Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Boriani S, Bandiera S, Donthineni R, Amendola L, Cappuccio M, De Iure F, Gasbarrini A. Morbidity of en bloc resections in the spine. Eur Spine J. 2010;19:231-241. [PMID: 19690899 DOI: 10.1007/s00586-009-1137-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 06/27/2009] [Accepted: 08/04/2009] [Indexed: 10/24/2022]

For:	Boriani S, Bandiera S, Donthineni R, Amendola L, Cappuccio M, De Iure F, Gasbarrini A. Morbidity of en bloc resections in the spine. Eur Spine J. 2010;19:231-241. [PMID: 19690899 DOI: 10.1007/s00586-009-1137-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 06/27/2009] [Accepted: 08/04/2009] [Indexed: 10/24/2022]

Number

Cited by Other Article(s)

Lu M, Hou C, Chen W, Lei Z, Dai S, Du S, Jin Q, Jin D, Li H. En Bloc Resection of Thoracic and Upper Lumbar Spinal Tumors Using a Novel Rotation-Reversion Technique through Posterior-Only Approach. Clin Orthop Surg 2025;17:346-353. [PMID: 40170772 PMCID: PMC11957812 DOI: 10.4055/cios24377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 11/01/2024] [Accepted: 12/09/2024] [Indexed: 04/03/2025] Open

Abstract

Background

En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy.

Methods

Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed.

Results

Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6-74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm. The mean operation time and blood loss were 458.5 minutes (range, 220-880 minutes) and 3,146.2 mL (range, 1,000-6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery.

Conclusions

The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

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Gasho JO, Desai V, Lozano-Calderón S, Nielsen GP, Hung YP, Schwab JH, Tobert DG. Osteosarcoma of the mobile spine: a single-institution experience of 32 patients. Spine J 2025:S1529-9430(25)00162-7. [PMID: 40154640 DOI: 10.1016/j.spinee.2025.03.017] [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] [Received: 09/30/2024] [Revised: 01/29/2025] [Accepted: 03/22/2025] [Indexed: 04/01/2025]

Abstract

BACKGROUND CONTEXT

Osteosarcoma of the mobile spine is a rare and complex condition, with limited case series informing treatment decisions. Recent advancements in treatment paradigms, particularly in en bloc resection and novel radiation techniques, may incite new treatment guidelines and improve patient outcomes. The clinical outcomes of patients treated for osteosarcoma of the mobile spine at our institution were reported over a decade ago, and this study provides an updated assessment of management strategies and patient outcomes since the initial publication.

PURPOSE

To provide an updated analysis of clinical results for the treatment of mobile spine osteosarcoma.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Thirty-two patients treated at a single center for osteosarcoma of the spine over 22 years.

OUTCOME MEASURES

Estimation of overall patient survival, local recurrence, and the presence of metastatic disease.

METHODS

Inclusion criteria were adult patients treated for osteosarcoma originating in the vertebral column with the exclusion of the sacrum at Massachusetts General Hospital between 2001 and 2023. The overall survival was evaluated using the Kaplan-Meier method, grouped by type of resection (en bloc versus intralesional) and histological subtype (osteoblastic, chondroblastic, other/unknown). Prognostic factors were assessed using Cox proportional hazards modeling.

RESULTS

Twenty-two of the 32 patients were given en bloc resection, while ten received piecemeal resection. We found higher overall survival with en bloc resection compared to intralesional resection (median survival 81.54 months versus 12.42 months, p=.006) using Kaplan-Meier analysis techniques. However, in multivariable regression, neither en bloc resection nor histological subtype were predictive of better outcomes. Resection of greater than one level and younger age were associated with poor survival (p<.05).

CONCLUSIONS

This study highlights the continued challenges for patients with spinal osteosarcoma despite advances in surgical techniques and radiation modalities. If feasible, en bloc resection yields improved overall survival compared to intralesional resection, but the five-year mortality rate remains high. Histological subtype did not significantly predict outcomes, while tumors involving multiple vertebral levels and younger age were associated with worse survival.

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Xu W, Zhou S, Bai D, Wang P, Xu G, Yuan H, Li B, Xiao J. Modified Standard Total en bloc Spondylectomy for Solitary Thoracic or Lumbar Spinal Metastasis: A 1-Stage Posterior Approach Under Direct Visualization. J Bone Joint Surg Am 2025;107:628-638. [PMID: 39303022 DOI: 10.2106/jbjs.24.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]

Abstract

BACKGROUND

Solitary spinal metastasis (SM) is one of the indications for total en bloc spondylectomy (TES). Conventional TES carries the risk of damage to the great vessels anterior to the vertebral column, mainly because of a lack of visualization of the anterior structures. In this study, we devised a modified standard TES technique to achieve direct visualization in a 1-stage posterior approach.

METHODS

Included in this study were patients ≥18 years old with solitary thoracic or lumbar SM who underwent the modified standard TES at our institution between January 2017 and October 2022. Patient data were retrospectively sourced from medical records, and patients had a minimum of 3 months of postoperative follow-up.

RESULTS

This study involved 71 East Asian patients (median age, 57 years; 34 males), comprising 38 patients with thoracic SM and 33 with lumbar SM. Lung cancer was the most common tumor histology. Fourteen patients (19.7%) experienced intraoperative complications; pleural rupture was the predominant complication, and there were no cases of injury to the spinal cord or great vessels. The median operative time was 305 minutes (range, 203 to 660 minutes). The median intraoperative blood loss was 1,000 mL (range, 400 to 4,000 mL). The median perioperative blood transfusion was 4 units (range, 0 to 12 units), and the median hospitalization duration was 17 days (range, 14 to 29 days). Additionally, 27 patients (38.0%) had acute (perioperative) complications. Seven patients were lost to follow-up. Significant clinical improvement was achieved 3 months postoperatively. Postoperative early and late complications were observed in 5 patients. Of the 64 patients with completed follow-up, 47 (73.4%) had negative surgical margins, and none received postoperative radiation therapy. Revision surgery for local tumor recurrence was performed in 4.7% of patients. The median follow-up was 31.5 months (range, 3 to 81 months).

CONCLUSIONS

Our modified standard TES was demonstrated to be a safe and effective surgical technique for solitary thoracolumbar SM.

