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Spinal metastases surgery

Michael Galgano, Jared Fridley, Adetokunbo Oyelese, Albert Telfian, Thomas Kosztowski, David Choi, Ziya L Gokaslan
Metastatic spinal disease is a source of significant morbidity in patients with cancer. Recent advancements in adjuvant oncologic therapy has led to increased survival for many patients who harbor neoplastic disease. As a result of this, the chance of developing metastatic spinal disease over the course of a cancer patient's lifespan has increased. Symptomatic metastatic spinal disease can cause significant morbidity including severe pain, neurologic deficit, and loss of ambulation. Current treatment of these patients typically involves the use of multiple modalities, including surgery, radiation, and chemotherapy...
March 21, 2018: Expert Review of Anticancer Therapy
Robert Foerster, B C John Cho, Daniel K Fahim, Peter C Gerszten, John C Flickinger, Inga S Grills, Maha S Jawad, C Ronald Kersh, Daniel Létourneau, Frederick Mantel, Arjun Sahgal, John H Shin, Brian A Winey, Matthias Guckenberger
BACKGROUND: Stereotactic body radiotherapy (SBRT) of the spine provides superior tumor control, but vertebral compression fractures are increased and the pathophysiological process underneath is not well understood. Data on histopathological changes, particularly after salvage SBRT (sSBRT) following conventional irradiation, are scarce. OBJECTIVE: To investigate surgical specimens after sSBRT and primary SBRT (pSBRT) regarding histopathological changes. METHODS: We assessed 704 patients treated with spine SBRT 2006 to 2012...
March 14, 2018: Neurosurgery
Nikita Zaborovskii, Dmitrii Ptashnikov, Dmitrii Mikaylov, Sergei Masevnin, Oleg Smekalenkov
BACKGROUND: Intraoperative hemorrhage can sometimes be massive in patients with spinal metastasis of renal cell carcinoma (MRCC). Preoperative embolization and local hemostatic agents are routinely use in spinal tumor surgery, but there have been no comparisons between these methods. This report compares the efficiency of various methods of bleeding control and their influence on outcome and survival after decompression procedures for MRCC. MATERIALS AND METHODS: This was a retrospective case-control study of 54 patients with hypervascular extraosseous MRCC...
March 10, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Grzegorz Guzik
BACKGROUND: Thoracic spine cancer metastases is frequently the cause of neurological deficits. Despite the availability of diagnostics, delays in treatment are still quite common. The aim of this work is to analyze the reasons for delayed diagnostics and treatment, in patients with neurological deficits in the course of metastatic spine disease. METHODS: In our study patients medical data was analyzed from 2013 to 2015. The analysis covered the following aspects: symptoms of metastases, time of neurological deficits occurrence, where and when initial diagnostics were performed, time from diagnosis to proper surgical treatment in an oncological centre...
March 7, 2018: BMC Palliative Care
M Dosani, S Lucas, J Wong, L Weir, S Lomas, C Cumayas, C Fisher, S Tyldesley
Background: The Spinal Instability Neoplastic Score (sins) was developed to identify patients with spinal metastases who may benefit from surgical consultation. We aimed to assess the distribution of sins in a population-based cohort of patients undergoing palliative spine radiotherapy (rt) and referral rates to spinal surgery pre-rt. Secondary outcomes included referral to a spine surgeon post-rt, overall survival, maintenance of ambulation, need for re-intervention, and presence of spinal adverse events...
February 2018: Current Oncology
D Adler, M Kriegsmann, P Sinn, A Schneeweiss, H Almansour, B Lehner, M Akbar
Breast cancer is the most common malignancy affecting women and the spinal column is most likely affected by metastases. Modern oncologic treatment options have significantly prolonged survival times in the last decade. Therefore, treatment of vertebral metastases has been of special interest in spine surgery. Different scores are described to evaluate prognosis and to choose correct treatment strategies, which however only differentiate tumor entities and not specific tumor phenotypes. Breast cancer has been classified into five intrinsic subtypes with different survival rates since the turn of the millennium...
February 27, 2018: Der Orthopäde
L Gatto, G Facchini, M Saponara, M Nannini, G Rossi, V Di Scioscio, G Biasco, M A Pantaleo
Herein is described the case of a 64-year-old patient affected by metastatic clear-cell carcinoma, with exclusive bone disease, subjected after the initial cytoreductive nephrectomy to 3 successive lines of medical treatment (sunitinib, everolimus, and sorafenib) and multiple locoregional treatments (spinal surgery, radiation therapy, and selective arterial embolization), resulting in a surprisingly long survival of over 75 months. In the era of target therapy, integration strategies, including additional locoregional treatment to medical therapy, are essential to optimize the clinical benefit, to maximize treatment duration overcoming focal progressive disease, and to improve the quality of life...
