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Chen JW, Chanbour H, Bowers M, Bendfeldt GA, Gangavarapu LS, Jonzzon S, Roth SG, Abtahi AM, Zuckerman SL, Stephens BF. Does Preoperative Bilsky Score Predict Outcome Following Surgical Resection of Primary Tumors of the Spine? World Neurosurg 2024; 184:e111-e120. [PMID: 38244684 DOI: 10.1016/j.wneu.2024.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE In patients undergoing surgery for primary bone tumors of the spine, we sought to compare Bilsky score 0-1 versus 2-3 in: 1) preoperative presentation, 2) perioperative variables, and 3) long-term outcomes. METHODS A single-center, retrospective cohort study was undertaken of patients undergoing surgery for extradural, primary bone tumors of the spine between January 2010 and January 2021. The primary exposure variable was Bilsky score, dichotomized as 0-1 versus 2-3. Survival analysis was performed to assess local recurrence (LR) and overall survival (OS). RESULTS Of 38 patients undergoing resection of primary spinal tumors, 19 (50.0%) patients presented with Bilsky 0-1 and 19 (50.0%) Bilsky 2-3 grades. The most common diagnosis was chondrosarcoma (33.3%), followed by chordoma (16.7%). There were 15 (62.5%) malignant tumors. Preoperatively, there was no significant difference in demographics, Karnofsky Performance Scale (KPS) (P > 0.999), or motor deficit (P > 0.999). Perioperatively, no difference was found in operative time (P = 0.954), blood loss (P = 0.416), length of stay (P = 0.641), neurologic deficit (P > 0.999), or discharge disposition (P = 0.256). No difference was found in Enneking resection status (69.2% vs. 54.5%, P = 0.675). Long-term, no differences were found regarding reoperation (P = 0.327), neurologic deficit (P > 0.999), postoperative KPS (P = 0.605) and modified McCormick Scale (MMS) (P = 0.870). No difference was observed in KPS (P = 0.418) and MMS (P = 0.870) at last follow-up. However, patients with Bilsky 2-3 had shorter time to LR (1715.0 vs. 513.0 ± 633.4 days, log-rank; P = 0.002) and shorter OS (2025.0 ± 1165.3 vs. 794.0 ± 952.6 days, log-rank; P = 0.002). CONCLUSIONS Bilsky 2-3 lesions were associated with shorter time to LR and shorter OS. Patients harboring primary spinal tumors with higher grade Bilsky score appear to be at a higher risk for worse outcomes.
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Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mitchell Bowers
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Nigro R, Scogna AA, Intraina D, Toccaceli G, Ieraci A, Zotta DC. Acute onset of paraplegia due to melanocytic cervicodorsal lesion. Surg Neurol Int 2021; 12:21. [PMID: 33598337 PMCID: PMC7881505 DOI: 10.25259/sni_878_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Melanocytomas are rare pigmented tumors of the central nervous system (CNS). They are more frequent in females in their fifties and are typically benign, but locally aggressive lesions that very are rarely found in the spine. They can occur in all the age groups. Case Description: A 62-year-old male presented with acute paraplegia a attributed to a C7-T1 intradural extramedullary melanocytoma. Urgent surgery, consisting of subtotal removal of the lesion, resulted in subtotal recovery of motor function with full resolution of his sensory deficit. Histologically, the lesion proved to be a melanocytoma. Conclusion: Rarely, patients with intradural extramedullary melanocytomas of the spine may present with acute paralytic deficits warranting emergent surgical intervention.
