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Eckhoff MD, Strub DR, Utset-Ward TJ, Wells ME, Scharschmidt TJ. Pediatric Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately? J Pediatr Orthop 2025; 45:e486-e491. [PMID: 39806537 DOI: 10.1097/bpo.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
BACKGROUND Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity. This study evaluates oncologic outcomes at this institution, comparing open versus closed biopsy, and biopsy tract resection with or separate from the main tumor resection. METHODS Retrospective review of a single institution of all patients treated for bone sarcomas from 2006 through December 2021. Patient and tumor characteristics, biopsy technique, biopsy resection method, and oncologic outcomes were collected. Subgroup statistical analysis was performed comparing closed biopsy and open biopsy techniques, and biopsy tract resection with the main tumor or separately. RESULTS A total of 73 patients met the inclusion criteria, including 48 (65.8%) open biopsies and 25 closed biopsies [23 (31.5%) core needle biopsies and 2 (2.7%) fine needle aspirations]. Biopsy tract resection was performed with the main tumor in 36 (49.3%), separate in 37 (50.7%). There were no statistical differences in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy methodology analysis and biopsy tract removal methods. CONCLUSION This study demonstrates the safety of both approaches for obtaining diagnostic tissues with low rates of biopsy tract seeding in both methods. In addition, it demonstrates that there is no difference in local recurrence, disease-free survival, metastatic progression, or overall survival between biopsy tract resection with or separate from the main tumor. Definitive surgical plan should not vary based on biopsy technique and biopsy tract management, but rather patient, tumor, institutional, and surgeon factors. LEVEL OF EVIDENCE Level III-retrospective chart review. The study was started after the patients were diagnosed and treated.
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Affiliation(s)
- Michael D Eckhoff
- Department of Orthopaedic Surgery, Nationwide Children's Hospital
- Department of Orthopaedic Surgery, Ohio State College of Medicine, The Ohio State University
| | - Daryn R Strub
- Department of Orthopaedic Surgery, Nationwide Children's Hospital
| | | | - Matthew E Wells
- Department of Orthopaedics, William Beaumont Army Medical Center
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Lam FC, Guru S, AbuReesh D, Hori YS, Chuang C, Liu L, Wang L, Gu X, Szalkowski GA, Wang Z, Wohlers C, Tayag A, Emrich SC, Ustrzynski L, Zygourakis CC, Desai A, Hayden Gephart M, Byun J, Pollom EL, Rahimy E, Soltys S, Park DJ, Chang SD. Use of Carbon Fiber Implants to Improve the Safety and Efficacy of Radiation Therapy for Spine Tumor Patients. Brain Sci 2025; 15:199. [PMID: 40002531 PMCID: PMC11852773 DOI: 10.3390/brainsci15020199] [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: 12/31/2024] [Revised: 01/22/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
Current standard of care treatment for patients with spine tumors includes multidisciplinary approaches, including the following: (1) surgical tumor debulking, epidural spinal cord decompression, and spine stabilization techniques; (2) systemic chemo/targeted therapies; (3) radiation therapy; and (4) surveillance imaging for local disease control and recurrence. Titanium pedicle screw and rod fixation have become commonplace in the spine surgeon's armamentarium for the stabilization of the spine following tumor resection and separation surgery. However, the high degree of imaging artifacts seen with titanium implants on postoperative CT and MRI scans can significantly hinder the accurate delineation of vertebral anatomy and adjacent neurovascular structures to allow for the safe and effective planning of downstream radiation therapies and detection of disease recurrence. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) spine implants have emerged as a promising alternative to titanium due to the lack of artifact signals on CT and MRI, allowing for more accurate and safe postoperative radiation planning. In this article, we review the tenants of the surgical and radiation management of spine tumors and discuss the safety, efficacy, and current limitations of CFR-PEEK spine implants in the multidisciplinary management of spine oncology patients.
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Affiliation(s)
- Fred C. Lam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Santosh Guru
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Deyaldeen AbuReesh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Yusuke S. Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Cynthia Chuang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Lianli Liu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Lei Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Gregory A. Szalkowski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Ziyi Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Christopher Wohlers
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Armine Tayag
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Sara C. Emrich
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Louisa Ustrzynski
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Corinna C. Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Atman Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - John Byun
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Erqi Liu Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - David J. Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
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Pekov SI, Bormotov DS, Bocharova SI, Sorokin AA, Derkach MM, Popov IA. Mass spectrometry for neurosurgery: Intraoperative support in decision-making. MASS SPECTROMETRY REVIEWS 2025; 44:62-73. [PMID: 38571445 DOI: 10.1002/mas.21883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Ambient ionization mass spectrometry was proved to be a powerful tool for oncological surgery. Still, it remains a translational technique on the way from laboratory to clinic. Brain surgery is the most sensitive to resection accuracy field since the balance between completeness of resection and minimization of nerve fiber damage determines patient outcome and quality of life. In this review, we summarize efforts made to develop various intraoperative support techniques for oncological neurosurgery and discuss difficulties arising on the way to clinical implementation of mass spectrometry-guided brain surgery.