LEVEL OF EVIDENCE

Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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Zhang Y, Chen W, Cao S, He S, Wei H. Surgical Treatments and Long-Term Outcomes for Pediatric Patients With Lumbar Spinal Tumors. Global Spine J 2025;15:808-817. [PMID: 38060695 PMCID: PMC11877547 DOI: 10.1177/21925682231212863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open

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

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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Muscogliati R, Palliyil N, Chin DSC, Deogaonkar K, Daher M, Najjar E, Quraishi N. Multilevel En-Bloc Excision of Thoracic Spine Primary Chondrosarcoma Through an All-Posterior Approach: A Report of Two Cases. Cureus 2024;16:e70884. [PMID: 39497871 PMCID: PMC11533881 DOI: 10.7759/cureus.70884] [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: 10/04/2024] [Indexed: 11/07/2024] Open

Du Z, Tang X, Cai Z, Wang H, Wei R, Wang J. Intentional Dural Resection during en bloc Spinal Resection Could Provide a Secure Surgical Margin for Patients with Recurrent Spinal Tumors. Orthop Surg 2024;16:1753-1760. [PMID: 38859700 PMCID: PMC11293908 DOI: 10.1111/os.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 06/12/2024] Open

Abstract

OBJECTIVE

It is always difficult to obtain a comfortable surgical margin for patients with recurrent malignant or invasive benign spinal tumors. Tumor intraspinal invasion and dural adhesion are the essential reasons. There are always residual tumor cells maintained at the edge of dura. Dural resection is a key point to obtain a comfortable surgical margin for such cases. Whether such patients benefit from this risky surgical procedure is unknown. This study aims to understand better the oncological results, associated risks, and neurological function of this risky surgical procedure.

METHODS

We retrospectively reviewed clinical data from six consecutive patients who registered spinal tumors in our institute and underwent dural resection during en bloc spinal resection from June 2013 to May 2020. The demographic and perioperative data, oncological outcomes, complications, and neurological status were collected and analyzed.

RESULTS

All six patients were followed up for 24 to 46 months (mean follow-up time: 32.8 months). Local recurrence was detected in one patient (1/6, 16.7%) at 36 months postoperatively and in five patients with no evidence of disease at the last follow up (survival rate 83.3%). Eleven complications occurred in four patients (66.7%), and the dural resection-related complications included only four cases of cerebrospinal fluid leakage (CSFL), which accounted for 36.4% (4/11) of all complications. Neurologic status evaluated by the Frankel grade showed improvement of one grade in one case and deterioration of one to two grades in five patients immediately after surgery. All deterioration cases recovered to the preoperative level 6 months after the operation.

CONCLUSION

Dural resection is significant for patients with dura matter invaded by recurrent primary malignant or invasive benign spinal tumors with the purpose of clinical cure. This study demonstrated that in strictly selected cases, intentional dural resection could provide satisfying local control and long-term disease-free survival with acceptable complications and satisfying neurological function.

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Court C, Girault A, Valteau B, Mercier O, Missenard G, Fadel E, Bouthors C. New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first 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;33:1930-1940. [PMID: 38246902 DOI: 10.1007/s00586-023-08121-5] [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: 06/28/2023] [Revised: 11/26/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024]

Peeters JB, Dessesard Olijnyk L, Janelle F, Shedid D, Bojanowski MW, Labidi M. Surgical management of tumors of the cervical spine and craniovertebral junction involving the vertebral artery: A narrative review. Neurochirurgie 2024;70:101550. [PMID: 38552591 DOI: 10.1016/j.neuchi.2024.101550] [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: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/12/2024]

Yeung CM, Bilsky M, Boland PJ, Vaynrub M. The Role of En Bloc Resection in the Modern Era for Primary Spine Tumors. Spine (Phila Pa 1976) 2024;49:46-57. [PMID: 37732462 PMCID: PMC10750970 DOI: 10.1097/brs.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/27/2023] [Indexed: 09/22/2023]

Leng A, Yang M, Sun H, Dai Z, Zhu Z, Wan W, Xiao J. Surgical Strategy for Recurrent Giant Cell Tumor in the Thoracolumbar Spine. Orthop Surg 2024;16:78-85. [PMID: 38014475 PMCID: PMC10782228 DOI: 10.1111/os.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 11/29/2023] Open

Abstract

OBJECTIVE

Recurrent giant cell tumor (RGCT) of the spine represents a clinical challenge for surgeons, and the treatment strategy remains controversial. This study aims to describe the long-term follow-up outcomes and compare the efficacy of en bloc spondylectomy versus piecemeal spondylectomy in treating RGCT of the thoracolumbar spine.

METHODS

A total of 32 patients with RGCT of the thoracolumbar spine treated from June 2012 to June 2019 were retrospectively reviewed. A total of 15 patients received total en bloc spondylectomy (TES) with wide or marginal margin while 17 patients received total piecemeal spondylectomy (TPS) with intralesional margin. Postoperative Eastern Cooperative Oncology Group Performance Score (ECOG-PS), Frankel classification and recurrence-free survival (RFS) were evaluated after surgery. Survival curves were estimated by the Kaplan-Meier method and differences were analyzed with the log-rank test. Multivariate analysis was performed with Cox regression to identify the independent prognostic factors affecting RFS.

RESULTS

During a median follow-up of 41.9 ± 17.5 months, all patients with compromised neurologic functions exhibit significant improvement, with the mean ECOG-PS decreasing from 1.5 ± 1.3 to 0.13 ± 0.3 (p < 0.05). Among the 17 patients treated with TPS, eight patients developed local recurrence after a median time of 15.9 ± 6.4 months and four patients died from progressive disease. On the other hand, local recurrence were well managed with TES, since only one out of 15 patients experienced local relapse and all patients are alive with satisfied function at the latest follow-up. The median RFS for patients receiving TES and TPS are 75.0 months (95% CI: 67.5-82.5 m) and 38.3 months (95% CI: 27.3-49.3 m) respectively (p = 0.008). Multivariate analysis shows that the Ki67 index (p = 0.016), resection mode (p = 0.022), and denosumab (p = 0.039) are independent risk factors affecting RFS.

CONCLUSIONS

TES with wide/marginal margin should be offered to patients with RGCT whenever feasible, given its long-term benefits in local control and symptom alleviation. Additionally, patients with lower Ki67 index and application of denosumab tend to have a better prognosis.

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Luo Y, Xiu P, Chen H, Zeng J, Song Y, Li T. Clinical and radiological outcomes of n-HA/PA66 cages in anterior spine reconstruction following total en bloc spondylectomy for tumors. Front Surg 2023;10:1278301. [PMID: 38162088 PMCID: PMC10755916 DOI: 10.3389/fsurg.2023.1278301] [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: 08/16/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open

Abstract

Objective

This retrospective monocentric study was conducted to evaluate the clinical and radiological outcomes of the nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in reconstructing the anterior column of the spine following total en bloc spondylectomy (TES).

Methods

A cohort of 24 patients, 20 diagnosed with primary malignant tumors and 4 with metastatic malignancies, was selected based on specific inclusion criteria. All were subjected to TES and anterior column reconstruction with the n-HA/PA66 cage from January 2013 to July 2023 at a single institution. Pre-operative embolization was performed on all patients. Documented factors included operation duration, intraoperative blood loss, length of hospital stay, treatment history, and involved level. Mechanical complications and radiological parameters such as the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH), cage subsidence, and bone fusion time were evaluated. Quality of life and neurological function were gauged using tools like the Visual Analog Scale (VAS), Eastern Cooperative Oncology Group (ECOG) performance score, Karnofsky Performance Score (KPS) scale, and American Spinal Injury Association (ASIA) grading.