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Affiliation(s)
- Raffaele Nigro
- Department of Emergency Neurosurgery, Pescara Hospital, Pescara, Abruzzo, Italy
| | | | - Daniele Intraina
- Department of Emergency Neurosurgery, Pescara Hospital, Pescara, Abruzzo, Italy
| | - Giada Toccaceli
- Department of Emergency Neurosurgery, Pescara Hospital, Pescara, Abruzzo, Italy
| | - Alfio Ieraci
- Department of Pathology, Pescara Hospital, Pescara, Abruzzo, Italy
| | - Donato Carlo Zotta
- Department of Emergency Neurosurgery, Pescara Hospital, Pescara, Abruzzo, Italy
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Quraishi NA, Boriani S, Sabou S, Varga PP, Luzzati A, Gokaslan ZL, Fehlings MG, Fisher CG, Dekutoski MB, Rhines LD, Reynolds JJ, Germscheid NM, Bettegowda C, Williams RP. A multicenter cohort study of spinal osteoid osteomas: results of surgical treatment and analysis of local recurrence. Spine J 2017; 17:401-408. [PMID: 27765711 DOI: 10.1016/j.spinee.2016.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 07/27/2016] [Accepted: 10/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal osteoid osteomas are benign primary tumors arising predominantly from the posterior column of the spine. These "osteoblastic" lesions have traditionally been treated with intralesional excision. PURPOSE The purpose of the present study was to review the treatment and local recurrence rates for symptomatic spinal osteoid osteomas. STUDY DESIGN/SETTING Multicenter ambispective cross-sectional observational cohort study. PATIENT SAMPLE During the study period, a total of 84 patients (65 males, 19 females) were diagnosed with a spinal osteoid osteoma and received surgical treatment. The mean age at surgery was 21.8 ± 9.0 years (range: 6.7-52.4 years) and the mean follow-up was 2.7 years (13 days-14.5 years). OUTCOME MEASURES Local recurrence, perioperative morbidity, and cross-sectional survival. METHODS Using the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated osteoid osteoma cases were identified. Patient demographic, clinical and diagnostic, treatment, local recurrence, perioperative morbidity, and cross-sectional survival data were collected and retrieved. Descriptive statistics were summarized using mean/standard deviation or frequency/percentage. RESULTS In our study, most of the tumors were localized in the mobile spine (81 of 84 [96%]); all patients reported pain as a symptom. According to the postoperative assessment, 10 (12%) patients received an en bloc resection with marginal or wide margins, whereas two (2%) patients received en bloc resections with intralesional margins, 69 (82%) patients were treated by piecemeal "intralesional" resection, and three (4%) patients were not assessed. A total of six patients (7%) experienced a local recurrence, all of which occurred in patients who had received an intralesional resection. CONCLUSIONS Benign bone-forming tumors of the spine are uncommon. Most patients in our series underwent a piecemeal resection with intralesional margins. This remains safe with a low local recurrence rate. En bloc excision may provide more chance of complete excision of the nidus but is not mandatory. The importance of complete excision of the nidus cannot be overemphasized.
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Affiliation(s)
- Nasir A Quraishi
- Centre for Spinal Studies and Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
| | - Stefano Boriani
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, via G.C.Pupilli, 1 - 40136 Bologna, Italy
| | - Silviu Sabou
- Centre for Spinal Studies and Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | - Peter P Varga
- The National Center for Spinal Disorders Budapest, Királyhágó u. 1, 1126, Hungary
| | - Alessandro Luzzati
- Centro di Chirurgia Ortopedica Oncologica e Ricostruttiva del Rachide Istituto Orthopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst St, Toronto, ON M5T 2S8, Canada
| | - Charles G Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, Blusson Spinal Cord Centre, University of British Columbia, 6th Floor, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Mark B Dekutoski
- Department of Orthopaedic Surgery, The CORE Institute, 14520 W Granite Valley Dr #210, Sun City West, AZ 85375, USA
| | - Laurence D Rhines
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 442, Houston, TX 77030, USA
| | - Jeremy J Reynolds
- Spinal Division, Nuffield Orthopedic Centre, University of Oxford, Windmill Road, Headington, Oxford OX3 7HE, UK
| | - Niccole M Germscheid
- Research Department, AOSpine International, Clavadelerstrasse, 87270 Davos Platz, Switzerland
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Richard P Williams
- Princess Alexandra Hospital, 237 Ipswich Rd, Woolloongabba, QLD 4102, Australia
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Tsuji T, Chiba K, Watanabe K, Ishii K, Nakamura M, Nishiwaki Y, Matsumoto M. Differentiation of spinal giant cell tumors from chordomas by using a scoring system. Eur J Orthop Surg Traumatol 2016; 26:779-84. [PMID: 27449029 DOI: 10.1007/s00590-016-1819-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Few reports have compared the clinical features and imaging characteristics of giant cell tumor and chordoma of the spine. The aim of the present study was to investigate whether the two types of tumors could be differentially diagnosed, by comparing clinical characteristics as well as magnetic resonance imaging (MRI) or computed tomography (CT) findings and then scoring the characteristic findings. METHODS A total of 18 patients were retrospectively assessed. To elucidate the characteristic findings, we investigated the following 10 items: age at diagnosis, sex, and site of occurrence; for MRI findings, the pattern of tumor expansion, T1-weighted images, T2-weighted images, septal structure, and cystic changes; and for CT findings, calcification or residual bone fragments and incomplete bone shells. Then, we developed a unique scoring system and investigated whether the two tumors could be differentiated by this scoring system. RESULTS Six items, including, age, site of occurrence, tumor expansion pattern, T2-weighted images, septal structure, and incomplete bone shells, were significantly different between giant cell tumor and chordoma patients. By using newly developed scoring system, the mean scores of 0.9 ± 0.6 (range 0-2) for giant cell tumor and 4.8 ± 1.5 (range 3-6) for chordoma patients were significantly different (P < 0.001), thereby allowing the differential diagnosis by setting the cutoff value to three. CONCLUSIONS We found that the six items were useful for differentially diagnosing giant cell tumor and chordoma. These results indicate that it may be possible to distinguish the two types of tumor by scoring these items.