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Affiliation(s)
- Stanislav I Pekov
- Skolkovo Institute of Science and Technology, Moscow, Russian Federation
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
- Siberian State Medical University, Tomsk, Russian Federation
| | - Denis S Bormotov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
| | | | - Anatoly A Sorokin
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
| | - Maria M Derkach
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
| | - Igor A Popov
- Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
- Siberian State Medical University, Tomsk, Russian Federation
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Noli LE, Alcherigi C, Griffoni C, Pesce E, Rosa S, Evangelisti G, Pipola V, Davassi PF, Monetta A, Barbanti Brodano G, Terzi S, Ghermandi R, Tedesco G, Girolami M, Bandiera S, Gasbarrini A. Health-related quality of life in patients treated with en bloc resection for primary tumors of the spine. Front Oncol 2024; 14:1485226. [PMID: 39640277 PMCID: PMC11618236 DOI: 10.3389/fonc.2024.1485226] [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: 08/23/2024] [Accepted: 10/28/2024] [Indexed: 12/07/2024] Open
Abstract
Study design Retrospective analysis. Objective The aim of this study is to evaluate the functional outcomes and the health-related quality of life (HRQOL) in patients undergoing en bloc resection of spinal tumor. Summary of background data En bloc resection in the spine is a surgical procedure designed to completely remove a tumor in one piece, with wide margins preserved, in order to reduce the risk of local recurrences. This demanding procedure has been shown to improve local control and survival rate, besides a relatively high morbidity. Methods Between 2016 and 2021, 70 patients underwent en bloc resection surgery for a primary spine tumor and 38 came out to be eligible for this analysis. Eligibility criteria include at least one follow-up visit within a two-year period from surgery and Patient Reported Outcomes evaluation collected prospectively at baseline and at least one follow- up in the range 4-24 months. The outcome variables (EQ5D Numeric Scale and Index, SF36 scores and NRS score) were analyzed with multilevel linear mixed-effects regression. Baseline- (age, gender, localization, histotype, number of levels of resection, previous surgery) and time-dependent covariates (adverse events, spinal cord damage) were included. Results Beside a slight improvement of all the scores, no significant differences were found between baseline and follow up times for EQ-5D-3L Numeric Scale and Index and for SF-36 Standardized Physical component. SF-36 Standardized Mental component appeared to be significantly better at 12-month FU compared to baseline. Ultimately, age over 50 years old and the occurrence of adverse events emerged to be as the two main factor determining worsening in several HRQOL scores. Pain came out to be significantly reduce at 24-month compared to baseline. Conclusions The aim of en bloc resection in the treatment of primary spinal tumors is to improve survival rates and reduce local recurrences. Despite its radicality, our preliminary results suggest that patients experience a slight to moderate improvement postoperatively compared to their preoperative perceived health status.
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Affiliation(s)
- Luigi Emanuele Noli
- ISNB Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara Alcherigi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonora Pesce
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Valerio Pipola
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Annalisa Monetta
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Silvia Terzi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Girolami
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Bandiera
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Beucler N, Farah K, Fuentes S. How I do it: en-bloc thoracic vertebrectomy. Acta Neurochir (Wien) 2024; 166:350. [PMID: 39186149 DOI: 10.1007/s00701-024-06237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Some young patients with preserved functional status suffering from aggressive isolated neoplastic disease of the thoracic spine may be eligible from curative en-bloc vertebrectomy surgical treatment. METHOD Long-segment posterior pedicle screw fixation is performed. Complete excision of the posterior arch and of ribs posterior aspect is performed. Finger blunt dissection is performed between vertebral body, pleura, and aorta allowing to place a soft abdominal valve and then Gigli saws surrounding the anterior aspect of the spine, in order to saw the upper and the lower discs. Unilateral temporary rod is placed. The vertebral body is dislodged from posterior ligament and then removed by circling laterally around spinal cord. An expandable vertebral implant is placed. CONCLUSION Posterior en-bloc thoracic vertebrectomy is a highly technical yet achievable procedure which carries a curative intent for isolated neoplastic spine lesions.
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Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 Boulevard Sainte-Anne, 83800 Cedex 9, Toulon, France.
| | - Kaissar Farah
- Spine Surgery Department, Timone University Hospital, APHM, 264 Rue Saint-Pierre, 13005, Marseille, France
| | - Stéphane Fuentes
- Spine Surgery Department, Timone University Hospital, APHM, 264 Rue Saint-Pierre, 13005, Marseille, France
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Mukhopadhyay KK, Nandi R, Sinha Sarkar A, Mandal A. Total En Bloc Spondylectomy in a Case of Solitary Metastatic Breast Carcinoma With Intact Neurology: A Case Report. Cureus 2024; 16:e67126. [PMID: 39290946 PMCID: PMC11407789 DOI: 10.7759/cureus.67126] [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] [Accepted: 08/18/2024] [Indexed: 09/19/2024] Open
Abstract
The management of spinal metastasis varies from patient to patient, depending on the type of lesion, stage of the disease, extension into the spinal canal, associated fractures, and life expectancy. We present a case of solitary metastasis with intact neurology in a 48-year-old lady who underwent a radical mastectomy for T2 N3 M0 breast carcinoma 34 months ago. Total en bloc spondylectomy in a neurologically intact patient is a challenging one. In all posterior approaches, there is a high chance of postoperative neurodeficiency. In our case, a combined approach seems to be a much safer procedure with easy accessibility to remove the total D8 vertebra.
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Affiliation(s)
| | - Ritwika Nandi
- Orthopedics, Nil Ratan Sircar Medical College and Hospital, Kolkata, IND
| | | | - Ananda Mandal
- Orthopedics, Nil Ratan Sircar Medical College and Hospital, Kolkata, IND
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Shea GKH, Kwan KYH. Management of Metastatic Spinal Disease - A Practical Approach. Global Spine J 2024:21925682231173646. [PMID: 39069670 DOI: 10.1177/21925682231173646] [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: 07/30/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE This review presents a comprehensive approach to the management of spinal metastases. METHODS N/A. RESULTS The wide spectrum of clinical presentation in spinal metastases necessitates a personalized approach to treatment planning. This includes a comprehensive diagnostic workup, oncological management, palliation of symptoms, and surgical intervention if appropriate. A systematic and multidisciplinary approach allows optimal shared decision making to reach an evidence-informed and value-congruent treatment plan for the patient. We highlight how advances in stereotactic body radiotherapy (SBRT) and separation surgery may be incorporated into clinical management from a spine surgeon's perspective. CONCLUSION This review summarizes the approach and management of spinal metastases, its outcomes and complications.