Results

All patients were followed up for 12-127 months, with an average period of 39.71 months. An average operation time of approximately 8.57 h and a blood loss volume of about 1,384 ml were recorded. No instances of tumor recurrence or multiple organ metastases were reported, though recurrence was detected in 2 living patients. Solid fusion was achieved in all patients at a mean time of 6.76 ± 0.69 months. Cage breakage or migration was not observed. Subsidence into the adjacent vertebral bodies was identified in 3 patients but was deemed clinically irrelevant. Significant improvements in VAS, ECOG performance score, KPS scale, and ASIA scores were noted from pre- to post-surgery (P < 0.05). A marked enhancement in the AVH was observed from before surgery to immediately after (P < 0.05). LKA, AVH, and PVH values between postoperative and final follow-up showed no significant variance (P > 0.05).

Conclusion

The integration of TES and the n-HA/PA66 cage was found to yield promising clinical and radiological outcomes in anterior column spine reconstruction. The use of this material did not hinder oncological care, including the provision of adjuvant treatments (chemo/radiotherapy), ultimately contributing to the enhanced long-term quality of life for spinal tumor patients.

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Martín Benlloch A, Bolós Ten L, Morales Codina AM. [Translated article] Vertebral metastases. En bloc treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023;67:S560-S575. [PMID: 37774916 DOI: 10.1016/j.recot.2023.09.007] [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: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open

Martín Benlloch A, Bolós Ten L, Morales Codina AM. Vertebral metastases. En bloc treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023;67:560-575. [PMID: 37689353 DOI: 10.1016/j.recot.2023.09.002] [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: 05/05/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023] Open

Sereno M, Franco SR, de la Reina L, Campo-Cañaveral de la Cruz JL, Muñoz de Legaría M, Casado Saénz E. Conversion in a Resectable Tumor after Denosumab Neoadjuvant in a Large Dorsal Giant Cells Tumor: A Case Report and a Literature Review. Curr Oncol 2023;30:9335-9345. [PMID: 37887575 PMCID: PMC10605573 DOI: 10.3390/curroncol30100675] [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: 08/27/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open

Affiliation(s)

María Sereno Medical Oncology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain; (S.R.F.); (E.C.S.) European University of Madrid, Medicine Departtment, Calle Tajo 1, Villaviciosa de Odón, 28745 Madrid, Spain; FIIB HUIS HHEN, 28703 Madrid, Spain Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI UAM, CSIC, 28049 Madrid, Spain
Silvia Roa Franco Medical Oncology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain; (S.R.F.); (E.C.S.) FIIB HUIS HHEN, 28703 Madrid, Spain Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI UAM, CSIC, 28049 Madrid, Spain
Laura de la Reina Neurosurgeon, Neurosurgery Department, Puerta de Hierro University Hospital, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain; (L.d.l.R.); (M.M.d.L.)
José Luis Campo-Cañaveral de la Cruz European University of Madrid, Medicine Departtment, Calle Tajo 1, Villaviciosa de Odón, 28745 Madrid, Spain; Thoracic Surgery Department, Puerta de Hierro University Hospital, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain
Marta Muñoz de Legaría Neurosurgeon, Neurosurgery Department, Puerta de Hierro University Hospital, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain; (L.d.l.R.); (M.M.d.L.) Pathology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain
Enrique Casado Saénz Medical Oncology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain; (S.R.F.); (E.C.S.) European University of Madrid, Medicine Departtment, Calle Tajo 1, Villaviciosa de Odón, 28745 Madrid, Spain; FIIB HUIS HHEN, 28703 Madrid, Spain Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI UAM, CSIC, 28049 Madrid, Spain

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Kotaka S, Fujiwara Y, Ota R, Manabe H, Adachi N. The Efficacy of Denosumab in Treating Spinal Aneurysmal Bone Cyst: A Case Report. Cureus 2023;15:e39954. [PMID: 37415990 PMCID: PMC10319940 DOI: 10.7759/cureus.39954] [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: 06/04/2023] [Indexed: 07/08/2023] Open

Liu X, Hu P, Zhai S, Liu X, Wang B, Zhou H, Liu X, Liu Z, Wei F. Surgery for metastatic spinal differentiated thyroid cancer: feasibility, outcome, and prognostic factors. Front Surg 2023;10:1140150. [PMID: 37273828 PMCID: PMC10232895 DOI: 10.3389/fsurg.2023.1140150] [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: 01/08/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open

Affiliation(s)

Xiajun Liu Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China Department of Spinal Surgery, Baoji Municipal Central Hospital, Baoji, China
Panpan Hu Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Shuheng Zhai Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Xiao Liu Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Ben Wang Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Hua Zhou Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Xiaoguang Liu Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Zhongjun Liu Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China
Feng Wei Department of Orthopaedics, Peking University Third Hospital, Beijing, China Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China Beijing Key Laboratory of Spinal Disease Research, Beijing, China

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Li H, Zhang P, Wang G, Liu H, Yang X, Wang G, Sun Z. Real-Time Navigation with Guide Template for Pedicle Screw Placement Using an Augmented Reality Head-Mounted Device: A Proof-of-Concept Study. Indian J Orthop 2023;57:776-781. [PMID: 37128571 PMCID: PMC10147887 DOI: 10.1007/s43465-023-00859-w] [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] [Received: 12/11/2022] [Accepted: 02/26/2023] [Indexed: 05/03/2023]

Medress ZA, Bobrow A, Tigchelaar SS, Henderson T, Parker JJ, Desai A. Augmented Reality-Assisted Resection of a Large Presacral Ganglioneuroma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023;24:e284-e285. [PMID: 36701554 DOI: 10.1227/ons.0000000000000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/22/2022] [Indexed: 01/27/2023] Open

Wang D, Liu F, Li B, Xu J, Gong H, Yang M, Wan W, Jiao J, Liu Y, Xiao J. Development and Validation of a Prognostic Model for Overall Survival in Patients with Primary Pelvis and Spine Osteosarcoma: A Population-Based Study and External Validation. J Clin Med 2023;12:jcm12072521. [PMID: 37048606 PMCID: PMC10095419 DOI: 10.3390/jcm12072521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open

