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Wei R, Sun K, Guo W, Ji T, Yu Y, Du Z, Yang Y, Tang X. Two-step osteotomy/discectomy through cannulated screw (TOCS) technique for en bloc resection of spine tumor: surgical technique and preliminary results. 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 2024; 33:1941-1949. [PMID: 38418739 DOI: 10.1007/s00586-024-08136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE We have developed a novel technique for osteotomy/discectomy during en bloc resection of spine tumors named two-step osteotomy/discectomy through cannulated screw (TOCS). This study aims at describing the procedure of TOCS technique and assessing its efficiency and safety. METHODS We retrospectively reviewed fourteen patients who underwent en bloc resection for spine tumors using TOCS technique in our center between August 2018 and September 2022. The technique was based on a specially designed "slotted" cannulated screw which was a cannulated screw with a longitudinal slot to provide the accessibility of T-saw. During osteotomy/discectomy, the "slotted" cannulated screw was inserted obliquely along the plane between the dura and the posterior wall of spine in light of the planned osteotomy/discectomy plane under routine fluoroscopic imaging guidance. The T-saw was introduced through the screw, and the osteotomy/discectomy was performed sequentially in two steps under the guidance of the screw by turning the slot away and toward the dura. The intra-/perioperative complication, neurological function (determined by Frankel grading), surgical margin (determined by a pathologist using AJCC R system), follow-up details were documented. RESULTS The mean duration of surgery was 599.3 (360-890) min with a mean volume of intra-operative hemorrhage of 2021.4 (800-5000) mL. The intra-/perioperative complications were found in four patients (28.6%). R0 and R1 resections were achieved in nine and five patients, respectively. There was no R2 resection. After a mean follow-up period of 30.6 (10-67) months, all patients were alive except one patient died ten months after surgery due to unrelated cause. No recurrence and implant failure were found. Thirteen patients (92.9%) exhibited completely normal neurological function same as their preoperative neurological status. CONCLUSION Using TOCS technique can facilitate a precise, complete and safe osteotomy/discectomy procedure during en bloc resection for spine tumor without the aid of intra-operative navigation.
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Affiliation(s)
- Ran Wei
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China
| | - Kunkun Sun
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China
| | - Yiyang Yu
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South St., Xicheng District, Beijing, 100044, China.
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Paholpak P, Wisanuyotin T, Sirichativapee W, Sirichativapee W, Kosuwon W, Wongratanacheewin J, Sangsin A, Kasai Y, Murakami H. Clinical results of total en bloc spondylectomy using a single posterior approach in spinal metastasis patients: Experiences from Thailand. Asia Pac J Clin Oncol 2023; 19:96-103. [PMID: 35590383 DOI: 10.1111/ajco.13778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 01/20/2023]
Abstract
AIM To demonstrate a single posterior approach, total en bloc spondylectomy (TES) could be performed safely without preoperative embolization in spinal metastasis patients. MATERIALS AND METHODS Thirteen solitary spinal metastasis patients (five males) underwent single posterior approach TES at the thoracolumbar spine without preoperative embolization from January 2018 to January 2020. The primary sites were the breast (n = 4), hepatocellular carcinoma (n = 2), colon (n = 2), and others (n = 5). All patients underwent single posterior TES. The Eastern Cooperative Oncology Group, Frankel neurological status, operative time and blood loss, and any complications were all recorded. The patients were regularly followed-up with radiography, computed tomography, and magnetic resonance imaging to detect any local recurrences. RESULTS The mean operative time was 354.6 min, and the mean operative blood loss was 2134.62 ml. None of the patients experienced any perioperative complications. Within the follow-up period (3-24 months), no local recurrences were detected. Two patients (15.38%) were found to have distant metastasis to adjacent and remote vertebrae. Three patients were lost to follow-up, and three patients died of disease. Six patients showed an improved ECOG functional status by at least one grade. Four of Frankel A patients improved their neurological status by at least one grade. CONCLUSION Even without embolization, single posterior TES at the thoracolumbar spine is safe and effective for short-term local control in solitary spinal metastasis. However, TES cannot prevent distant metastasis. Longer-term follow-up studies will be able to further identify the benefits of TES for the long-term local control of diseases.