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Affiliation(s)
- Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
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Sperber J, Zachem TJ, Prakash R, Owolo E, Yamamoto K, Nguyen AD, Hockenberry H, Ross WA, Herndon JE, Codd PJ, Goodwin CR. A blinded study using laser induced endogenous fluorescence spectroscopy to differentiate ex vivo spine tumor, healthy muscle, and healthy bone. Sci Rep 2024; 14:1921. [PMID: 38253556 PMCID: PMC10803777 DOI: 10.1038/s41598-023-50995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Ten patients undergoing surgical resection for spinal tumors were selected. Samples of tumor, muscle, and bone were resected, de-identified by the treating surgeon, and then scanned with the TumorID technology ex vivo. This study investigates whether TumorID technology is able to differentiate three different human clinical fresh tissue specimens: spine tumor, normal muscle, and normal bone. The TumorID technology utilizes a 405 nm excitation laser to target endogenous fluorophores, thereby allowing for the detection of tissue based on emission spectra. Metabolic profiles of tumor and healthy tissue vary, namely NADH (bound and free emission peak, respectively: 487 nm, 501 nm) and FAD (emission peak: 544) are endogenous fluorophores with distinct concentrations in tumor and healthy tissue. Emission spectra analyzed consisted of 74 scans of spine tumor, 150 scans of healthy normal bone, and 111 scans of healthy normal muscle. An excitation wavelength of 405 nm was used to obtain emission spectra from tissue as previously described. Emission spectra consisted of approximately 1400 wavelength intensity pairs between 450 and 750 nm. Kruskal-Wallis tests were conducted comparing AUC distributions for each treatment group, α = 0.05. Spectral signatures varied amongst the three different tissue types. All pairwise comparisons among tissues for Free NADH were statistically significant (Tumor vs. Muscle: p = 0.0006, Tumor vs. Bone: p < 0.0001, Bone vs. Muscle: p = 0.0357). The overall comparison of tissues for FAD (506.5-581.5 nm) was also statistically significant (p < 0.0001), with two pairwise comparisons being statistically significant (Tumor vs. Muscle: p < 0.0001, Tumor vs. Bone: p = 0.0045, Bone vs. Muscle: p = 0.249). These statistically significant differences were maintained when stratifying tumor into metastatic carcinoma (N = 57) and meningioma (N = 17). TumorID differentiates tumor tissue from normal bone and normal muscle providing further clinical evidence of its efficacy as a tissue identification tool. Future studies should evaluate TumorID's ability to serve as an adjunctive tool for intraoperative assessment of surgical margins and surgical decision-making.
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Affiliation(s)
- Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - Tanner J Zachem
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Ravi Prakash
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - Kent Yamamoto
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
| | - Annee D Nguyen
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | | | - Weston A Ross
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
| | - James E Herndon
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, USA
| | - Patrick J Codd
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, USA
- Duke Cancer Institute, Duke University Medical Center, 200 Trent Drive DUMC 3807, Durham, NC, 27710, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, USA.
- Duke Cancer Institute, Duke University Medical Center, 200 Trent Drive DUMC 3807, Durham, NC, 27710, USA.
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Dalton T, Darner G, McCray E, Price M, Baëta C, Erickson M, Karikari IO, Abd-El-Barr MM, Goodwin CR, Brown DA. Prophylactic Muscle Flaps Decrease Wound Complication Rates in Patients with Oncologic Spine Disease. Plast Reconstr Surg 2024; 153:221-231. [PMID: 37075264 DOI: 10.1097/prs.0000000000010568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Patients with oncologic spine disease face a high systemic illness burden and often require surgical intervention to alleviate pain and maintain spine stability. Wound healing complications are the most common reason for reoperation in this population and are known to impact quality of life and initiation of adjuvant therapy. Prophylactic muscle flap (MF) closure is known to reduce wound healing complications in high-risk patients; however, the efficacy in oncologic spine patients is not well established. METHODS A collaboration at our institution presented an opportunity to study the outcomes of prophylactic MF closure. The authors performed a retrospective cohort study of patients who underwent MF closure versus a cohort who underwent non-MF closure in the preceding time. Demographic and baseline health data were collected, as were postoperative wound complication data. RESULTS A total of 166 patients were enrolled, including 83 patients in the MF cohort and 83 control patients. Patients in the MF group were more likely to smoke ( P = 0.005) and had a higher incidence of prior spine irradiation ( P = 0.002). Postoperatively, five patients (6%) in the MF group developed wound complications, compared with 14 patients (17%) in the control group ( P = 0.028). The most common overall complication was wound dehiscence requiring conservative therapy, which occurred in six control patients (7%) and one MF patient (1%) ( P = 0.053). CONCLUSIONS Prophylactic MF closure during oncologic spine surgery significantly reduces the wound complication rate. Future studies should examine the precise patient population that stands to benefit most from this intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Grant Darner
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery
| | | | | | | | - Melissa Erickson
- Department of Orthopedic Surgery, Duke University Medical Center
| | | | | | | | - David A Brown
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery
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10
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Pokorni AJ, Turbucz M, Kiss RM, Eltes PE, Lazary A. Comparison of anterior column reconstruction techniques after en bloc spondylectomy: a finite element study. Sci Rep 2023; 13:18767. [PMID: 37907570 PMCID: PMC10618450 DOI: 10.1038/s41598-023-45736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
Total en bloc spondylectomy (TES) effectively treats spinal tumors. The surgery requires a vertebral body replacement (VBR), for which several solutions were developed, whereas the biomechanical differences between these devices still need to be completely understood. This study aimed to compare a femur graft, a polyetheretherketone implant (PEEK-IMP-C), a titan mesh cage (MESH-C), and a polymethylmethacrylate replacement (PMMA-C) using a finite element model of the lumbar spine after a TES of L3. Several biomechanical parameters (rotational stiffness, segmental range of motion (ROM), and von Mises stress) were assessed to compare the VBRs. All models provided adequate initial stability by increasing the rotational stiffness and decreasing the ROM between L2 and L4. The PMMA-C had the highest stiffness for flexion-extension, lateral bending, and axial rotation (215%, 216%, and 170% of intact model), and it had the lowest segmental ROM in the instrumented segment (0.2°, 0.5°, and 0.7°, respectively). Maximum endplate stress was similar for PMMA-C and PEEK-IMP-C but lower for both compared to MESH-C across all loading directions. These results suggest that PMMA-C had similar or better primary spinal stability than other VBRs, which may be related to the larger contact surface and the potential to adapt to the patient's anatomy.