Abstract Background: Primary pelvis and spine osteosarcoma (PSOS) is a specific type of osteosarcoma that is difficult to treat and has a poor prognosis. In recent years, the research on osteosarcoma has been increasing, but there have been few studies on PSOS; in particular, there have been a lack of analyses with a large sample size. This study aimed to construct and validate a model to predict the overall survival (OS) of PSOS patients, as currently there are no tools available for assessing their prognosis. Methods: Data including demographic information, clinical characteristics, and follow-up information on patients with PSOS were collected from the Surveillance, Epidemiology, and End Results (SEER) database, as well as from the Spine Tumor Center of Changzheng Hospital. Variable selection was achieved through a backward procedure based on the Akaike Information Criterion (AIC). Prognostic factors were identified by univariate and multivariate Cox analysis. A nomogram was further constructed for the estimation of 1-, 3-, and 5-year OS. Calibration plots, the concordance index (C-index), and the receiver operating characteristic (ROC) were used to evaluate the prediction model. Results: In total, 83 PSOS patients and 90 PSOS patients were separately collected from the SEER database and Changzheng Hospital. In the SEER cohort, liver metastasis, lung metastasis, and chemotherapy were recognized as independent prognostic factors for OS (p < 0.05) and were incorporated to construct the initial nomogram. However, the initial nomogram showed poor predictive accuracy in internal and external validation. Then, we shifted our focus to the Changzheng data. Lung metastasis involving segments, Eastern Cooperative Oncology Group (ECOG) performance score, alkaline phosphatase (ALP) level, and en bloc resection were ultimately identified as independent prognostic factors for OS (p < 0.05) and were further incorporated to construct the current nomogram, of which the bias-corrected C-index was 0.834 (0.824–0.856). The areas under the ROC curves (AUCs) of the current nomogram regarding 1-, 3-, and 5-year OS probabilities were 0.93, 0.96, and 0.92, respectively. Conclusion: We have developed a predictive model with satisfactory performance and clinical practicability, enabling effective prediction of the OS of PSOS patients and aiding clinicians in decision-making. Collapse

Moscinksi N, Sullivan PZ, Gokaslan ZL. Benign primary bone tumors, long-term management into adulthood. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open

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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Lutz BM, Schaser KD, Weitz J, Kirchberg J, Fritzsche H, Disch AC, Busch A, Wolk S, Reeps C. Thoracoabdominal Aortic Replacement Together with Curative Oncological Surgery in Retroperitoneal and Spinal Tumours. Curr Oncol 2023;30:2555-2568. [PMID: 36975408 PMCID: PMC10047559 DOI: 10.3390/curroncol30030195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open

Affiliation(s)

Brigitta M. Lutz Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany Correspondence:
Klaus-Dieter Schaser University Center for Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, 01307 Dresden, Germany National Center for Tumor Diseases (NCT/UCC), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01037 Dresden, Germany
Jurgen Weitz Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany National Center for Tumor Diseases (NCT/UCC), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01037 Dresden, Germany
Johanna Kirchberg Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany National Center for Tumor Diseases (NCT/UCC), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01037 Dresden, Germany
Hagen Fritzsche University Center for Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, 01307 Dresden, Germany National Center for Tumor Diseases (NCT/UCC), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01037 Dresden, Germany
Alexander C. Disch University Center for Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, 01307 Dresden, Germany National Center for Tumor Diseases (NCT/UCC), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universitaet Dresden, German Cancer Research Center (DKFZ), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01037 Dresden, Germany
Albert Busch Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany
Steffen Wolk Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany
Christian Reeps Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany

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Berjano P, Baroncini A, Cecchinato R, Langella F, Boriani S. En-bloc resection of a chordoma in L3 by a combined open posterior and less invasive retroperitoneal approach: technical description and case report. Arch Orthop Trauma Surg 2023;143:801-808. [PMID: 34562120 DOI: 10.1007/s00402-021-04177-4] [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] [Received: 03/24/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]

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]

Xu N, Chang S, Liu X, Jiang L, Yu M, Wu F, Dang L, Zhou H, Li Y, Wang Y, Liu X, Wu Y, Wei F, Liu Z. Medium to long term follow-up of survival and quality of life in patients with primary tumors of the cervical spine: Experience From a large single center. Front Surg 2023;9:1011100. [PMID: 36684347 PMCID: PMC9852619 DOI: 10.3389/fsurg.2022.1011100] [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: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open

Abstract

Objectives

To evaluate the survival and medium to long term health-related quality of life (HRQoL) of patients with primary cervical spinal tumors in a cross-sectional study and to identify any significant associations with demographic or clinical characteristics.

Methods

Patients diagnosed with primary cervical spinal tumors were retrospectively enrolled and their clinical, radiologic, and follow-up data (specifically the EQ-5D questionnaire) were collected. Univariate and multivariate Cox time-dependent regression analyses were performed to examine the significance of certain variables on overall survival. Univariate and multivariate logistic regression analyses were conducted to identify variables significant for overall HRQoL and each dimension of the EQ-5D.

Results

A total of 341 patients were enrolled in the study with a mean follow-up of 70 months. The diagnosis was benign in 246 cases, malignant in 84, and unconfirmed in 11. The 5-year overall survival rate was 86% and the 10-year overall survival rate was 65%. Multivariate analysis suggested that surgical treatment (P = 0.002, hazard ratio [HR] = 0.431, 95% CI. [0.254, 0.729]), benign and malignant tumors [P < 0.001, HR = 2.788, 95% CI. (1.721, 4.516)], tumor and surrounding normal tissue boundary [P = 0.010, HR = 1.950, 95% CI. (1.171, 3.249)], and spinal instability [P = 0.031, HR = 1.731, 95% CI. (1.051, 2.851)] still had significant effects on survival.

Conclusions

In this cross-sectional study, we evaluated the survival period and medium and long-term health-related quality of life of patients with primary tumors of the cervical spine, and analyzed the significant related factors of tumor clinical characteristics. Surgery, myelopathy, malignancy, spinal pain relieved by lying down or supine position, and tumor infiltration on MRI were significant predictors for overall survival. Enneking stage and age were significant predictors for HRQoL.

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Affiliation(s)

Nanfang Xu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Shuai Chang Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Xiaoguang Liu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Liang Jiang Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Miao Yu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Fengliang Wu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Lei Dang Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Hua Zhou Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Yan Li Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Yongqiang Wang Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Xiao Liu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Yunxia Wu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
Feng Wei Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China,Correspondence: Feng Wei Zhongjun Liu
Zhongjun Liu Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China,Correspondence: Feng Wei Zhongjun Liu

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Hashmi SMM, Hammoud I, Kumar P, Sartaj AA, Ghosh K, Ray A, Golash A. Outcome of Surgical Treatment for Metastatic Spinal Cord Compression: A Single-Center Retrospective Study. Asian J Neurosurg 2022;17:577-583. [PMID: 36570752 PMCID: PMC9771617 DOI: 10.1055/s-0042-1758846] [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] [Indexed: 12/14/2022] Open

Lu M, Zhou Z, Chen W, Lei Z, Dai S, Hou C, Du S, Jin Q, Jin D, Boriani S, Li H. En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the "rotation-reversion" technique: Feasibility, safety, and clinical outcome of 11 cases. Front Oncol 2022;12:1031708. [PMID: 36530980 PMCID: PMC9751655 DOI: 10.3389/fonc.2022.1031708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 03/16/2025] Open

Abstract

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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Tigchelaar SS, Medress ZA, Quon J, Dang P, Barbery D, Bobrow A, Kin C, Louis R, Desai A. Augmented Reality Neuronavigation for En Bloc Resection of Spinal Column Lesions. World Neurosurg 2022;167:102-110. [PMID: 36096393 DOI: 10.1016/j.wneu.2022.08.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022]

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

Zhou H, Liu S, Li Z, Liu X, Dang L, Li Y, Li Z, Hu P, Wang B, Wei F, Liu Z. 3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors. J Neurosurg Spine 2022;37:274-282. [PMID: 35213828 DOI: 10.3171/2022.1.spine21900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/07/2022] [Indexed: 11/06/2022]

Abstract

OBJECTIVE

A 3D-printed vertebral prosthesis can be used to reconstruct a bone defect more precisely because of its tailored shape, with its innermost porous structure inducing bone ingrowth. The aim of this study was to evaluate the clinical outcomes of using a 3D-printed artificial vertebral body for spinal reconstruction after en bloc resection of thoracolumbar tumors.

