RESUMEN
INTRODUCTION: Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST. METHODS: We conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients. RESULTS: The study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy. CONCLUSION: Despite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient's neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.
Asunto(s)
Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Niño , Lactante , Adolescente , Resultado del Tratamiento , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/terapia , Sarcoma de Ewing/complicaciones , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/complicaciones , Ependimoma/terapia , Ependimoma/cirugía , Ependimoma/diagnóstico , Laminectomía , Descompresión Quirúrgica/métodos , Teratoma/complicaciones , Teratoma/cirugía , Teratoma/diagnóstico , Teratoma/terapia , Procedimientos Neuroquirúrgicos/métodos , Neuroblastoma/cirugía , Neuroblastoma/complicaciones , Astrocitoma/complicaciones , Astrocitoma/cirugía , Astrocitoma/terapia , Tumor Rabdoide/terapia , Tumor Rabdoide/complicaciones , Meningioma/cirugía , Meningioma/terapia , Meningioma/complicaciones , Meningioma/diagnósticoRESUMEN
BACKGROUND: Schwannomas originating from the intravertebral canal rarely extend into the paravertebral region or form large masses. There are few reports on such medical cases, and their clinical diagnosis and management are poorly understood. Here, we report a case of an intraspinal schwannoma with a giant extraspinal mass in a middle-aged Chinese woman and the clinical implications of the symptoms, diagnosis, and treatment of thoracic vertebral schwannoma. CASE PRESENTATION: A 59-year-old female patient who presented with sudden lower limb numbness and difficulty in walking was referred to our department. Magnetic resonance imaging (MRI) revealed a tumor compressing the T11-T12 spinal canal and extensively invading the left thoracic cavity to form a giant paravertebral mass. Schwannoma was diagnosed after intraoperative pathological examination, in which tumor cells were immunoreactive to S100 and Sox10 but negative for smooth muscle actin (SMH). Intraspinal mass resection through the posterior approach and extraspinal chest mass resection under video-assisted thoracoscopy through the left lateral approach were performed simultaneously, and instrumentation was used to maintain thoracic spinal stability. CONCLUSION: In patients with large schwannomas, customized treatment plans are crucial. Tailoring the approach to an individual's specific condition by considering factors such as tumor size and location is essential for optimal outcomes.
Asunto(s)
Neurilemoma , Neoplasias de la Columna Vertebral , Vértebras Torácicas , Humanos , Femenino , Neurilemoma/cirugía , Neurilemoma/diagnóstico por imagen , Neurilemoma/complicaciones , Neurilemoma/patología , Persona de Mediana Edad , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/complicaciones , Imagen por Resonancia Magnética , Cirugía Torácica Asistida por Video , Resultado del TratamientoRESUMEN
The significant progress made in the diagnosis and treatment of malignant tumors has led to improved patient survival rates. However, the metastatic spread of these tumors to the thoracic vertebrae remains a significant challenge, often resulting in bone-related adverse events, such as pathological fractures and severe complications. To address this issue, a refined multidisciplinary approach has been explored, which utilizes thoracoscopic techniques for tumor resection and spinal interventions. Thoracoscopic techniques offer a minimally invasive alternative to traditional open surgical methods, aiming to reduce the overall trauma experienced by patients. By leveraging the advantages of thoracoscopy, clinicians can effectively resect metastatic tumors within the thoracic vertebrae while minimizing the impact on surrounding tissues and structures. This approach, combined with targeted spinal interventions, has the potential to improve patient outcomes and quality of life by mitigating the debilitating effects of pathological fractures and other complications associated with metastatic bone disease. The implementation of this multidisciplinary strategy, incorporating thoracoscopic tumor resection and spinal interventions, represents a promising avenue for the management of metastatic tumors within the thoracic vertebrae. Further research and clinical evaluation are necessary to fully elucidate the long-term benefits and establish the optimal treatment protocols for this patient population, ultimately enhancing the care and outcomes for individuals afflicted by this challenging condition.