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Affiliation(s)
- Agoston Jakab Pokorni
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Mate Turbucz
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Rita Maria Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Műegyetem Rkp. 3., Budapest, 1111, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary.
- Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
| | - Aron Lazary
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó St. 1-3, Budapest, 1126, Hungary
- Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
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11
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Zhao Y, Liu F, Wang W. Treatment progress of spinal metastatic cancer: a powerful tool for improving the quality of life of the patients. J Orthop Surg Res 2023; 18:563. [PMID: 37537684 PMCID: PMC10399009 DOI: 10.1186/s13018-023-03975-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Spinal metastasis is a common secondary malignant tumor of the bone, often resulting in spinal cord and nerve root compression, leading to obvious pain and related compression symptoms. This condition has a high incidence and mortality rate. The treatment approach for most patients with spinal metastasis is primarily palliative. Consultation with a multidisciplinary team is widely accepted as a comprehensive treatment approach for patients with spinal metastases. With advancements in research and technology, the evaluation and treatment of spinal metastatic cancer are continuously evolving. This study provides an overview of surgical treatment, minimally invasive treatment, and radiotherapy for spinal metastatic cancer and also analyzes the clinical effects, advantages, and current limitations associated with various treatment approaches.
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Affiliation(s)
- Yuliang Zhao
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Liaoning, 110000, Shenyang, China
| | - Fei Liu
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Liaoning, 110000, Shenyang, China
| | - Wei Wang
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Liaoning, 110000, Shenyang, China.
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12
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Kawai M, Demura S, Kato S, Yokogawa N, Shimizu T, Kurokawa Y, Kobayashi M, Yamada Y, Nagatani S, Uto T, Murakami H. The Impact of Frailty on Postoperative Complications in Total En Bloc Spondylectomy for Spinal Tumors. J Clin Med 2023; 12:4168. [PMID: 37373861 DOI: 10.3390/jcm12124168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Total en bloc spondylectomy (TES) is an effective treatment for spinal tumors. However, its complication rate is high, and the corresponding risk factors remain unclear. This study aimed to clarify the risk factors for postoperative complications after TES, including the patient's general condition, such as frailty and their levels of inflammatory biomarkers. We included 169 patients who underwent TES at our hospital from January 2011-December 2021. The complication group comprised patients who experienced postoperative complications that required additional intensive treatments. We analyzed the relationship between early complications and the following factors: age, sex, body mass index, type of tumor, location of tumor, American Society of Anesthesiologists score, physical status, frailty (categorized by the 5-factor Modified Frailty Index [mFI-5]), neutrophil-to-lymphocyte ratio, C-reactive protein/albumin ratio, preoperative chemotherapy, preoperative radiotherapy, surgical approach, and the number of resected vertebrae. Of the 169 patients, 86 (50.1%) were included in the complication group. Multivariate analysis showed that high mFI-5 scores (odds ratio [OR] = 2.99, p < 0.001) and an increased number of resected vertebrae (OR = 1.87, p = 0.018) were risk factors for postoperative complications. Frailty and the number of resected vertebrae were independent risk factors for postoperative complications after TES for spinal tumors.
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Affiliation(s)
- Masafumi Kawai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yuki Kurokawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Motoya Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yohei Yamada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Nagatani
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takaaki Uto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
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13
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Mirzashahi B, Razzaghof M, Tabatabaei Irani P. Direct epidural metastasis of breast cancer mimicking a large lumbar disc sequestrum: A case report and review of literature. Clin Case Rep 2023; 11:e7098. [PMID: 36992677 PMCID: PMC10041379 DOI: 10.1002/ccr3.7098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/15/2022] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
We report a case of cauda equina syndrome (CES) caused by an epidural metastasis of breast cancer, which oddly mimicked a large disc sequestrum leading to misdiagnosis. To our knowledge, it is the first report of a metastatic epidural breast cancer lesion mimicking a disc sequestrum.
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Affiliation(s)
- Babak Mirzashahi
- Orthopedic Spine Surgeon, Joint Reconstruction Research Center (JRRC)Tehran University of Medical SciencesTehranIran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center (JRRC)Tehran University of Medical SciencesTehranIran
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14
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Abunimer AM, Hammoudeh L, Dee EC, Lak AM, Chi J, Lu Y, Groff M, Shin JH, Lam MB, Zaidi HA. Gross total resection of spinal chondrosarcoma is associated with improved locoregional relapse-free survival and overall survival. 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; 32:994-1002. [PMID: 36592209 DOI: 10.1007/s00586-022-07505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Spinal chondrosarcomas are rare malignant osseous tumors. The low incidence of spinal chondrosarcomas and the complexity of spine anatomy have led to heterogeneous treatment strategies with varying curative and survival rates. The goal of this study is to investigate prognostic factors for locoregional recurrence-free survival (LRFS) and overall survival (OS) comparing en bloc vs. piecemeal resection for the management of spinal chondrosarcoma. METHODS We retrospectively identified patients who underwent curative-intent resection of primary and metastatic spinal chondrosarcoma over a 25-year period. Univariate and multivariate survival analyses were conducted with LRFS as primary endpoint and OS as secondary endpoint. LRFS and OS were modeled using the Kaplan-Meier method and assessed using Cox regression analysis. RESULTS For 72 patients who underwent first resection, the median follow-up time was 5.1 years (95% CI 2.2-7.0). Thirty-three patients (45.8%) had en bloc resection, and 39 (54.2%) had piecemeal resection. Of the 68 patients for whom extent of resection was known, 44 patients had gross total resection (GTR) and 24 patients had subtotal resection. In survival analyses, both LRFS and OS showed statistically significant difference based on the extent of resection (p = 0.001; p = 0.04, respectively). However, only LRFS showed statistically significant difference when assessing the type of resection (p = 0.02). In addition, higher tumor grade and more invasive disease were associated with worse LRFS and OS rates. CONCLUSION Although in our study en bloc and GTR were associated with improved survival, heterogenous and complex spinal presentations may limit total resection. Therefore, the surgical management should be tailored individually to ensure the best local control and maximum preservation of function.