METHODS

This was a retrospective analysis of 23 consecutive patients who underwent surgical treatment for thoracolumbar tumors at our hospital. En bloc resection was performed in all cases, based on the Weinstein-Boriani-Biagini surgical staging system, and anterior reconstruction was performed using a 3D-printed artificial vertebral body. Prosthesis subsidence, fusion status, and instrumentation-related complications were evaluated. Stability of the anterior reconstruction method was evaluated by CT, and CT Hounsfield unit (HU) values were measured to evaluate fusion status.

RESULTS

The median follow-up was 37 (range 24-58) months. A customized 3D-printed artificial vertebral body was used in 10 patients, with an off-the-shelf 3D-printed artificial vertebral body used in the other 13 patients. The artificial vertebral body was implanted anteriorly in 5 patients and posteriorly in 18 patients. The overall fusion rate was 87.0%. The average prosthesis subsidence at the final follow-up was 1.60 ± 1.79 mm. Instrument failure occurred in 2 patients, both of whom had substantial subsidence (8.47 and 3.69 mm, respectively). At 3 months, 6 months, and 1 year postoperatively, the mean CT HU values within the artificial vertebral body were 1930 ± 294, 1997 ± 336, and 1994 ± 257, respectively, with each of these values being significantly higher than the immediate postoperative value of 1744 ± 321 (p < 0.05).

CONCLUSIONS

The use of a 3D-printed artificial vertebral body for anterior reconstruction after en bloc resection of the thoracolumbar spinal tumor may be a feasible and reliable option. The low incidence of prosthesis subsidence of 3D-printed endoprostheses can provide good stability instantly. Measurement of HU values with CT is a valuable method to evaluate the osseointegration at the bone-metal interface of a 3D-printed vertebral prosthesis.

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Affiliation(s)

Hua Zhou 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Shanshan Liu 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Zhehuang Li 4Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
Xiaoguang Liu 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Lei Dang 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Yan Li 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Zihe Li 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Panpan Hu 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Ben Wang 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Feng Wei 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and
Zhongjun Liu 1Department of Orthopaedics, Peking University Third Hospital, Beijing 2Engineering Research Center of Bone and Joint Precision Medicine, Beijing 3Beijing Key Laboratory of Spinal Disease Research, Beijing; and

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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]

Zaborovskii NS, Ptashnikov DA, Mikhailov DA, Smekalenkov OA, Masevnin SV, Diusenov DO, Kazantsev ND. Complications in spinal tumor surgery (review of literature). GREKOV'S BULLETIN OF SURGERY 2022. [DOI: 10.24884/0042-4625-2022-181-2-92-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]

Xu L, Huang W, Cai W, Sun Z, Fang M, Ji Y, Wang S, Zhang J, Hu T, Cheng M, Yan W. Comparison of Surgical Outcomes Between Separation Surgery and Piecemeal Spondylectomy for Spinal Metastasis: A Retrospective Analysis. Front Surg 2021;8:686930. [PMID: 34881284 PMCID: PMC8645642 DOI: 10.3389/fsurg.2021.686930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open

Abstract

Objective: This study aimed to compare the outcomes between piecemeal spondylectomy and separation surgery for patients with spinal metastasis.

Summary of Background Data: Piecemeal spondylectomy and separation surgery are two widely-used treatment options for spinal metastasis. However, no studies have compared the surgical outcomes between both treatment modalities.

Methods: Patients with spinal metastasis who underwent piecemeal spondylectomy or separation surgery between August 2017 and April 2020 at our spine center were recruited. Demographic, preoperative, perioperative, and follow-up data were collected and analyzed. Kaplan–Meier analysis and the log-rank test were used to analyze overall survival (OS) and progression-free survival (PFS) in patients with spinal metastasis.

Results: Overall, 26 patients were treated with piecemeal spondylectomy, and 29 underwent separation surgery with postoperative stereotactic radiosurgery. Both groups showed significant postoperative improvements in neurological status. The piecemeal spondylectomy group had significantly more blood loss (1784.62 ± 833.64 vs. 1165.52 ± 307.38 ml) and required longer operative time (4.76 ± 0.93 vs. 3.73 ± 1.15 h) than the separation surgery group. No significant difference in OS was found between the groups (P = 0.064); however, patients in the separation surgery group experienced less local recurrence than those in the piecemeal spondylectomy group (P = 0.0014). Notably, significant differences were detected in the development of complications between the groups (P = 0.029).

Conclusion: Separation surgery led to less blood loss and reduced complications and had shorter operation time than piecemeal spondylectomy. Although no significant differences were found in OS between the groups, separation surgery was associated with better PFS compared with piecemeal spondylectomy. These findings suggest that separation surgery has some advantages over piecemeal spondylectomy for patients with spinal metastatic disease.

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Affiliation(s)

Lun Xu Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Wending Huang Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Weiluo Cai Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
ZhengWang Sun Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Meng Fang Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Yingzheng Ji Department of Orthopedic, Naval Medical Center of PLA, Second Military Medical University, Shanghai, China
Shuoer Wang Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Jianing Zhang Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Tu Hu Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Mo Cheng Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Wangjun Yan Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Autologous mesenchymal stem cells in the treatment of spinal aneurysmal bone cyst. Pathol Res Pract 2021;229:153722. [PMID: 34952421 DOI: 10.1016/j.prp.2021.153722] [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] [Received: 08/24/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/20/2022]

Early Major Complications After Radical Resection of Primary C2-Involved Upper Cervical Chordoma Through the Combined Anterior Retropharyngeal-Posterior Approach: Incidence and Risk Factors. World Neurosurg 2021;154:e790-e796. [PMID: 34389526 DOI: 10.1016/j.wneu.2021.08.001] [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: 05/30/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022]

Abstract

BACKGROUND

We investigated the frequency of postoperative major complications, length of stay (LOS), and associated risk factors for primary C2-involved upper cervical chordoma through the combined anterior retropharyngeal-posterior approach.

METHODS

Clinical data were collected from 102 patients with primary C2-involved upper cervical chordoma treated at our institute from January 2016 to January 2021. Additionally, the Changzheng Hospital (CZH) surgical classification system was designed to describe the different anatomic types of C2 chordomas. A multivariate logistic regression analysis was performed and a multivariate Cox proportional hazards model was used to identify the risk factors associated with the occurrence of major complications and prolonged length of stay (LOS), respectively.