Asunto(s)
Neoplasias de la Columna Vertebral , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirugía , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Toracoscopía/métodos , Cirugía Torácica Asistida por Video/métodosRESUMEN
Objectives: To investigate the survival and tumor recurrence after en bloc spondylectomy of spinal tumor and analyze the risk factors of postoperative tumor recurrence. Methods: This is a retrospective case series study. Data of 101 patients undergoing en bloc spondylectomy of spinal tumors in the Musculoskeletal Tumor Center, Peking University People's Hospital from December 2006 to June 2022 were analyzed. There were 58 males and 43 females, aged (38.2±15.8) years (range: 10 to 79 years) at the time of surgery; the follow-up time was(44.0±36.0) months (range: 12 to 171 months).Among them, there were 25 relapsed patients, with 7 females and 18 males; aged (34.8±16.3) years (range: 12 to 66 years) at the time of surgery. The types of tumors included 5 giant cell tumors of bone, 6 osteosarcomas, 1 chordoma, 5 chondrosarcomas, 1 undifferentiated sarcoma, 1 fibrosarcoma, 2 Ewing sarcomas, 3 metastases and 1 malignant giant cell tumor of bone. Survival analysis of overall and relapsed patients were performed using the Kaplan-Meier curves. A segmented regression model was used to fit the sequence of recurrence rate changes over time since admission and identify change points for further analysis on risk factors. Univariate and multivariate Logistic regression analysis were performed to assess risk factors associated with recurrence rate; results from multivariate regression analysis were presented using a forest plot. Results: The tumor recurrence rate after en bloc spondylectomy was 24.8% (25/101).The overall median recurrence-free survival after en bloc spondylectomy was 161 months (95%CI: 92 months to NA).The median recurrence-free survival of recurrent patients was 13 months (95%CI: 12 to 27 months).Regarding the classification based on tumor malignancy, and relapse-free survival of metastatic tumors was significantly shorter (P=0.007); and among the surgical margin groups, relapse-free survival of R0 group was significantly better than the R1 and R2 groups (P<0.01). According to the segmented regression model, the tumor recurrence rate for en bloc spondylectomy showed a significant downward trend over time, with relatively higher recurrence rates before 2009 and a relatively stable trend after 2014. The results of univariate analysis showed that surgical margin and time of admission were the influencing factors of patient recurrence. The results of multivariate analysis showed that the R1 resection(OR=13.453,95%CI:2.897 to 97.941,P=0.002) and R2 resection(OR=11.379,95%CI:2.658 to 79.429,P=0.003) were independent influencing factor affecting patient recurrence. Conclusions: The overall tumor recurrence rate after en bloc spondylectomy was high. The surgical margin of tumor resection is an independent risk factor affecting tumor recurrence. Specifically, R2 and R1 resections significantly increase the risk of tumor recurrence.
Asunto(s)
Recurrencia Local de Neoplasia , Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/cirugía , Persona de Mediana Edad , Adolescente , Adulto Joven , Niño , Anciano , Osteosarcoma/cirugía , Cordoma/cirugía , Cordoma/patología , Condrosarcoma/cirugía , Condrosarcoma/patologíaRESUMEN
BACKGROUND: Deep venous thrombosis (DVT) after spinal surgery has recently attracted increasing attention. Patients with spinal metastases who undergo decompression with fixation are at a high risk of developing DVT. D-dimer levels indicate the risk of DVT, and the purpose of our study was to investigate D-dimer levels as a predictor of DVT perioperatively. METHODS: We prospectively evaluated 100 patients with spinal metastases. D-dimer tests were performed twice: once before surgery and one day postoperatively. DVT was diagnosed by duplex ultrasonographic assessment of both lower extremities. Pulmonary embolisms (PEs) were diagnosed using multidetector computed tomography and pulmonary angiography. Perioperative serum D-dimer levels were compared between the DVT (+) and DVT (-) groups. The cutoff value of the D-dimer level was calculated using receiver operating characteristic analysis. RESULTS: Preoperative and postoperative DVT prevalences were 8.0% (8/100) and 6.6% (6/91), respectively, and none of the patients developed PE. Before surgery, there was no significant differences in D-dimer levels between the pre-DVT (+) and pre-DVT (-) groups. After surgery, the D-dimer level one-day postoperatively for the post-DVT (+) group (17.6 ± 11.8 mg/L) was significantly higher than that of the post-DVT (-) group (5.0 ± 4.7 mg/L). The cutoff value of the postoperative D-dimer level was 9.51(mg/L), and the sensitivity and specificity for the optimum threshold were 83.3% and 89.4%, respectively. CONCLUSIONS: Our findings suggest that preoperative D-dimer level may not be a predictor of DVT. Preoperative ultrasound examinations should be routinely performed in patients with spinal metastases. Postoperative D-dimer levels greater than 9.51(mg/L) are a predictive factor for the early diagnosis of DVT after spine surgery. TRIAL REGISTRATION: Our study was registered on Chinese Clinical Trial Registry (No.ChiCTR2000029737). Registered 11 February 2020 - Retrospectively registered, https://www.chictr.org.cn/index.aspx.