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Affiliation(s)
- Abdullah M Abunimer
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Lubna Hammoudeh
- Department of Radiation Medicine, The Oregon Health & Science University Hospital, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Asad M Lak
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - John Chi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Yi Lu
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Michael Groff
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - John H Shin
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Dana Farber Cancer Institute, Boston, USA.
| | - Hasan A Zaidi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
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15
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Complications and Risk Factors in En Bloc Resection of Spinal Tumors: A Retrospective Analysis on 298 Patients Treated in a Single Institution. Curr Oncol 2022; 29:7842-7857. [PMID: 36290897 PMCID: PMC9600441 DOI: 10.3390/curroncol29100620] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
En bloc resection consists in the surgical removal of a vertebral tumor in a single piece with a sufficient margin, to improve survival and reduce recurrence rate. This procedure is technically demanding and correlates with a high complication rate. The purpose of this study is to investigate the risk factors for complications in en bloc resection and evaluate if benefits overcome the risks in term of overall survival. We retrospectively analyzed prospectively collected data of patients treated with en bloc resection between 1980 and 2021. Complications were classified according to SAVES-V2. Overall Survival was estimated using Kaplan-Meier method. A total of 149 patients out of 298 (50%) suffered from at least one complication. Moreover, 220 adverse events were collected (67 intraoperative, 82 early post-operative, 71 late post-operative), 54% of these were classified as grade 3 (in a severity scale from 1 to 6). Ten years overall survival was 67% (95% CI 59-74). The occurrence of relapses was associated to an increased risk of mortality with OR 3.4 (95% CI 2.1-5.5), while complications did not affect the overall survival. Despite a high complication rate, en bloc resection allows for a better control of disease and should be performed in selected patients by specialized surgeons.
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16
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Lange N, Jörger AK, Ryang YM, Liesche-Starnecker F, Gempt J, Meyer B. Primary Bone Tumors of the Spine—Proposal for Treatment Based on a Single Centre Experience. Diagnostics (Basel) 2022; 12:diagnostics12092264. [PMID: 36140664 PMCID: PMC9498005 DOI: 10.3390/diagnostics12092264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed 92 patients receiving surgery for PBTs from 2007 to 2019 at our center. They were analyzed based on surgical management and the course of the disease. A total of 145 surgical procedures were performed (50 cervical, 46 thoracic, 28 lumbar, and 21 sacral). Complete tumor resection was achieved in 65%, of which 22% showed tumor recurrence during follow-up (mean time to recurrence 334 days). The five-year mortality rate was significantly lower after complete resection (3% versus 25% after subtotal resection). Most of the patients improved in their symptoms through surgery. Regarding the tumor entity, the most common PBTs were vertebral hemangiomas (20%), osteoid osteomas (15%), and chordomas (16%). The Enneking graduation system showed a good correlation with the risk of recurrence and mortality. Complete resection in PBTs increased survival rates and remains the method of choice. Thus, quality of life—especially with a higher extent of resection—should be considered.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
- Correspondence:
| | - Ann-Kathrin Jörger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany
| | | | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
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17
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Spinal Tumors: Diagnosis and Treatment. J Am Acad Orthop Surg 2022; 30:e1106-e1121. [PMID: 35984082 DOI: 10.5435/jaaos-d-21-00710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
Tumors that present in or around the spine can be challenging to diagnose and treat. A proper workup involves a complete history and physical examination, appropriate staging studies, appropriate imaging of the entire spine, and a tissue biopsy. The biopsy defines the lesion and guides treatment, but in some rare instances, rapid neurological decline may lead to urgent or emergent surgery before it can be analyzed. "Enneking-appropriate" margins should remain the goal for primary tumors while adequate debulking/separation/stabilization are often the goals in metastatic disease. Primary tumors of the spine are rare and often complex tumors to operate on-achieving Enneking-appropriate margins provides the greatest chance of survival while decreasing the chance of local recurrence. Metastatic tumors of the spine are increasingly more common, and timing of surgery must be considered within the greater framework of the patient and the patient's disease, deficits, stability, and other treatments available. The specific tumor type will dictate what other multidisciplinary approaches are available, allowing for chemotherapy and radiation as needed.
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18
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Tong Y, Huang Z, Jiang L, Pi Y, Gong Y, Zhao D. Individualized assessment of risk and overall survival in patients newly diagnosed with primary osseous spinal neoplasms with synchronous distant metastasis. Front Public Health 2022; 10:955427. [PMID: 36072380 PMCID: PMC9441606 DOI: 10.3389/fpubh.2022.955427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/28/2022] [Indexed: 01/24/2023] Open
Abstract
Background The prognosis of patients with primary osseous spinal neoplasms (POSNs) presented with distant metastases (DMs) is still poor. This study aimed to evaluate the independent risk and prognostic factors in this population and then develop two web-based models to predict the probability of DM in patients with POSNs and the overall survival (OS) rate of patients with DM. Methods The data of patients with POSNs diagnosed between 2004 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistics regression analyses were used to study the risk factors of DM. Based on independent DM-related variables, we developed a diagnostic nomogram to estimate the risk of DM in patients with POSNs. Among all patients with POSNs, those who had synchronous DM were included in the prognostic cohort for investigating the prognostic factors by using Cox regression analysis, and then a nomogram incorporating predictors was developed to predict the OS of patients with POSNs with DM. Kaplan-Meier (K-M) survival analysis was conducted to study the survival difference. In addition, validation of these nomograms were performed by using receiver operating characteristic (ROC) curves, the area under curves (AUCs), calibration curves, and decision curve analysis (DCA). Results A total of 1345 patients with POSNs were included in the study, of which 238 cases (17.70%) had synchronous DM at the initial diagnosis. K-M survival analysis and multivariate Cox regression analysis showed that patients with DM had poorer prognosis. Grade, T stage, N stage, and histological type were found to be significantly associated with DM in patients with POSNs. Age, surgery, and histological type were identified as independent prognostic factors of patients with POSNs with DM. Subsequently, two nomograms and their online versions (https://yxyx.shinyapps.io/RiskofDMin/ and https://yxyx.shinyapps.io/SurvivalPOSNs/) were developed. The results of ROC curves, calibration curves, DCA, and K-M survival analysis together showed the excellent predictive accuracy and clinical utility of these newly proposed nomograms. Conclusion We developed two well-validated nomograms to accurately quantify the probability of DM in patients with POSNs and predict the OS rate in patients with DM, which were expected to be useful tools to facilitate individualized clinical management of these patients.