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Affiliation(s)
- Permsak Paholpak
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Taweechok Wisanuyotin
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Winai Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Wilasinee Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Weerachai Kosuwon
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Janista Wongratanacheewin
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Apiruk Sangsin
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - Yuichi Kasai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Musculoskeletal Oncology Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Carroll AM, Kim KG, Walters ET, Phillips BK, Singh B, Dekker PK, Steinberg JS, Attinger CE, Kim PJ, Evans KK. Glove and instrument changing to prevent bacterial contamination in infected wound debridement and closure procedures: A prospective observational study. Int Wound J 2021; 18:664-669. [PMID: 33955150 PMCID: PMC8450785 DOI: 10.1111/iwj.13568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022] Open
Abstract
Many surgeons use a single table of instruments for both excisional debridement and coverage/closure of infected wounds. This study investigates the effectiveness of a two-table set-up of sterile instruments, in addition to glove exchange, to reduce instrument cross-contamination during these procedures. This is a prospective, single-site, institutional review board-approved observational study of surgical debridements of infected wounds over a 17-month period. Two separate sterile surgical tables were used for each case: Table A for initial wound debridement (debridement set-up) and Table B for wound coverage/closure (clean set-up). Swabs of each table and its respective instruments were taken after debridement but prior to coverage/closure. The primary outcome of interest was bacterial growth at 48 hours. There were 72 surgical cases included in this study. Culture results of Table A demonstrated bacterial growth in 23 of 72 (32%) cases at 48 hours compared with 5of 72 (7%) from Table B (P = .001). These data suggest that there is significant bacterial contamination of surgical instruments used for debridement of infected wounds. Use of a two-table set-up reduced instrument cross-contamination by 78%, suggesting avoidable re-contamination of the wound.
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Affiliation(s)
| | - Kevin G Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elliot T Walters
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Brian K Phillips
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Brinder Singh
- MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paige K Dekker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John S Steinberg
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paul J Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Blaauwgeers H, Russell PA, Jones KD, Radonic T, Thunnissen E. Pulmonary loose tumor tissue fragments and spread through air spaces (STAS): Invasive pattern or artifact? A critical review. Lung Cancer 2018; 123:107-111. [PMID: 30089579 DOI: 10.1016/j.lungcan.2018.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/08/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
The concept of loose tumor tissue fragments as a pattern of invasion in lung carcinoma has recently been proposed and is included in the 2015 WHO fascicle on the classification of lung tumors, so-called "spread through airs paces" or STAS. This inclusion is controversial, as there are significant data to support that this histologic finding represents an artifact of tissue handling and processing rather than a pattern of invasion. These data are summarized in this review. These data are summarized in this review and support the conclusion that the inclusion of STAS in the WHO classification for lung cancer as a pattern of invasion was premature and erroneous. In our opinion, these tumor cell clusters or loose cells appear to be simply an artifact, although one which may or may not pinpoint to a high-grade tumor with discohesive cells and adverse prognosis.
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Affiliation(s)
- Hans Blaauwgeers
- Department of Pathology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Prudence A Russell
- Department of Anatomical Pathology, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, Victoria, Australia
| | - Kirk D Jones
- Department of Pathology, UCSF Medical Center, 550 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Teodora Radonic
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Afsoun S, Saied SA, Amir N, Hamed J. En-bloc Resection of a Giant Cell Tumor Causing Cervical Vertebral Collapse. Asian J Neurosurg 2018; 13:150-153. [PMID: 29492149 PMCID: PMC5820874 DOI: 10.4103/1793-5482.181136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Giant cell tumors (GCTs) are rare, benign, and locally aggressive primary bone neoplasms. Spine is seldom affected, especially above the level of sacrum. In this report, we describe a case with GCT of the cervical vertebrae which causes collapse of the corpus. A 32-year-old female presented with gradual neck pain and abrupt paresthesia of the left hand. Computed tomography scan showed C6 vertebral collapse and magnetic resonance imaging demonstrated vertebral plana of C6 by a low signal intensity lesion on T1- and T2-weighted images. Emergent surgical intervention was taken due to the possibility of spinal injury. The tumor was removed by en-bloc resection and histopathological investigation confirmed GCT. In most of the cases, en-bloc resection of GCTs of the spine is not feasible. Despite the location and close contact of the lesion with spinal cord, later approach was successful for our case; thus, appropriate differential diagnosis for vertebral column lesions as well as selecting an optimum treatment is mandatory.