Asunto(s)
Descompresión Quirúrgica , Productos de Degradación de Fibrina-Fibrinógeno , Neoplasias de la Columna Vertebral , Trombosis de la Vena , Humanos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Femenino , Masculino , Trombosis de la Vena/sangre , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Descompresión Quirúrgica/efectos adversos , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/sangre , Adulto , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Embolia Pulmonar/sangre , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico , Valor Predictivo de las Pruebas , Biomarcadores/sangreRESUMEN
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
Asunto(s)
Procedimientos Quirúrgicos Robotizados , Fusión Vertebral , Humanos , Inteligencia Artificial , Vértebras Cervicales/cirugía , Historia del Siglo XX , Historia del Siglo XXI , Vértebras Lumbares/cirugía , Procedimientos Quirúrgicos Robotizados/historia , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/tendencias , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral/historia , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Fusión Vertebral/tendencias , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Vértebras Torácicas/cirugíaRESUMEN
INTRODUCTION: The management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices. METHODS: We conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery. RESULTS: The study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery. CONCLUSIONS: Our 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.
Asunto(s)
Sarcoma , Neoplasias de la Columna Vertebral , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Masculino , Femenino , Adulto , Sarcoma/cirugía , Sarcoma/mortalidad , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/mortalidad , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Anciano , Sarcoma Sinovial/cirugía , Sarcoma Sinovial/mortalidad , Condrosarcoma/cirugía , Condrosarcoma/mortalidad , Condrosarcoma/patología , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/mortalidad , Complicaciones Posoperatorias/etiología , Grupo de Atención al PacienteRESUMEN
PURPOSE: Patients with spinal metastases undergoing surgical treatment face challenges related to preoperative anemia, intraoperative blood loss, and frailty, emphasizing the significance of perioperative blood management. This retrospective analysis aimed to assess the correlation between hemoglobin-related parameters and outcomes, identifying key markers to aid in blood management. METHODS: A retrospective review was performed to identify patients who underwent surgical treatment for spinal metastases. Hb-related parameters, including baseline Hb, postoperative nadir Hb, predischarge Hb, postoperative nadir Hb drift, and predischarge Hb drift (both in absolute values and percentages) were subjected to univariate and multivariate analyses. These analyses were conducted in conjunction with other established variables to identify independent markers predicting patient outcomes. The outcomes of interest were postoperative short-term (6-week) mortality, long-term (1-year) mortality, and postoperative 30-day morbidity. RESULTS: A total of 289 patients were included. Our study demonstrated that predischarge Hb (OR 0.62, 95% CI 0.44-0.88, P = 0.007) was an independent prognostic factor of short-term mortality, while baseline Hb (OR 0.76, 95% CI 0.66-0.88, P < 0.001) was identified as an independent prognostic factor of long-term mortality. Additionally, nadir Hb drift (OR 0.82, 95% CI 0.70-0.97, P = 0.023) was found to be an independent prognostic factor for postoperative 30-day morbidity. CONCLUSIONS: This study demonstrated that predischarge Hb, baseline Hb, and nadir Hb drift are prognostic factors for outcomes. These findings provide a foundation for precise blood management strategies. It is crucial to consider Hb-related parameters appropriately, and prospective intervention studies addressing these markers should be conducted in the future.