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Affiliation(s)
- Yuexin Tong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhangheng Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Liming Jiang
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yangwei Pi
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Gong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dongxu Zhao
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China,*Correspondence: Dongxu Zhao
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19
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Hersh AM, Patel J, Pennington Z, Porras JL, Goldsborough E, Antar A, Elsamadicy AA, Lubelski D, Wolinsky JP, Jallo G, Gokaslan ZL, Lo SFL, Sciubba DM. Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. J Neurosurg Spine 2022; 37:252-262. [PMID: 35213831 DOI: 10.3171/2022.1.spine211235] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms whose treatment is often technically challenging. Given the low volume seen at most centers, perioperative outcomes have been reported infrequently. Here, the authors present the largest single-institution series of IMSCTs, focusing on the clinical presentation, histological makeup, perioperative outcomes, and long-term survival of surgically treated patients. METHODS A cohort of patients operated on for primary IMSCTs at a comprehensive cancer center between June 2002 and May 2020 was retrospectively identified. Data on patient demographics, tumor histology, neuraxial location, baseline neurological status, functional deficits, and operative characteristics were collected. Perioperative outcomes of interest included length of stay, postoperative complications, readmission, reoperation, and discharge disposition. Data were compared across tumor histologies using the Kruskal-Wallis H test, chi-square test, and Fisher exact test. Pairwise comparisons were conducted using Tukey's honest significant difference test, chi-square test, and Fisher exact test. Long-term survival was assessed across tumor categories and histological subtype using the log-rank test. RESULTS Three hundred two patients were included in the study (mean age 34.9 ± 19 years, 77% white, 57% male). The most common tumors were ependymomas (47%), astrocytomas (31%), and hemangioblastomas (11%). Ependymomas and hemangioblastomas disproportionately localized to the cervical cord (54% and 59%, respectively), whereas astrocytomas were distributed almost equally between the cervical cord (36%) and thoracic cord (38%). Clinical presentation, extent of functional dependence, and postoperative 30-day outcomes were largely independent of underlying tumor pathology, although tumors of the thoracic cord had worse American Spinal Injury Association (ASIA) grades than cervical tumors. Rates of gross-total resection were lower for astrocytomas than for ependymomas (54% vs 84%, p < 0.01) and hemangioblastomas (54% vs 100%, p < 0.01). Additionally, 30-day readmission rates were significantly higher for astrocytomas than ependymomas (14% vs 6%, p = 0.02). Overall survival was significantly affected by the underlying pathology, with astrocytomas having poorer associated prognoses (40% at 15 years) than ependymomas (81%) and hemangioblastomas (66%; p < 0.01) and patients with high-grade ependymomas and astrocytomas having poorer long-term survival than those with low-grade lesions (p < 0.01). CONCLUSIONS The neuraxial location of IMSCTs, extent of resection, and postoperative survival differed significantly across tumor pathologies. However, perioperative outcomes did not vary significantly across tumor cohorts, suggesting that operative details, rather than pathology, may have a stronger influence on the short-term clinical course, whereas pathology appears to have a stronger impact on long-term survival.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaimin Patel
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Jose L Porras
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Earl Goldsborough
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Antar
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel Lubelski
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- 4Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - George Jallo
- 5Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ziya L Gokaslan
- 6Department of Neurosurgery, Brown University, Providence, Rhode Island; and
| | - Sheng-Fu Larry Lo
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
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20
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Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers (Basel) 2022; 14:cancers14143480. [PMID: 35884541 PMCID: PMC9317366 DOI: 10.3390/cancers14143480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023] Open
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.
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21
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Matsuoka M, Onodera T, Yokota I, Iwasaki K, Hishimura R, Suzuki Y, Iwata A, Kondo E, Iwasaki N. Does Primary Tumor Resection in Patients with Metastatic Primary Mobile Vertebral Column Sarcoma Improve Survival? World Neurosurg 2022; 163:e647-e654. [PMID: 35439623 DOI: 10.1016/j.wneu.2022.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary mobile vertebral column sarcoma is an exceedingly rare malignancy. Although primary tumor resection has been reported to prolong survival in patients with metastatic bone sarcoma, whether primary tumor resection in patients with advanced primary mobile vertebral column sarcoma is associated with survival remains unclear owing to the rarity of this pathological entity. METHODS Using the Surveillance, Epidemiology, and End Results database, 182 patients with metastatic primary mobile vertebral column sarcoma were identified between 1983 and 2015. Of the 182 patients enrolled, 101 patients (55%) underwent primary tumor resection (Surgery group) and 81 patients (45%) did not undergo resection (No Surgery group). To account for imbalances in the basic characteristics of patients between groups, propensity score matching was performed. Survival analysis was performed by weighted Cox proportional hazards modeling to calculate hazard ratios. RESULTS After adjusting for patient background characteristics, 138 patients were included for the analysis (Surgery group: 69 patients; No Surgery group: 69 patients). The Surgery group did not show improved cancer-specific survival (hazard ratio = 0.73, 95% CI 0.49-1.10). Similarly, the Surgery group did not show improved overall survival compared with the No Surgery group (hazard ratio = 0.80, 95% CI 0.55-1.16). CONCLUSIONS To our knowledge, this is the first study to indicate that surgical resection for advanced primary mobile vertebral column sarcoma does not have a positive impact on survival.