RESULTS

The incidence of major complication was 29.41% (30 of 102) in our cohort. A long surgical duration (P = 0.001), increased age (P = 0.001), more preoperative comorbidities (P = 0.008) and CZH types indicating extensive tumor involvement (P < 0.001) were identified as significant predictors of the occurrence of a major complication postoperatively. The mean LOS for the entire study population was 21.50 ± 0.64 days. The patients who experienced complications required a significant longer LOS (25.50 ± 1.26 days) than those without complications (19.83 ± 0.65; P < 0.001). The independent factors affecting LOS included age (P = 0.001), Frankel grade (P = 0.001), CZH classification (P < 0.001), and surgical duration (P = 0.001).

CONCLUSIONS

Patients who are older, experience longer operative duration, or have larger tumor extension have a greater risk of postoperative major complication. The LOS can be predicted by age, preoperative neurological deficit, CZH classification, surgical approach, and surgical duration. Accordingly, patients with these risk factors should be monitored and targeted with preventative measures.

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Court C, Boulate D, Missenard G, Mercier O, Fadel E, Bouthors C. Video-Assisted Thoracoscopic En Bloc Vertebrectomy for Spine Tumors: Technique and Outcomes in a Series of 33 Patients. J Bone Joint Surg Am 2021;103:1104-1114. [PMID: 33861543 DOI: 10.2106/jbjs.20.01417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Abstract

BACKGROUND

In en bloc vertebrectomy, the posterior approach is associated with limited access to anterior structures (vertebral body, esophagus, aorta, azygos vein). Video-assisted thoracoscopic surgery (VATS) might prove to be advantageous during thoracic en bloc vertebrectomy by allowing a combined anterior-posterior access in the prone position. We describe the technique and review the outcomes of 33 cases of video-assisted thoracoscopic en bloc vertebrectomy.

METHODS

A retrospective, single-center cohort study included all cases of VATS with a minimum follow-up of 1 year. A team of thoracic and orthopaedic surgeons performed the surgical procedure with the patient in a single, prone position. Anterior release was carried out thoracoscopically, followed by posterior en bloc tumor removal.

RESULTS

From 2003 to 2019, 33 patients were included. Nine patients underwent total vertebrectomy (8 had single-level and 1 had 3-level), and 24 patients underwent partial vertebrectomy (1 had single-level, 8 had 2-level, 13 had 3-level, and 2 had 4-level). Ten patients had pulmonary resection. Histology revealed 18 cases (55%) of primary bone tumors, 6 cases (18%) of lung cancer invading the spine, 6 cases (18%) of solitary metastasis, and 3 other cases (9%). The margins were tumor-free in 28 cases (85%). The median operative time was 240 minutes (range, 150 to 510 minutes), with a median blood loss of 1,200 mL (range, 400 to 6,700 mL), and there were 2 cases of conversion to thoracotomy. A total of 33 complications occurred in 18 patients (55%), and these were predominantly pulmonary. One death was surgery-related (infection). One patient had a persistent monoplegia. At a median follow-up of 63 months (range, 12 to 156 months), there were 21 surviving patients (64%) with 2 local recurrences and 1 distant recurrence, and 2 patients (6%) were lost to follow-up. The survival rates were 94% at 1 year, 71% at 2 years, and 68% at 5 years.

CONCLUSIONS

VATS en bloc vertebrectomy may be indicated for T2-to-T11 spine tumors with the exception of massive tumors, substantial chest wall and/or mediastinal invasion, and lung cancer exceeding 7 cm. The technique yielded satisfactory surgical and oncologic outcomes.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Elsamadicy AA, Koo AB, David WB, Zogg CK, Kundishora AJ, Hong CS, Kuzmik GA, Gorrepati R, Coutinho PO, Kolb L, Laurans M, Abbed K. Thirty- and 90-day Readmissions After Spinal Surgery for Spine Metastases: A National Trend Analysis of 4423 Patients. Spine (Phila Pa 1976) 2021;46:828-835. [PMID: 33394977 PMCID: PMC8278805 DOI: 10.1097/brs.0000000000003907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Abstract

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The aim of this study was to investigate differences in 30- and 90-day readmissions for spine metastases treated with decompression and/or fusion spine surgery in a nationwide readmission database.

SUMMARY OF BACKGROUND DATA

Patients with metastases to the spine represent a particularly vulnerable patient group that may encounter frequent readmissions. However, the 30- and 90-day rates for readmission following surgery for spine metastases have not been well described.

METHODS

The Nationwide Readmission Database years 2013 to 2015 was queried. Patients were grouped by no readmission (non-R), readmission within 30 days (30-R), and readmission within 31 to 90 days (90-R). Weighted multivariate analysis assessed impact of treatment approach and clinical factors associated with 30- and 90-day readmissions.

RESULTS

There were a total of 4423 patients with a diagnosis of spine metastases identified who underwent spine surgery, of which 1657 (37.5%) encountered either a 30-or 90-day unplanned readmission (30-R: n = 1068 [24-.1%]; 90-R: n = 589 [13.3%]; non-R: n = 2766). The most prevalent inpatient complications observed were postoperative infection (30-R: 16.3%, 90-R: 14.3%, non-R: 11.5%), acute post-hemorrhagic anemia (30-R: 13.4%, 90-R: 14.2%, non-R: 14.5%), and genitourinary complication (30-R: 5.7%, 90-R: 2.9%, non-R: 6.2%). The most prevalent 30-day and 90-day reasons for admission were sepsis (30-R: 10.2%, 90-R: 10.8%), postoperative infection (30-R: 13.7%, 90-R: 6.5%), and genitourinary complication (30-R: 3.9%, 90-R: 4.1%). On multivariate regression analysis, surgery type, age, hypertension, and renal failure were independently associated with 30-day readmission; rheumatoid arthritis/collagen vascular diseases, and coagulopathy were independently associated with 90-day readmission.

CONCLUSION

In this study, we demonstrate several patient-level factors independently associated with unplanned hospital readmissions after surgical treatment intervention for spine metastases. Furthermore, we find that the most common reasons for readmission are sepsis, postoperative infection, and genitourinary complications.Level of Evidence: 3.

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Jawad MU, Farhan S, Haffner MR, Le HV, Thorpe SW, Klineberg EO, Randall RL. Primary mobile vertebral column sarcomas: Prognostic factors vary by histologic subtypes. J Surg Oncol 2021;124:635-645. [PMID: 34091907 DOI: 10.1002/jso.26530] [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: 02/18/2021] [Revised: 04/08/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]

Tang X, Cai Z, Wang R, Ji T, Guo W. En bloc resection and reconstruction of a huge chondrosarcoma involving multilevel upper thoracic spine and chest wall: case report. BMC Musculoskelet Disord 2021;22:348. [PMID: 33845805 PMCID: PMC8042902 DOI: 10.1186/s12891-021-04208-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/31/2021] [Indexed: 01/23/2023] Open

Tang X, Yang Y, Zang J, Du Z, Yan T, Yang R, Guo W. Preliminary Results of a 3D-Printed Modular Vertebral Prosthesis for Anterior Column Reconstruction after Multilevel Thoracolumbar Total En Bloc Spondylectomy. Orthop Surg 2021;13:949-957. [PMID: 33817999 PMCID: PMC8126945 DOI: 10.1111/os.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open

Abstract

OBJECTIVE

To evaluate preliminary results of a 3D-printed modular prosthesis for spinal reconstruction after multilevel thoracolumbar total en bloc spondylectomy (TES).