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Affiliation(s)
- Seddighi Afsoun
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seddighi Amir Saied
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nikouei Amir
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javadian Hamed
- Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abdel-Wanis MES, Tsuchiya H, Kawahara N, Tomita K. EFFICACY OF CYTOTOXIC AGENTS FOR PREVENTION OF TUMOR GROWTH AFTER TUMOR CONTAMINATION AND BLOCKS INOCULATION: AN IN VIVO COMPARATIVE STUDY OF CISPLATIN AND DISTILLED WATER, POVIDONE IODINE, HYDROGEN PEROXIDE AND SALINE IN ATHYMIC MICE. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0218957705001552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We tested the efficacy of 4 local agents for protection against tumor growth after tumor contamination and tumor bloc inoculation. Tumors were prepared by injecting human HT-1080 fibrosarcoma cells into the subcutaneous tissue of 6–9 week old male athymic nude mice (BALB/c nu/nu). When the tumors reached the desired size, the nude mice were sacrificed, and the tumors were harvested en bloc. Then the tumors were used in either contamination group or tumor inoculation group. In the contamination group, 34 tumors were cut by Gigli saw (Group G) and 35 tumors were cut by No. 11 scalpel (Group S). The cut surface of the tumor was rubbed into the subcutaneous tissues of non-tumor bearing nude mice for 10 seconds. Then, the nude mice from the S and G groups were randomized into either one of five subgroups: groups S–N and G–N: no local agent was used, groups S–S and G–S: lavage by saline, groups S–P and G–P: lavage by povidone iodine 10%, groups S–H and G–H: lavage by hydrogen peroxide 3%, groups S–C and G–C: lavage by cisplatin and distilled water. In the tumor inoculation group, a tumor weight of 100 mg was inoculated into 32 non-tumor bearing nude mice. Then, the nude mice were randomized into either of 5 subgroups: group B–N: no local agent was used, group B–S: lavage by saline, group B–P: lavage by povidone iodine 10%, group B–H: lavage by hydrogen peroxide, group B–C: lavage by cisplatin and distilled water. For lavage, the fluid was kept in the wound for 5 minutes apart from the cisplatin which was kept in the wound for 2.5 minutes and then the wound was filled with distilled water for the next 2.5 minutes. Tumor growth occurred in S–N, S–S, S–H, S–P and S–C groups in 33.3%, 67.7%, 16.7%, 16.7%, and 0% respectively. Tumor growth occurred in G–N, G–S, G–H, G–P, and G–C groups in 50%, 67.7%, 33.3%, 33.3%, and 0%, respectively. The total growth incidence after tumor contamination in the no-agent, saline, hydrogen peroxide, povidone iodine and cisplatin groups were 41.7%, 58.3%, 25%, 25% and 0%, respectively. Growth occurred in 100% of B–N and B–S groups, 83% of B–H and B–P groups and 33.3% of the B–C group. Cisplatin used for 2.5 minutes followed by distilled water for 2.5 minutes is effective for protection against local tumor recurrence due to tumor contamination. It also has a reasonable effect against tumor blocks.
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Affiliation(s)
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Norio Kawahara
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Katsuro Tomita
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
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Demura S, Kawahara N, Murakami H, Abdel-Wanis ME, Kato S, Yoshioka K, Tomita K, Tsuchiya H. Total en bloc spondylectomy for spinal metastases in thyroid carcinoma. J Neurosurg Spine 2010; 14:172-6. [PMID: 21184643 DOI: 10.3171/2010.9.spine09878] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Thyroid carcinoma generally has a favorable prognosis, and patients rarely present with distant metastases. Authors of several studies have proposed piecemeal resection for spinal metastases in thyroid carcinoma; however, few have analyzed the impact of local curative surgery such as total en bloc spondylectomy (TES) for thyroid carcinoma. The purposes of the present study are to determine the strategy of surgical treatment for spinal metastases of thyroid carcinoma and to evaluate the surgical results of and the prognosis associated with TES. METHODS Twenty-four cases of spinal metastases were retrospectively reviewed. The patients included 16 women and 8 men, with a mean age of 60.7 years. Histological examination showed follicular carcinoma in 15 cases, papillary carcinoma in 8, and medullary carcinoma in 1. Total en bloc spondylectomy was performed in 10 cases; debulking surgery, such as piecemeal excision or eggshell curettage, was performed in 14. The average follow-up time was 55 months (12-180 months). RESULTS Four patients had no evidence of disease, 8 were alive with the disease, and 12 had died of the disease. The overall survival rate from the time of surgery was 74% at 5 years. Patients with visceral metastases had a significant, higher risk of death. The survival rate of patients following TES was 90% at 5 years, which was higher than the rate in patients who underwent debulking surgery (63%). However, no significant difference was observed between the 2 types of surgery. There was a local recurrence after debulking surgery in 8 (57%) of 14 cases. Because of the recurrences, reoperation was required after a mean of 41 months. In contrast, there was a local recurrence after TES in only 1 (10%) of 10 cases. The difference between debulking surgery and TES regarding local recurrence was statistically significant. CONCLUSIONS Total en bloc spondylectomy with enough of a margin provided favorable local control of spinal metastases of thyroid carcinoma during a patient's lifetime.
