Spondylectomy in the treatment of neoplastic spinal lesions - A retrospective outcome analysis of 582 patients using a patient-level meta-analysis

Feasibility of ADC histogram analysis for predicting of postoperative recurrence in aggressive spinal tumors

Background

Risk stratification of spinal tumors is a major unmet clinical need for personalized therapy.

Purpose

To explore the feasibility of pretreatment whole-lesion apparent diffusion coefficient (ADC) histogram in predicting local recurrence of aggressive spinal tumors.

Methods

119 aggressive spinal tumor patients (median age, 40; range, 13-74  years) confirmed by pathological findings with a mean follow-up of 36 months were enrolled and divided into the recurrence and non-recurrence group. The histogram metrics of whole-lesion, including the maximum, mean, kurtosis, skewness, entropy, and percentiles (10th, 25th, 50th, 75th, 95th) ADC values, were evaluated and take the average. Fractal dimension (FD) was assessed in the three orthogonal directions and take maximum. Clinical and general imaging features were used to construct an alternative prognostic model for comparison. Variables with statistical differences would be included in stepwise logistic regression analysis.

Results

As for the clinical model, Enneking staging (odds ratio [OR]: 3.572; P = 0.04) and vertebral compression (OR: 4.302; P = 0.002) were independent predictors of recurrence. There was no statistical difference in FD between the two groups (P = 0.623). Among the ADC histogram parameters compared, skewness, maximum, and mean ADC values were independent risk factors and constructed ADC histogram prediction models. The ADC histogram model (AUC = 0.871) and the combined model (AUC = 0.884) performed better than the clinical prediction model (AUC = 0.704) with P-values of 0.004 and 0.001, respectively.

Conclusion

Prediction models based on the ADC histogram analysis might represent serviceable instruments for the aggressive spinal tumors.

En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the "rotation-reversion" technique: Feasibility, safety, and clinical outcome of 11 cases

BACKGROUND

En bloc resection of spinal tumors provides better local control and survival outcomes than intralesional resection. Safe margins during en bloc resection of primary spinal tumors with epidural involvement are required for improved outcomes. The present study describes a "rotation-reversion" technique that has been used for en bloc resection of huge primary tumors in the mobile spine with epidural involvement and reported the clinical outcomes in these patients.

METHODS

All patients with primary spinal tumors who were treated with the rotation-reversion technique at our institution between 2015 and 2021 were evaluated retrospectively. Of the patients identified, those with both huge extraosseous soft-tissue masses and epidural involvement were selected for a case review. Clinical and radiological characteristics, pathologic findings, operative procedures, complications, and oncological and functional outcomes of these patients were reviewed.

RESULTS

Of the 86 patients identified with primary spinal tumors who underwent en bloc resection using the rotation-reversion technique between 2015 and 2021, 11 had huge extraosseous soft-tissue masses with epidural involvement in the mobile spine. The average maximum size of these 11 tumors was 8.1 × 7.5 × 9.7 cm. Median follow-up time was 28.1 months, mean operation time was 849.1 min (range 465-1,340 min), and mean blood loss was 6,972.7 ml (range 2,500-17,700 ml), with 10 (91%) of the 11 patients experiencing perioperative complications. The negative margin rate was 91%, with only one patient (9%) experiencing local recurrence. Ten patients were able to walk normally or with a crutch at the last follow-up, whereas one was completely paralyzed preoperatively.

CONCLUSION

The rotation-reversion technique is an effective procedure for the en bloc resection of huge primary spinal tumors, with the extension of invasion in selected patients including not only the vertebral body but also the pedicle and part of the posterior arch.