Asunto(s)
Hemoglobinas , Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Hemoglobinas/análisis , Anciano , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/sangre , Neoplasias de la Columna Vertebral/mortalidad , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Pérdida de Sangre Quirúrgica/prevención & control , Resultado del Tratamiento , Anemia/sangre , Anemia/diagnóstico , Adulto , Pronóstico , Transfusión Sanguínea/estadística & datos numéricos , Biomarcadores/sangre , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiologíaRESUMEN
PURPOSE: Chordomas are rare malignant neoplasms primarily treated surgically. Disparities related to race and socioeconomic status, may affect patient outcomes. This study aims to identify prognostic factors for access to care and survival in patients with spinal chordomas. METHODS: The NCDB database was queried between the years 2004 and 2017. Kaplan-Meier curves were constructed to compare survival probabilities among different groups, based on race and socioeconomic determinents. RESULTS: 1769 patients were identified, with 87% being White, 5% Hispanic, 4% Black, and Asian each. The mean age was 61.3 years. Most patients received care at academic/research centers and lived in a large metropolitan area, with no difference between races. A significantly higher percentage of Black patients did not undergo surgery (p < 0.001), with no statistically significant difference in survival between races (p = 0.97). A higher survival probability was seen in patients with other government insurances (p < 0.0001), in higher income quartiles (p < 0.0001), in metropolitan areas (p = 0.023), and at an academic/research center (p < 0.0001). A lower survival probability was seen in patients who are uninsured, in rural areas, and at community cancer programs (p < 0.0001). CONCLUSION: This study highlights disparities in access to surgical intervention for patients with spinal chordomas, especially among Black individuals. It emphasizes the significant impact of insurance status and income on access to surgical care and highlights geographical and institutional variations in survival rates. Addressing socioeconomic differences is crucial for fostering equity in neurosurgical outcomes.
Asunto(s)
Cordoma , Bases de Datos Factuales , Accesibilidad a los Servicios de Salud , Factores Socioeconómicos , Neoplasias de la Columna Vertebral , Humanos , Femenino , Persona de Mediana Edad , Masculino , Cordoma/mortalidad , Cordoma/terapia , Cordoma/cirugía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Neoplasias de la Columna Vertebral/mortalidad , Neoplasias de la Columna Vertebral/terapia , Neoplasias de la Columna Vertebral/cirugía , Disparidades en Atención de Salud/estadística & datos numéricos , Anciano , Tasa de Supervivencia , Estados Unidos/epidemiología , Adulto , PronósticoRESUMEN
INTRODUCTION: Osteochondromas, also known as osteocartilaginous exostosis, are among the most common benign cartilaginous bone tumors, primarily occurring as solitary lesions. While typically found in long bones, spinal involvement is rare, accounting for only a small percentage of benign lesions in this location. Solitary osteochondromas responsible for spinal cord compression are seldom. CASE PRESENTATION: We describe the case of a 34-year-old male with no significant medical history, presenting with progressive symptoms suggestive of spinal cord compression. Imaging studies revealed a bony lesion originating from the left lateral aspect of the posterior arch of the T8 vertebra, causing spinal cord compression and myelopathy. Surgical intervention was necessary to decompress the spinal cord and obtain histological samples, resulting in immediate postoperative improvement in motor function. Pathologic exam concluded to an osteochondroma. DISCUSSION: Osteochondromas primarily affect growing bones and are more commonly observed as solitary lesions, particularly in male patients. Spinal involvement is rare, and neurological symptoms are typically indicative of intracanalar extension of the exostosis, leading to compression of neural elements. Imaging modalities such as MRI are crucial for assessing cartilage thickness and the impact of compression on the spinal cord.
Asunto(s)
Osteocondroma , Compresión de la Médula Espinal , Neoplasias de la Columna Vertebral , Vértebras Torácicas , Humanos , Masculino , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/diagnóstico por imagen , Osteocondroma/complicaciones , Osteocondroma/diagnóstico por imagen , Osteocondroma/cirugía , Osteocondroma/patología , Adulto , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Descompresión QuirúrgicaRESUMEN
Late recurrence of hepatocellular carcinoma (HCC) following orthotopic liver transplant (OLT) is infrequently reported, and among cases, those isolated to the spine are rare. Prognoses are poor for this patient population, and no work has been undertaken to create uniform guidelines for management. Here, we report two cases of late recurrent HCC to the spine after OLT and favorable survival outcomes following intervention.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Trasplante de Hígado , Recurrencia Local de Neoplasia , Humanos , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundarioRESUMEN
Primary bone lymphoma is an infrequently encountered tumor of the spine that has a better prognosis than other primary spinal malignancies. The understanding of this entity and its differences from other secondary bone lymphomas have evolved over time. The thoracic spine is the commonly reported site of the lesions. However, it is seldom considered as a first diagnosis when the patient presents to the neurosurgeon. A case of this uncommon tumor in a 68-year-old woman at an extremely rare location-the lateral mass of C1-is used to illustrate the detailed evaluation, nuances in treatment, and outcomes of primary bone lymphomas.