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Affiliation(s)
- Satoru Demura
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
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Modified total en bloc spondylectomy in thoracic vertebra tumour. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:655-60. [PMID: 21076844 DOI: 10.1007/s00586-010-1618-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 10/22/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
Abstract
Total en bloc spondylectomy (TES) for vertebral tumour was previously reported by Tomita through a single posterior approach using a T-saw. A modified total en bloc spondylectomy (MTES) technique is reported in the present study. The disc puncture needle with a sleeve was used to obliquely puncture from the posterior to the anterior direction. A T-saw was inserted through the sleeve and led out to the operator's side by the leading clamp. The disc was partially cut with the saw from its medial to lateral aspect. After a spinal fixation rod was applied on the operator's side, the residual discs on the opposite side were cut as described above. Six patients with thoracic vertebral tumours were operated on using the MTES technique. Five patients showed improvement in their neurological deficits postoperatively. There was no evidence of tumour recurrence at the final follow-up. The MTES is technically feasible with improved practicality and safety.
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Cloyd JM, Acosta FL, Polley MY, Ames CP. En Bloc Resection for Primary and Metastatic Tumors of the Spine. Neurosurgery 2010; 67:435-44; discussion 444-5. [DOI: 10.1227/01.neu.0000371987.85090.ff] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
The efficacy of en bloc resection for spinal tumors is unknown because most of the current evidence is provided by small, single-institution clinical series or case reports.
OBJECTIVE
To combine all previously published reports of en bloc resection for primary and metastatic spinal tumors, to describe the overall pattern of disease-free survival, and to investigate potentially prognostic factors for recurrence.
METHODS
A complete MEDLINE search for all articles reporting survival data for en bloc resection of spinal tumors was undertaken; 44 articles met inclusion criteria from which 306 eligible patients were identified.
RESULTS
There were 229 cases of primary tumors with a mean follow-up of 65.0 months and 77 cases of solitary metastatic tumors with a mean follow-up of 26.5 months. Median time to recurrence was 113 months for the primary group and 24 months for the metastatic group. Disease-free survival rates at 1, 5, and 10 years were 92.6%, 63.2%, and 43.9%, respectively, for the primary group and 61.8%, 37.5%, and 0%, respectively, for the metastatic group; 5-year disease-free survival rates were 58.4% for chordoma and 62.9% for chondrosarcoma. After adjusting for covariates, age, male sex, metastatic tumors, and osteosarcomas were significantly associated with a tumor recurrence.
CONCLUSION
This study provides the largest published series of patients undergoing en bloc resection for spinal tumors. Median time to recurrence reached almost 10 years in patients with primary tumors; however, it was only 2 years in those with isolated metastatic tumors.
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Affiliation(s)
- Jordan M. Cloyd
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Frank L. Acosta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Mei-Yin Polley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Christopher P. Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Hsieh PC, Li KW, Sciubba DM, Suk I, Wolinsky JP, Gokaslan ZL. Posterior-Only Approach For Total En Bloc Spondylectomy For Malignant Primary Spinal Neoplasms: Anatomic Considerations and Operative Nuances. Oper Neurosurg (Hagerstown) 2009; 65:173-81; discussion 181. [DOI: 10.1227/01.neu.0000345630.47344.17] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
MALIGNANT PRIMARY SPINAL tumors are rare tumors that are locally invasive and can metastasize. The majority of these tumors have a poor response rate to chemotherapy and conventional radiotherapy. Studies have shown that long-term survival and the potential for cure is best achieved with en bloc surgical excision of these tumors with negative surgical margins. Total en bloc spondylectomy involves removal of vertebral segment(s) in whole to achieve wide tumor excision. Total en bloc spondylectomy can be performed through staged or combined anterior and posterior approaches, or from a posterior-only approach. The posterior-only approach offers the advantage of achieving complete tumor excision and circumferential spinal reconstruction in a single setting. In this report, we discuss the operative management of malignant primary vertebral tumors using the posterior-only approach for total en bloc spondylectomy. The oncological considerations and surgical nuances that allow for safe but aggressive surgical excision of primary spinal tumors to achieve favorable oncological and neurological outcomes are highlighted.