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Affiliation(s)
- Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Hokkaido, Japan
| | - Ryosuke Hishimura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yuki Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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Cao S, Chen K, Jiang L, Wei F, Liu X, Liu Z. Intralesional Marginal Resection for Osteoblastoma in the Mobile Spine: Experience From a Single Center. Front Surg 2022; 9:838235. [PMID: 35733437 PMCID: PMC9207176 DOI: 10.3389/fsurg.2022.838235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Osteoblastoma (OB) is a benign bone tumor with aggressive behavior and a tendency for local recurrence. The appropriate surgical strategy for spinal OB remains unclear. This retrospective study aimed to verify the clinical efficacy and safety of intralesional marginal resection of OB in the mobile spine. We enrolled 50 consecutive patients with spinal OB between January 2009 and December 2019. The tumors were staged based on the Enneking system, with 21 and 29 lesions being determined as stage 2 (St.2) and stage 3 (St.3), respectively. Among them, 42 patients underwent intralesional marginal resection, five underwent extensive curettage, and three underwent en bloc resection successfully since their lesions were limited to the posterior element in a single vertebra. We analyzed clinical characteristics, perioperative and follow-up images, surgical details, and follow-up data. Within a median follow-up duration of 50 (range: 24–160) months, six (12.0%) patients had local recurrence. The recurrence rates among patients who underwent intralesional marginal resection, curettage, en bloc resection were 7.1%(3/42), 60.0%(3/5), and 0%(0/3), respectively. The recurrence rate of intralesional marginal resection of St.3 lesions was slightly higher than that of St.2 lesions (7.7%[2/26] vs. 6.3%[1/16]). There were 16(38.1%), 3(60.0%), and 0 patients with surgical complications among those who underwent intralesional marginal resection, curettage, and en bloc resection, respectively. Local recurrence was observed in five (5/14, 35.7%) patients who had vertebral artery extension and in none who did not have vertebral artery extension (p = 0.02). Our findings suggest that intralesional marginal resection could be an appropriate treatment choice for patients with spinal OB, both St.2 and St.3 lesions, with an acceptable local recurrence rate and a low risk of complications. Vertebral artery extension could be a strong risk factor for local recurrence in patients with spinal OB.
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Abstract
BACKGROUND A mesenchymal hamartoma is a rare benign tumor of the chest wall seen prenatally or at birth. Typically arising from one or more ribs, this tumor will have a rapid growth between weeks 28 and 36 of gestation, followed by a plateau and a spontaneous regression, usually within the first year of life. CLINICAL FINDINGS A 37-week 2-day, 3.48-kg female infant was admitted to the neonatal intensive care unit with a prenatally diagnosed left chest mass with a large pleural effusion and respiratory failure. PRIMARY DIAGNOSIS The infant was referred to our institution with multiple chest masses on the left side, resulting in the thorax's marked deformity. Imaging studies confirmed the presence of a multifocal mesenchymal hamartoma. INTERVENTIONS At laparotomy, 3 mesenchymal hamartomas were found. The lateral mass, encompassing ribs 5 and 6, resulted in an en bloc resection. The ribs cephalad and caudal were bowed and displaced but not involved in the mesenchymal hamartoma. Complete excision of the lateral mass was done, and histopathological examination confirmed the diagnosis of mesenchymal hamartoma. OUTCOMES After resection of the largest mass, the left lung reinflated appropriately, and within a few weeks, the infant was discharged home without supplemental oxygen support. PRACTICE RECOMMENDATIONS Symptomatic patients with cardiorespiratory compromise are best treated with surgical resection. In asymptomatic patients, it is best to proceed with serial imaging and conservative management with watchful waiting. Due to the rarity of the condition, data on long-term follow-up and outcomes are needed.
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Feler J, Sun F, Bajaj A, Hagan M, Kanekar S, Sullivan PLZ, Fridley JS, Gokaslan ZL. Complication Avoidance in Surgical Management of Vertebral Column Tumors. Curr Oncol 2022; 29:1442-1454. [PMID: 35323321 PMCID: PMC8947448 DOI: 10.3390/curroncol29030121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
The surgical management of spinal tumors has grown increasingly complex as treatment algorithms for both primary bone tumors of the spine and metastatic spinal disease have evolved in response to novel surgical techniques, rising complication rates, and additional data concerning adjunct therapies. In this review, we discuss actionable interventions for improved patient safety in the operative care for spinal tumors. Strategies for complication avoidance in the preoperative, intraoperative, and postoperative settings are discussed for approach-related morbidities, intraoperative hemorrhage, wound healing complications, cerebrospinal fluid (CSF) leak, thromboembolism, and failure of instrumentation and fusion. These strategies center on themes such as pre-operative imaging review and medical optimization, surgical dissection informed by meticulous attention to anatomic boundaries, and fastidious wound closure followed by thorough post-operative care.
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Affiliation(s)
- Joshua Feler
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Felicia Sun
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ankush Bajaj
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
| | - Matthew Hagan
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
| | - Samika Kanekar
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
| | - Patricia Leigh Zadnik Sullivan
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Jared S. Fridley
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
- Correspondence:
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25
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Ansari D, Guntin JA, Shah P, Patil SN, Patel S, Kumar M, Heron D, Mehta AI. Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection. World Neurosurg 2022; 160:e199-e208. [PMID: 34990841 DOI: 10.1016/j.wneu.2021.12.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. OBJECTIVE To evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2011-2019. Patients were categorized according to baseline preoperative platelet count, in 25,000/μL increments: 125,000-149,000/μL, 100,000-125,000/μL, 75,000-100,000/μL, and < 75,000/μL. These were compared to a control group with platelet count >150,000/μL. Outcomes in each cohort were analyzed using multivariate logistic regression analysis. RESULTS The database search revealed 3,574 patients undergoing extradural tumor resection; 2,171 (4.8%) of patients with platelets 125,000-149,000/μL, 114 (3.2%) with 100,000-125,000/μL, 75,000-100,000/μL in 43 (1.2%), and < 75,000/μL in 42 (1.2%). Platelet counts <100,000/μL was associated with perioperative blood transfusion, cardiac complications, and non-home discharge, and 30-day mortality. On subgroup analysis for mortality, an interaction was present between individuals with moderate/severe thrombocytopenia and cervical tumors. CONCLUSION In patients undergoing surgery for extradural spine tumor, degree of baseline thrombocytopenia-rather than presence alone-is an independent predictor of several adverse events. Wherever possible, optimization of preoperative platelet count to at least 100,000/μL may improve outcomes.