METHODS

Patients with thoracolumbar spinal tumors treated surgically between January 2016 and April 2019 were included in this retrospective study. A total of 17 male and 10 female patients with a mean age of 42 (range, 15-72) years comprised the sample. The pathological diagnoses included six chondrosarcomas (one of them was mesenchymal chondrosarcoma), six giant cell tumors, three malignant peripheral nerve sheath tumors, two osteosarcomas, two undifferentiated high-grade pleomorphic sarcomas (UPS), two solitary fibrous tumors, one Ewing's sarcoma, one liposarcoma, and four metastatic tumors. Tumors involved 2 levels in 14 patients, 3 levels in seven patients, 4 levels in four patients, 5 levels in one patient, and 6 levels in one patient. A 3D-printed modular prosthesis was used for anterior column reconstruction after TES. All analyses were performed using SPSS version 18.0 (SPSS, Inc., Chicago, IL). Descriptive statistics were used to analyze the demographic data and clinical outcomes. Data forms included mean, standard deviation and range.

RESULTS

Under general anesthesia, all patients received TES with an average operative time of 639 (range, 210-1650) min, and the mean blood loss during operation was 4.1 (range, 0.8-13.3) L. Twenty-two patients have been transferred to ICU for a mean time of 3.2 (range, 0-6) d. All patients had follow-up procedures except for one, who died of perioperative complications. Mean time of follow-up was 22 (range, 12-41) months. Local recurrence (19.2%) occurred in two patients with intralesional margin and three patients with marginal margin, respectively. At the end of follow-up, three patients died of disease, eight patients were alive with disease, and 15 patients had no evidence of disease. Average lengths of resected vertebrae and modular prostheses were 71.4 ± 26.5 mm (range, 40-142 mm) and 68.4 ± 23.9 mm (range, 40-132 mm), respectively. In 26 patients with minimum follow-up of more than 1 year, no evidence of internal fixation failure or dislocation of vertebral prosthesis was found. Asymptomatic prosthetic subsidence into adjacent vertebral bodies occurred in 10 patients with a mean length of 1.8 ± 1.0 mm (range, 1-4 mm). The subsidence was seen at proximal end in two patients, distal end in four patients, and both ends in four patients. Eighteen major complications and 14 minor complications were found in 15 patients. All patients fully recovered at 3 or 6 months after operation. At the latest follow-up, in 23 alive patients, 19 can walk independently and two can achieve outdoor activities by walking aid.

CONCLUSION

For spinal reconstruction after multilevel thoracolumbar TES, 3D-printed modular vertebral prosthesis is suitable for different length of anterior column reconstruction with less mechanical complications, and can provide a stable environment to maintain or rehabilitate patients' neurological function in short-term follow-up.

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Ali S, Qasim A, Sarwar MR, Munam AU, Shams S. Primary Intraosseous Xanthogranuloma in Adult Cervical Spine: A Case Report of Benign Cause of Lytic Bone Lesion. Asian J Neurosurg 2021;16:208-211. [PMID: 34211897 PMCID: PMC8202395 DOI: 10.4103/ajns.ajns_480_20] [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: 10/24/2020] [Revised: 10/31/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open

Bongers MER, Ogink PT, Chu KF, Patel A, Rosenthal B, Shin JH, Lee SG, Hornicek FJ, Schwab JH. The use of autologous free vascularized fibula grafts in reconstruction of the mobile spine following tumor resection: surgical technique and outcomes. J Neurosurg Spine 2021;34:283-292. [PMID: 33157532 DOI: 10.3171/2020.6.spine20521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]

Abstract

OBJECTIVE

Reconstruction of the mobile spine following total en bloc spondylectomy (TES) of one or multiple vertebral bodies in patients with malignant spinal tumors is a challenging procedure with high failure rates. A common reason for reconstructive failure is nonunion, which becomes more problematic when using local radiation therapy. Radiotherapy is an integral part of the management of primary malignant osseous tumors in the spine. Vascularized grafts may help prevent nonunion in the radiotherapy setting. The authors have utilized free vascularized fibular grafts (FVFGs) for reconstruction of the spine following TES. The purpose of this article is to describe the surgical technique for vascularized reconstruction of defects after TES. Additionally, the outcomes of consecutive cases treated with this technique are reported.

METHODS

Thirty-nine patients were treated at the authors' tertiary care institution for malignant tumors in the mobile spine using FVFG following TES between 2010 and 2018. Postoperative union, reoperations, complications, neurological outcome, and survival were reported. The median follow-up duration was 50 months (range 14-109 months).

RESULTS

The cohort consisted of 26 males (67%), and the median age was 58 years. Chordoma was the most prevalent tumor (67%), and the lumbar spine was most affected (46%). Complete union was seen in 26 patients (76%), the overall complication rate was 54%, and implant failure was the most common complication, with 13 patients (33%) affected. In 18 patients (46%), one or more reoperations were needed, and the fixation was surgically revised 15 times (42% of reoperations) in 10 patients (26%). A reconstruction below the L1 vertebra had a higher proportion of implant failure (67%; 8 of 12 patients) compared with higher resections (21%; 5 of 24 patients) (p = 0.011). Graft length, number of resected vertebrae, and docking the FVFG on the endplate or cancellous bone was not associated with union or implant failure on univariate analysis.

CONCLUSIONS

The FVFG is an effective reconstruction technique, particularly in the cervicothoracic spine. However, high implant failure rates in the lumbar spine have been seen, which occurred even in cases in which the graft completely healed. Methods to increase the weight-bearing capacity of the graft in the lumbar spine should be considered in these reconstructions. Overall, the rates of failure and revision surgery for FVFG compare with previous reports on reconstruction after TES.

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He LM, Ma X, Chen C, Zhang HY. Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review. World J Clin Cases 2021;9:644-650. [PMID: 33553403 PMCID: PMC7829725 DOI: 10.12998/wjcc.v9.i3.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy. The purpose was to reduce the risk and trauma of spondylectomy.

CASE SUMMARY

A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo. Preoperative diagnosis was C4 metastasis of thyroid cancer. Preoperative visual analogue scale score was 5. American Spinal Cord Injury Association (ASIA) grade was E. Tomita classification was 7. Weinstein-Boriani-Biagini (WBB) classification was A-D, 3-9. Tomita score was 5. Modified Tokuhashi score was 9. Spinal instability neoplastic score (SINS) was 13. The patient underwent minimally invasive cervical spondylectomy on September 28, 2017. The operative time was 200 min; the estimated blood loss was 1200 mL. The operation was successful, without complications. The postoperative visual analogue scale score was 0. The patient remained classified as ASIA grade E at the last follow-up. She accepted regular iodine-131 therapy postoperatively. The serum thyroglobulin (Tg) level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/mL at the last follow-up. There was no local recurrence at the 25-mo follow-up, according to images, single-photon emission computed tomography, and serum Tg levels. Obvious ossification and solid fusion of C3-C5 were found at the last follow-up.