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Affiliation(s)
- Patrick C. Hsieh
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Khan W. Li
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian Suk
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cloyd JM, Chou D, Deviren V, Ames CP. En bloc resection of primary tumors of the cervical spine: report of two cases and systematic review of the literature. Spine J 2009; 9:928-35. [PMID: 19716772 DOI: 10.1016/j.spinee.2009.07.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 07/02/2009] [Accepted: 07/21/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Survival data and rates of recurrence after en bloc resection for cervical spinal tumors are limited to single case reports and small case series, making the true risk of recurrence after this procedure unknown. PURPOSE To report two cases of cervical chordoma managed via en bloc resection. To conduct a systematic review of the existing literature to determine the overall incidence of disease-free survival and investigate potential prognostic factors of recurrence. STUDY DESIGN Case report and systematic review. METHODS We present the cases of a 60-year-old woman and a 76-year-old man who underwent en bloc resection of C3-C6 and C2 chordomas, respectively. A complete MEDLINE search was then undertaken for all articles reporting survival data for en bloc resections of primary tumors of the cervical spine. Exclusion criteria included non-English articles, lack of explicit mention or description of en bloc technique, age less than 16, no demographic or survival information reported, and follow-up less than 1 month. Survivorship analysis was conducted, and Kaplan-Meier plots were created with the primary outcome of interest being any tumor recurrence. RESULTS A total of 10 articles comprising 18 cases were included for analysis with a mean follow-up of 47.4+/-41.5 months. Mean operative time, estimated blood loss, and length of hospitalization were 18.6 hours, 2.9L, and 34.6 days, respectively. Postoperative complications occurred in eight of the nine patients in which these data were reported. There were three cases of local recurrence, occurring at 12, 44, and 113 months, and one case of distant metastasis, occurring at 12 months postoperatively. With the available data, 1- and 5-year disease-free survival rates of 88.2% and 73.5% were calculated. On Cox proportional hazards analysis, no factors were found to be predictive of recurrence. CONCLUSIONS In this systematic review of the literature, en bloc resection provided good disease-free survival rates in patients with primary tumors of the cervical spine. However, there are insufficient data on long-term subjective outcomes in these patients, and larger series are needed to determine the efficacy compared with piecemeal resection techniques. Other investigators should be encouraged to publish their results so that combined analyses like these may be performed with larger sample sizes.
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Affiliation(s)
- Jordan M Cloyd
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, Box 0112, San Francisco, CA 94143, USA
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Kawahara N, Tomita K, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: surgical techniques and related basic background. Orthop Clin North Am 2009; 40:47-63, vi. [PMID: 19064055 DOI: 10.1016/j.ocl.2008.09.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors' group has developed a new surgical technique of spondylectomy (vertebrectomy) called "total en bloc spondylectomy" (TES). This technique is different from spondylectomy in that it involves en bloc removal of the lesion, that is, removal of the whole vertebra, body and lamina, as one compartment. The surgical technique of TES has been remarkably improved based on adequate knowledge and consideration of the surgical anatomy, physiology, and biomechanics of the spine and spinal cord. Review of the developmental process of this operation leads to recognition of the tips, pitfalls, and solutions.
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Affiliation(s)
- Norio Kawahara
- Department of Orthopedic Surgery, Graduate school of Medical Science Kanazawa University, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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Lipscomb IP, Sihota AK, Botham M, Harris KL, Keevil CW. Rapid method for the sensitive detection of protein contamination on surgical instruments. J Hosp Infect 2006; 62:141-8. [PMID: 16290315 DOI: 10.1016/j.jhin.2005.07.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 07/05/2005] [Indexed: 11/16/2022]
Abstract
Hospital sterile service departments (SSDs) currently rely on simple visual confirmation of cleanliness as an assessment of the efficacy of cleaning surgical instruments. The inherent inability to monitor low levels of infectious or proteinaceous contamination on surgical instruments creates the possibility that highly dangerous and robust biological agents may remain infectious and undetected even after standard cleaning and sterilization procedures have been employed. This paper describes the development of a novel microscopy technique, episcopic differential interference contrast microscope, combined with the fluorescent reagent, SYPRO Ruby, to rapidly detect brain tissue protein to below 400 pg/mm(2) on an instrument surface. This technique has displayed a minimum level of detection observed by 50% of volunteers of 85 pg/mm(2) (95% confidence intervals 67-112 pg/mm(2)). Quantitative assessment of instruments supplied from various SSDs enabled the establishment of a 'contamination index' of both proteinaceous and non-proteinaceous deposits on the surface. This new methodology for the assessment of surface contamination is generally applicable and should facilitate future quantitative surveys of instrument contamination in hospitals and other healthcare environments.
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Affiliation(s)
- I P Lipscomb
- Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, Southampton, UK.
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Tomita K, Kawahara N, Murakami H, Demura S. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci 2006; 11:3-12. [PMID: 16437342 PMCID: PMC2780651 DOI: 10.1007/s00776-005-0964-y] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Indexed: 12/01/2022]
Affiliation(s)
- Katsuro Tomita
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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