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Affiliation(s)
- Takashi Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan. .,Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, 160-8582, Japan. .,Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kazuhiro Chiba
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.,Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.,Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.,Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yuji Nishiwaki
- Division of Environmental and Occupational Health, Department of Social Medicine, Faculty of Medicine, Toho University, 5-21-16 Ohmorinishi, Ohta-ku, Tokyo, 143-8540, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.,Keio Spine Research Group (KSRG), 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Halevi PD, Ramirez-de-Noriega F, Fellig Y, Gomori JM, Cohen JE, Itshayek E. Primary pleomorphic liposarcoma of the thoracic epidural space: case report. Spine J 2015; 15:e71-5. [PMID: 26343245 DOI: 10.1016/j.spinee.2015.08.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pleomorphic liposarcoma (PLS) is a rare malignant soft tissue tumor comprising 5%-15% of liposarcomas and characterized by high malignant potential. To our knowledge only three cases of this entity have been reported in the spine. PURPOSE We describe the only reported case of a purely epidural PLS with no macroscopic bone involvement at diagnosis. STUDY DESIGN/SETTING A case presenting clinical evidence that PLS may arise from the epidural fat is reported. METHODS The clinical presentation, management, and outcome in a case of primary PLS of the thoracic spine, and a review of the literature, are presented. RESULTS A 70-year-male presented with sudden onset lower extremity weakness, constipation, and back pain. Magnetic resonance imaging revealed an epidural lesion at T5 with noted mass effect compressing the spinal cord and extension to the T5-T6 foramen. Urgent decompressive laminectomy with gross total resection was performed. Histopathology revealed high-grade PLS. Adjunct radiotherapy was prescribed. The tumor recurred 3 months later. In spite of repeat surgery, additional radiation, and chemotherapy, the patient developed widespread metastases and succumbed to his disease 1 year after treatment began. CONCLUSIONS Spinal PLS is a rare entity, but nonetheless may arise from epidural fat and should be considered in the differential diagnosis of primary spinal cord lesions.
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Affiliation(s)
- P David Halevi
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel
| | | | - Yakov Fellig
- Department of Pathology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel
| | - José E Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel
| | - Eyal Itshayek
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
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Jung YS, Kim SH, Ha SK, Kim SD, Lim DJ. Triple primary origin tumor: a case report. Korean J Spine 2014; 10:91-3. [PMID: 24757467 PMCID: PMC3941720 DOI: 10.14245/kjs.2013.10.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/23/2013] [Accepted: 05/31/2013] [Indexed: 11/19/2022]
Abstract
Generally, among the extradural spinal tumors, metastatic spinal tumor is much more common than primary spinal tumors. Thus, in the case of a spinal tumor patient with cancer history (such as lung cancer, breast cancer, etc.), we used to infer that the spinal lesion is the metastasis from, primary malignancy. We introduce an experience of a case of triple primary origin tumor in a 57-year-old man. When the spinal lesion was found on the abdominal computed tomography scan, he already had a history of colon cancer and liver cancer. Initially, it was thought that the lesion would probably be a metastatic tumor from the liver or colon cancers, and the operation was performed accordingly. In the pathologic final report, however, the mass was proven to plasmacytoma - the third primary lesion. The patient underwent chemotherapy after surgery. Globally, the triple primary origin tumor has been reported very rarely. With this report, we wish to emphasize the necessity of pathologic confirmation and adequate treatment even in a patient with known malignancies.
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Affiliation(s)
- Yong-Su Jung
- Department of Neurosurgery, Ansan Hospital, Korea University School of Medicine, Ansan, Republic of Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Ansan Hospital, Korea University School of Medicine, Ansan, Republic of Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Ansan Hospital, Korea University School of Medicine, Ansan, Republic of Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Ansan Hospital, Korea University School of Medicine, Ansan, Republic of Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Ansan Hospital, Korea University School of Medicine, Ansan, Republic of Korea
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