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Affiliation(s)
- Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jordan A Guntin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pal Shah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Megh Kumar
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David Heron
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Wu H, Tong K, Liu X, Li J, Li X, Gao M, Tian W, Chen D, Zhou Z, Liu S. A comparison between two laminectomy procedures in mouse spinal cord injury on Allen's animal model. J Neurosci Methods 2021; 368:109461. [PMID: 34958819 DOI: 10.1016/j.jneumeth.2021.109461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Huachuan Wu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Orthopaedic Research Institute/Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Kuileung Tong
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Xizhe Liu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Orthopaedic Research Institute/Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jianfeng Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Orthopaedic Research Institute/Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xianlong Li
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Orthopaedic Research Institute/Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Manman Gao
- Department of Sport Medicine, Inst Translat Med, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518000, China; Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering,Shenzhen University Health Science Center, Shenzhen 518060, China
| | - Wei Tian
- Laboratory of Bone Tissue Engineering, Beijing Laboratory of Biomedical Materials, Beijing Research Institute of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Dafu Chen
- Laboratory of Bone Tissue Engineering, Beijing Laboratory of Biomedical Materials, Beijing Research Institute of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Zhiyu Zhou
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Orthopaedic Research Institute/Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
| | - Shaoyu Liu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopaedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Orthopaedic Research Institute/Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Massaad E, Shankar GM, Shin JH. Novel Applications of Spinal Navigation in Deformity and Oncology Surgery-Beyond Screw Placement. Oper Neurosurg (Hagerstown) 2021; 21:S23-S38. [PMID: 34128068 DOI: 10.1093/ons/opaa322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Computer-assisted navigation has made a major impact on spine surgery, providing surgeons with technological tools to safely place instrumentation anywhere in the spinal column. With advances in intraoperative image acquisition, registration, and processing, many surgeons are now using navigation in their practices. The incorporation of navigation into the workflow of surgeons continues to expand with the evolution of minimally invasive techniques and robotic surgery. While numerous investigators have demonstrated the benefit of navigation for improving the accuracy of instrumentation, few have reported applying this technology to other aspects of spine surgery. Surgeries to correct spinal deformities and resect spinal tumors are technically demanding, incorporating a wide range of techniques not only for instrumentation placement but also for osteotomy planning and executing the goals of surgery. Although these subspecialties vary in their objectives, they share similar challenges with potentially high complications, invasiveness, and consequences of failed execution. Herein, we highlight the utility of using spinal navigation for applications beyond screw placement: specifically, for planning and executing osteotomies and guiding the extent of tumor resection. A narrative review of the work that has been done is supplemented with illustrative cases demonstrating these applications.
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Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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28
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Trivedi RJ. Spinal Cord Compression as a Consequence of Spinal Plasmacytoma in a Patient with Multiple Myeloma: A Case Report. Clin Pract 2021; 11:124-130. [PMID: 33668980 PMCID: PMC7930977 DOI: 10.3390/clinpract11010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
Multiple myeloma (MM) is a B cell malignancy resulting in osteolytic lesions. Pathological fracture of the vertebral body resulting in spinal cord compression is a common complication and accounts for approximately 5% of patients with MM. To date, there are no definitive guidelines for the treatment of spinal cord compression as a consequence of MM. Radiotherapy has frequently been the preferred form of treatment. Some surgeons, however, feel that spinal lesions in multiple myeloma should be treated in the same manner as spinal metastases from solid organs. I report the management of a 46-year-old gentleman with multiple myeloma that had resulted in neural compression in the lumbar and thoracic areas. Initial emergent treatment in this patient consisted of spinal decompression and stabilisation.
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29
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Wei H, Dong C, Wu J, Zhu Y, Ma H. Total en bloc spondylectomy combined with the satellite rod technique for spinal tumors. J Orthop Surg Res 2020; 15:536. [PMID: 33198816 PMCID: PMC7670808 DOI: 10.1186/s13018-020-02058-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background Instrumentation failure (IF) is a common complication after total en bloc spondylectomy (TES) in spinal tumors. This study aims to evaluate the clinical outcomes of TES combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors. Methods The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with the satellite rod technique by a single posterior approach from June 2015 to September 2018 were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively, and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded. Results The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI, and ASIA scores significantly improved from before to after surgery (P < 0.05). The LKA, AVH, and PVH significantly improved from before to immediately after surgery and to the final follow-up (P < 0.05), and the postoperative and final follow-up values did not significantly differ (P > 0.05). Conclusions TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.
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Affiliation(s)
- Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Chunke Dong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, 11 North Third Ring East Road, Chaoyang District, Beijing, 100029, China
| | - Jun Wu
- Department of Orthopaedic Surgery, People's Hospital of Ningxia Hui Autonomous Region, 301 Zhengyuan North Street, Jinfeng District, Yingchuan, 750002, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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30
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Caldaria A, Giuffrida R, di Meo N, Massari L, Dianzani C, Cannavò SP, Degrassi F, Casablanca E, Zalaudek I, Conforti C. Diagnosis and treatment of melanoma bone metastasis: A multidisciplinary approach. Dermatol Ther 2020; 33:e14193. [DOI: 10.1111/dth.14193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Antonio Caldaria
- Orthopedic and Traumatology Unit Sant'Anna University Hospital Ferrara Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology University of Messina Messina Italy
| | - Nicola di Meo
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
| | - Leo Massari
- Orthopedic and Traumatology Unit Sant'Anna University Hospital Ferrara Italy
| | - Caterina Dianzani
- Plastic Surgery Unit, Section of Dermatology Campus Biomedico University Rome Italy
| | | | - Ferruccio Degrassi
- Department of Radiology, Maggiore Hospital of Trieste University of Trieste Trieste Italy
| | - Edoardo Casablanca
- Department of Orthopedics and Trauma Surgery University of Verona Verona Italy
| | - Iris Zalaudek
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
| | - Claudio Conforti
- Dermatology Clinic, Hospital Maggiore of Trieste University of Trieste Trieste Italy
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