CONCLUSION

Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma, intraoperative traction injury, and paraspinal muscle injury, accelerating postoperative recovery. This technique requires a rich experience in cervical spine surgery with tubular retractors, so that surgeons can visualize the anatomical structure in a small field.

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Garg B, Mehta N, Kandasamy D, Mridha AR. Rare case of juvenile ossifying fibroma of the lumbar spine causing vertebra plana. BMJ Case Rep 2021;14:14/1/e239097. [PMID: 33462042 PMCID: PMC7813401 DOI: 10.1136/bcr-2020-239097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open

Rajgor HD, James S, Botchu R, Grainger M, Czyz M. Should Denosumab or Radical Surgery Be Recommended for a Spinal Giant Cell Tumour in a Fertile Female? Cureus 2020;12:e11526. [PMID: 33354470 PMCID: PMC7746321 DOI: 10.7759/cureus.11526] [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] [Indexed: 11/06/2022] Open

Multi-level En Bloc Resection as a Preferred Salvage Therapy for Recurrent Thoracolumbar Chondrosarcoma: A Comparative Study With Piecemeal Resection. Spine (Phila Pa 1976) 2020;45:789-797. [PMID: 32058425 DOI: 10.1097/brs.0000000000003403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Abstract

STUDY DESIGN

A retrospective analysis was performed.

OBJECTIVE

The aim of this study was to evaluate the feasibility and effectiveness of multilevel en bloc resection versus piecemeal resection for recurrent thoracolumbar chondrosarcoma (CHS).

SUMMARY OF BACKGROUND DATA

Multilevel en bloc resection for recurrent thoracolumbar CHS is rarely performed.

METHODS

Included in this retrospective study were 27 patients with recurrent thoracolumbar CHS who received either multilevel en bloc resection or piecemeal resection as a salvage revision procedure in our center between 2010 and 2018. Relevant data between the two methods were compared. Relapse-free survival (RFS) and overall survival (OS) were analyzed by log-rank analysis.

RESULTS

Our series comprised 16 males and 11 females with a mean age of 40.7 years. Multilevel en bloc resection was performed in 17 patients, and piecemeal resection in 10 patients. Of the 17 patients receiving multilevel en bloc resection, five patients experienced recurrence, of whom three died, whereas in the 10 patients receiving piecemeal resection, seven experienced recurrence and all of them died, showing a significant difference between the two groups (P = 0.04 for recurrence, P = 0.007 for death). Complications occurred more frequently in the patients receiving multilevel en bloc resection (P = 0.04), but RFS and OS were prolonged significantly in this group of patients as compared with piecemeal resection group (56.8 ± 9.7 vs. 17.2 ± 4.2, P = 0.016; 67.3 ± 8.4 vs. 21.4 ± 3.5, P = 0.002).

CONCLUSION

Multilevel en bloc resection as a salvage therapy for recurrent thoracolumbar CHS is technically challenging with high risk of complications, but it can significantly prolong RFS and OS of such patients as compared with piecemeal resection.

LEVEL OF EVIDENCE

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Sagittal en bloc resection of primary tumors in the thoracic and lumbar spine: feasibility, safety and outcome. Sci Rep 2020;10:9108. [PMID: 32499491 PMCID: PMC7272461 DOI: 10.1038/s41598-020-65326-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/29/2020] [Indexed: 12/28/2022] Open

Murray FR, Snider JW, Schneider RA, Walser M, Bolsi A, Pica A, Lomax AJ, Weber DC. Prognostic factors for spinal chordomas and chondrosarcomas treated with postoperative pencil-beam scanning proton therapy: a large, single-institution experience. J Neurosurg Spine 2020;32:921-930. [PMID: 32005008 DOI: 10.3171/2019.11.spine1927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]

Abstract

OBJECTIVE

The aim of this paper was to evaluate the prognostic factors in surgical and adjuvant care for spinal chordomas and chondrosarcomas after surgery followed by high-dose pencil-beam scanning proton therapy (PBS-PT).

METHODS

From 1997 to 2016, 155 patients (61 female patients; median age 55 years) with spinal (cervical, n = 61; thoracic, n = 29; lumbar, n = 13; sacral, n = 46; pelvic, n = 6) classic chordomas (n = 116) and chondrosarcomas (n = 39; most were low grade) were treated with maximal safe resection followed by PBS-PT (median dose prescribed: 74 Gy [relative biological effectiveness], range 48.6-77 Gy). The majority of patients (n = 153, 98.7%) had undergone at least 1 resection prior to PBS-PT (median 1, range 0-5; biopsy only, n = 2). Fewer than half (45.1%) of the surgeries were rated as gross-total resections (GTRs) prior to PBS-PT. Surgical stabilization (SS) was present in 39% of all patients (n = 60). Ninety-one patients (59%) presented with macroscopic tumor at the start of PBS-PT. The median follow-up duration was 64.7 months (range 12.2-204.8 months).

RESULTS

The 5-year local tumor control, disease-free survival (DFS), and overall survival were 64.9% (95% CI 56.3%-73.5%), 59.4% (95% CI 50.6%-68.2%), and 77.9% (95% CI 70.6%-85.2%), respectively. In total, 63 patients (40.6%) experienced failure during the follow-up period: local only in 32 (20.6%), distal only in 7 (4.5%), local + distal in 19 (12.3%), surgical pathway failure (SPF) only in 2 (1.3%), local + SPF in 2 (1.3%), and distal + SPF in 1 (< 1%). Univariate analysis identified gross residual disease, the presence of SS, and treatment era prior to 2008 as highly significant for worse outcome, with all 3 remaining significant on multivariate analysis. The type of surgery (GTR or subtotal resection/biopsy) and whether GTR was achieved by en bloc or curettage did not show a significant prognostic effect. Surgical complications prior to PBS-PT were present in 42.5% of all surgically treated patients and were seen more commonly in patients with multiple surgical interventions (p = 0.005) and those operated on with the intent of en bloc resection (p = 0.006).

CONCLUSIONS

The extent of resection and metallic stabilization substantially influenced clinical outcomes for patients with spinal chordoma or chondrosarcoma despite high-dose adjuvant PBS-PT. Optimal upfront surgical management of these tumors continues to include GTR, as possible, with prompt adjuvant proton therapy.

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Honda A, Iizuka Y, Imai R, Nishinome M, Hirato J, Koshi H, Mieda T, Sonoda H, Ishiwata S, Kakuta Y, Tajika T, Chikuda H. Recurrent lumbar-origin osteoblastoma treated with multiple surgery and carbon ion radiotherapy: a case report. BMC Musculoskelet Disord 2020;21:321. [PMID: 32443969 PMCID: PMC7245031 DOI: 10.1186/s12891-020-03349-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open