Asunto(s)
Linfoma , Humanos , Femenino , Anciano , Linfoma/patología , Linfoma/diagnóstico , Neoplasias Óseas/patología , Neoplasias Óseas/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/diagnóstico , Imagen por Resonancia Magnética , Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagenRESUMEN
BACKGROUND: Some young patients with preserved functional status suffering from aggressive isolated neoplastic disease of the thoracic spine may be eligible from curative en-bloc vertebrectomy surgical treatment. METHOD: Long-segment posterior pedicle screw fixation is performed. Complete excision of the posterior arch and of ribs posterior aspect is performed. Finger blunt dissection is performed between vertebral body, pleura, and aorta allowing to place a soft abdominal valve and then Gigli saws surrounding the anterior aspect of the spine, in order to saw the upper and the lower discs. Unilateral temporary rod is placed. The vertebral body is dislodged from posterior ligament and then removed by circling laterally around spinal cord. An expandable vertebral implant is placed. CONCLUSION: Posterior en-bloc thoracic vertebrectomy is a highly technical yet achievable procedure which carries a curative intent for isolated neoplastic spine lesions.
Asunto(s)
Neoplasias de la Columna Vertebral , Vértebras Torácicas , Humanos , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Tornillos Pediculares , Resultado del TratamientoRESUMEN
PURPOSE: Implanted devices used in metastatic spine tumor surgery (MSTS) include pedicle screws, fixation plates, fixation rods, and interbody devices. A material to be used to fabricate any of these devices should possess an array of properties, which include biocompatibility, no toxicity, bioactivity, low wear rate, low to moderate incidence of artifacts during imaging, tensile strength and modulus that are comparable to those of cortical bone, high fatigue strength/long fatigue life, minimal or no negative impact on radiotherapy (RT) planning and delivery, and high capability for fusion to the contiguous bone. The shortcomings of Ti6Al4V alloy for these applications with respect to these desirable properties are well recognized, opening the field for an investigation about novel biomaterials that could replace the current gold standard. Previously published reviews on this topic have exhibited significant shortcomings in the studies they included, such as a small, heterogenous sample size and the lack of a cost-benefit analysis, extremely useful to understand the practical possibility of applying a novel material on a large scale. Therefore, this review aims to collect information about the clinical performance of these biomaterials from the most recent literature, with the objective of deliberating which could potentially be better than titanium in the future, with particular attention to safety, artifact production and radiotherapy planning interference. The significant promise showed by analyzing the clinical performance of these devices warrants further research through prospective studies with a larger sample size also taking into account each aspect of the production and use of such materials. METHODS: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. The search was performed from March 2022 to September 2023. RESULTS: At the end of the screening process, 20 articles were considered eligible for this study. Polyetheretherketone (PEEK), Carbon-fibre reinforced polyetheretherketone (CFR-PEEK), long carbon fiber reinforced polymer (LCFRP), Polymethylmethacrylate (PMMA), and carbon screw and rods were used in the included studies. CONCLUSION: CFR-PEEK displays a noninferior safety and efficacy profile to titanium implanted devices. However, it also has other advantages. By decreasing artifact production, it is able to increase detection of local tumor recurrence and decrease radiotherapy dose perturbation, ultimately bettering prognosis for patients necessitating adjuvant treatment. Nonetheless, its drawbacks have not been explored fully and still require further investigation in future studies. This does not exclude the fact that CFR-PEEK could be a valid alternative to titanium in the near future.
