, 53.7%), followed by OP (n = 13, 24.1%), and VP or KP (n = 10, 18.5%). Only 13 of 29 RT cases and 7 of 13 OP cases demonstrated a fair or good response. The mean survival time following detection of pathological spinal fractures was 11.1 months for 29 patients, who died during the study period. CONCLUSIONS RT was the most common primary choice of treatment for metastatic pathological fractures of the spine. However, the response rate was suboptimal. Although OP should be considered for the relief of mechanical back pain or neurologic symptoms, care should be taken in determining the surgical indication. VP or KP could be considered for short-term control of localized pain, although the number of cases was too small to confirm the conclusion. It is difficult to determine the superiority of the treatment modalities, hence, a common guideline for the diagnosis and treatment of metastatic pathological fractures of the spine is required.
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Affiliation(s)
- Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Ki Ha
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Araujo JLV, Veiga JCE, Figueiredo EG, Barboza VR, Daniel JW, Panagopoulos AT. Management of metastatic spinal column neoplasms--an update. Rev Col Bras Cir 2015; 40:508-14. [PMID: 24573631 DOI: 10.1590/s0100-69912013000600015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 09/25/2012] [Indexed: 11/22/2022] Open
Abstract
The increased survival of cancer patients due to the improvement and advancement of therapeutic modalities has promoted progressive increase in the prevalence of metastatic tumors of the spine, making it important for healthcare professionals to acquire knowledge in the field. Spinal column metastases are usually secondary to malignant neoplasm of the breast, lung and prostate, male gender being the most often affected and pain being the initial symptom in 90% of patients. It is estimated that 30-90% of terminally ill patients with cancer have metastases at some spinal column segment. Clinical history, physical and neurological assessments are critical to determine the degree and extent of the lesion, and therefore choose the appropriate imaging method to be requested. This study aims to perform a review and didactic description of the main aspects related to the physiopathology, diagnosis and treatment of this disease.
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Chae SM, Lee GW, Son SH. The effect of multileaf collimator leaf width on the radiosurgery planning for spine lesion treatment in terms of the modulated techniques and target complexity. Radiat Oncol 2014; 9:72. [PMID: 24606890 PMCID: PMC3995916 DOI: 10.1186/1748-717x-9-72] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 03/02/2014] [Indexed: 11/12/2022] Open
Abstract
Purpose We aim to evaluate the effects of multileaf collimator (MLC) leaf width (5 mm vs. 2.5 mm) on the radiosurgery planning for the treatment of spine lesions according to the modulated techniques (intensity-modulated radiotherapy [IMRT] vs. volumetric-modulated arc therapy [VMAT]) and the complexity of the target shape. Methods For this study, artificial spinal lesions were contoured and used for treatment plans. Three spinal levels (C5, T5, and L2 spines) were selected, and four types of target shapes reflecting the complexity of lesions were contoured. The treatment plans were performed using 2.5-mm and 5-mm MLCs, and also using both static IMRT and VMAT. In total, 48 treatment plans were established. The efficacy of each treatment plan was compared using target volume coverage (TVC), conformity index (CI), dose gradient index (GI), and V30%. Results When the 5-mm MLC was replaced by the 2.5-mm MLC, TVC and GI improved significantly by 5.68% and 6.25%, respectively, while CI did not improve. With a smaller MLC leaf width, the improvement ratios of the TVC were larger in IMRT than VMAT (8.38% vs. 2.97%). In addition, the TVC was improved by 14.42-16.74% in target type 4 compared to the other target types. These improvements were larger in IMRT than in VMAT (27.99% vs. 6.34%). The V30% was not statistically different between IMRT and VMAT according to the MLC leaf widths and the types of target. Conclusion The smaller MLC leaf width provided improved target coverage in both IMRT and VMAT, and its improvement was larger in IMRT than in VMAT. In addition, the smaller MLC leaf width was more effective for complex-shaped targets.
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Affiliation(s)
| | | | - Seok Hyun Son
- Department of Radiation Oncology, Incheon St, Mary's hospital, College of Medicine, the Catholic University of Korea, Incheon, Korea.
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Gasbarrini A, Boriani S, Capanna R, Casadei R, Di Martino A, Silvia Spinelli M, Papapietro N, Piccioli A. Management of patients with metastasis to the vertebrae: recommendations from the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Expert Rev Anticancer Ther 2013; 14:143-50. [DOI: 10.1586/14737140.2014.856532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dasenbrock HH, Pradilla G, Witham TF, Gokaslan ZL, Bydon A. The Impact of Weekend Hospital Admission on the Timing of Intervention and Outcomes After Surgery for Spinal Metastases. Neurosurgery 2012; 70:586-93. [DOI: 10.1227/neu.0b013e318232d1ee] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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10
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Abstract
Persistent axial pain with or without neurologic changes should prompt workup for a possible tumor of the spine. Metastatic disease is more predominant than primary tumors, but still needs adequate evaluation before any management. The various steps of evaluation, diagnosis, and staging are reviewed.
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Affiliation(s)
- Rakesh Donthineni
- Spine and Orthopaedic Oncology, 5700 Telegraph Avenue, Suite 100, Oakland, CA 94609, USA.
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