Asunto(s)
Neoplasias de la Columna Vertebral , Titanio , Humanos , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/secundario , Aleaciones , Materiales Biocompatibles , Polímeros , Resultado del Tratamiento , Cetonas , Benzofenonas , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Tornillos PedicularesRESUMEN
This addresses the study by Lenga P. et al. on the surgical management of elderly patients with metastatic spinal cord compression (MSCC), acknowledging its valuable insights but suggesting areas for improvement. The absence of Patient-Reported Outcomes Measurement Information System (PROMIS) tools, arguing that patient-reported outcomes are crucial for evaluating the impact of interventions, the need for standardization in surgical approaches, the integration of a multidisciplinary team to optimize patient outcomes, non-surgical management strategies and stressing the importance of long-term follow-up is elaborated.
Asunto(s)
Compresión de la Médula Espinal , Humanos , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/terapia , Anciano , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugía , Anciano de 80 o más Años , Medición de Resultados Informados por el Paciente , Descompresión Quirúrgica/métodosAsunto(s)
Plexo Braquial , Radiocirugia , Neoplasias de la Columna Vertebral , Humanos , Radiocirugia/métodos , Plexo Braquial/efectos de la radiación , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Fraccionamiento de la Dosis de Radiación , Planificación de la Radioterapia Asistida por Computador/métodos , Órganos en Riesgo/efectos de la radiaciónRESUMEN
BACKGROUND: This systematic review and meta-analysis aimed to consolidate the existing evidence regarding the comparison between en-bloc resection surgery and debulking surgery for spinal tumors, including both primary and metastatic tumors. MATERIALS AND METHODS: The databases of PubMed, Embase, Cochrane database, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database was carried out and included all studies that directly compared en-bloc resection surgery with debulking surgery for spinal tumors in patients through March 2024. The primary outcomes included recurrence rate, postoperative metastasis rate, mortality rate, overall survival (OS), recurrence-free survival (RFS), complication, and so on. The statistical analysis was conducted using Review Manager 5.3. RESULTS: We systematically reviewed 868 articles and included 27 studies involving 1135 patients who underwent either en-bloc resection surgery (37.89%) or debulking surgery (62.11%). Our meta-analysis demonstrated significant advantages of en-bloc resection over debulking surgery. Specifically, the en-bloc resection group had a lower recurrence rate (OR = 0.19, 95%CI: 0.13-0.28, P < 0.00001), lower postoperative metastasis rate (P = 0.002), and lower mortality rate (P < 0.00001). Additionally, en-bloc resection could improve OS and RFS (HR = 0.45, 95%CI: 0.32-0.62, P < 0.00001 and HR = 0.37, 95%CI: 0.17-0.80, P = 0.01, respectively). However, en-bloc resection required longer operative times and was associated with a higher overall complication rate compared to debulking surgery (P = 0.0005 and P < 0.00001, respectively). CONCLUSION: The current evidence indicates that en-bloc surgical resection can effectively control tumor recurrence and mortality, as well as improve RFS and OS for patients with spinal tumors. However, it is crucial not to overlook the potential risks of perioperative complications. Ultimately, these findings should undergo additional validation through multi-center, double-blind, and large-scale randomized controlled trials (RCTs).
Asunto(s)
Procedimientos Quirúrgicos de Citorreducción , Neoplasias de la Columna Vertebral , Humanos , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/mortalidad , Procedimientos Quirúrgicos de Citorreducción/métodos , Procedimientos Quirúrgicos de Citorreducción/mortalidad , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Tasa de Supervivencia , Pronóstico , Recurrencia Local de Neoplasia/cirugía , Recurrencia Local de Neoplasia/patología , Complicaciones Posoperatorias/epidemiologíaRESUMEN
BACKGROUND: Bone metastases can compromise the integrity of the spinal canal and cause epidural spinal cord compression (ESCC). The Spinal Instability Neoplastic Score (SINS) was developed in order to evaluate spinal instability due to a neoplastic process. The SINS has reached wide acceptance among clinicans but its prognostic value is still controversial. The aim was to investigate the correlation between the SINS and ESCC and the association between SINS and ambulation before and survival after surgery. METHODS: Correlations were assessed between SINS and grades of ESCC in patients who underwent spine surgery for spinal metastases. CT and MRI were used to calculate SINS and the grades of ESCC respectively. Correlations were analyzed with the Spearman's correlation test. Postoperative survival was estimated with Kaplan-Meier analysis and survival curves were compared with the log-rank test. The Cox proportional hazard model was used to assess the effect of prognostic variables including age, ambulation before surgery, SINS, and the Karnofsky Performance Status (KPS) as covariates. RESULTS: The study included 256 patients (196 men and 60 women) with a median age of 70 (24-88) years. The mean SINS was 10. One hundred fifty-two patients (59%) had lost ambulation before surgery. One hundred and one patients had grades 0-2 and 155 patients had grade 3 according to the ESCC-scale. SINS correlated with the grades of ESCC (p = 0.001). The SINS score was not associated with ambulation before surgery (p = 0.63). The median postoperative survival was 10 months, and there was no difference in postoperative survival between the SINS categories (p = 0.25). The ability to walk before surgery and a high KPS were associated with longer postoperative survival. CONCLUSION: SINS correlated with grades of ESCC, which implies that higher SINS may be considered as an indicator of risk for developing ESCC. The SINS was not associated with ambulation before or survival after surgery.
Asunto(s)
Compresión de la Médula Espinal , Neoplasias de la Columna Vertebral , Humanos , Masculino , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Femenino , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/mortalidad , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Adulto , Anciano de 80 o más Años , Adulto Joven , Pronóstico , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiologíaRESUMEN
OBJECTIVE: A significant dilemma exists for the surgical plan of spinal metastases with a spinal instability neoplastic score (SINS) of 7-12. Our aim is to trim down this range of "potential instability" and find a virtual cut-off value for instrumentation. METHODS: We performed a retrospective study on 60 patients who underwent surgical intervention for vertebral metastasis. They were segregated into 'instrumented' and "noninstrumented" groups. The primary endpoint of the study was to see whether surgical stabilization was done. RESULTS: Although univariate analysis showed the overall SINS score, involvement of posterior elements, and mechanical pain to be the factors that significantly affected our decision making in favor of stabilization, only the SINS score was found to be statistically significant on multivariate analysis. On plotting the proportion of patients undergoing stabilization at each SINS score we found the curves to crossover between SINS 8 and 9, ran almost parallel to each other at values 9 and 10 and then seemed to diverge from each other significantly at values above 10. Taking SINS 9 as the cut-off value above which instrumentation is advised, the receiver operating characteristic curve had a sensitivity of 67.57% (95% confidence interval 50.21% to 81.99%) and specificity of 73.91% (95% confidence interval 51.59% to 89.77%). The area under the curve was 0.79 (0.67-0.91). CONCLUSIONS: SINS 9-10 seems to be the actual ambiguous subset in the wider subgroup of the 'potentially unstable' category SINS 7-12, like a 'Matryoshka doll'. A SINS value of 9 can be seen as a cut-off value for instrumentation.
Asunto(s)
Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Anciano , Inestabilidad de la Articulación/cirugía , AdultoRESUMEN
BACKGROUND: The estimation of survival is extremely important for metastatic disease in the spine. The aim of this study was to determine the factors affecting the outcome of patients with spinal metastasis, primarily the character of neurologic deficit and the histopathology of the tumor. METHOD: A retrospective examination was made of 158 patients with spinal metastasis who were followed up in our clinic between 2010 and 2020 and underwent surgical intervention. The patients were examined in respect of demographic characteristics, the primary tumor, comorbidities, preoperative-postoperative visual aAnalog scale scores, preoperative-postoperative neurologic examinations and neurologic deficit if present and ambulation status, postoperative survival duration, tumor localization, characteristics of the surgeries, complications, the Karnofsky Performance Scale, revised Tokuhashi, and Tomita scores. RESULTS: Spinal metastasis was seen more frequently in males (72.8% male, 27.8% female). Male gender, multiple level involvement, intradural localization, and Karnofsky Performance Scale <70 were seen to cause a shorter survival time. Patients with a primary focus of hematologic malignancy, breast cancer, and lymphoma had a longer survival. The revised Tokuhashi and Tomita scores were observed to be successful in the prediction of survival. A decrease in postoperative visual analog scale score had a positive effect on functional survival. The absence of preoperative neurological deficit and the patient's ability for preoperative and postoperative ambulation affected survival positively. The overall survival period decreased in patients who were mobilized in the early postoperative period but became nonmobile in the late period, and in those who were nonmobile in both the early and late postoperative periods. CONCLUSIONS: The neurologic and ambulatory status, the Tomita and Tokuhashi scores, intradural localization, and gender are the factors with a significant effect on prognosis.