December 2017: Radiology Case Reports
Noopur Raje, Evangelos Terpos, Wolfgang Willenbacher, Kazuyuki Shimizu, Ramón García-Sanz, Brian Durie, Wojciech Legieć, Marta Krejčí, Kamel Laribi, Li Zhu, Paul Cheng, Douglas Warner, G David Roodman
BACKGROUND: Multiple myeloma is characterised by monoclonal paraprotein production and osteolytic lesions, commonly leading to skeletal-related events (spinal cord compression, pathological fracture, or surgery or radiotherapy to affected bone). Denosumab, a monoclonal antibody targeting RANKL, reduces skeletal-related events associated with bone lesions or metastases in patients with advanced solid tumours. This study aimed to assess the efficacy and safety of denosumab compared with zoledronic acid for the prevention of skeletal-related events in patients with newly diagnosed multiple myeloma...
February 8, 2018: Lancet Oncology
Áron Lazáry, Zsolt Szövérfi, Péter Pál Varga
The incidence of spinal metastases is constantly growing, but due to the advancements in oncologic treatment methods, the survival and the quality of life of the patients are persistently improving. Choosing the optimal treatment method is essential, and several factors should be considered: type of the primary tumor, segmental stability, the symptoms caused by the metastasis and the general condition of the patient. Using modern radiotherapeutic methods combined with minimally invasive surgical techniques (minimally invasive stabilization, separation surgery) in the majority of patients permits adequate local control with low complication rate...
February 2018: Orvosi Hetilap
Péter Pollner, Anna Horváth, Tamás Mezei, Péter Banczerowski, Gábor Czigléczki
OBJECTIVE: The metastatic spinal diseases are common health problems and there is no consensus on the appropriate treatment of metastases in several conditions. Using clinical measures (e.g. survival time, functional status), the prognosis prediction systems advise on the appropriate interventions. The aim of this article is to assess and compare four widely used scoring systems (revised Tokuhashi, Tomita, Van der Linden and modified Bauer scores) on a single center cohort. METHODS: A retrospective study of 329 patients was designed who were subjected to surgeries because of metastatic spinal diseases...
January 31, 2018: World Neurosurgery
Anne L Versteeg, Arjun Sahgal, Laurence D Rhines, Daniel M Sciubba, James M Schuster, Michael H Weber, Peter Pal Varga, Stefano Boriani, Chetan Bettegowda, Michael G Fehlings, Michelle J Clarke, Paul M Arnold, Ziya L Gokaslan, Charles G Fisher
BACKGROUND: The Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) was developed as the first spine oncology-specific health-related quality of life (HRQOL) measure. This study evaluated the psychometric properties and clinical validity of the SOSGOQ in a diverse cohort of patients with spinal metastases. METHODS: An international, multicenter, prospective observational cohort study including patients with spinal metastases who underwent surgery and/or radiotherapy was conducted by the AOSpine Knowledge Forum Tumor...
February 6, 2018: Cancer
Jianru Xiao, Shaohui He, Jian Jiao, Wei Wan, Wei Xu, Dan Zhang, Weibo Liu, Nanzhe Zhong, Tielong Liu, Haifeng Wei, Xinghai Yang
PURPOSE: Multi-level reconstruction incorporating the chest wall and ribs is technically demanding after multi-segmental total en bloc spondylectomy (TES) of thoracic spinal tumours. Few surgical techniques are reported for effective reconstruction. A novel and straightforward technical reconstruction through posterior-lateral approach was presented to solve the extensive chest wall defect and prevent occurrences of severe respiratory dysfunctions after performing TES. The preliminary outcomes of surgery were reviewed...
February 5, 2018: International Orthopaedics
Zemin Li, Houqing Long, Rui Guo, Jinghui Xu, Xiaobo Wang, Xing Cheng, Yangliang Huang, Fobao Li
BACKGROUND: The cervicothoracic junction (CTJ) site accounts for approximately 10% of all spinal metastases. The complex anatomical and biomechanical features increase the difficulty in surgical treatment of the CTJ metastases. However, few studies in the literature on surgical treatment for spinal metastases are focusing on this special area. The aim of this study was to evaluate the surgical outcome of patients with CTJ metastases and analyze the prognostic factor for the postoperative survival...
January 30, 2018: Journal of Orthopaedic Surgery and Research
Ananya Chakravorty, Ellen Frydenberg, Tint Tint Shein, John Ly, Peter Earls, Timothy Steel
Ependymomas are neuroectodermal tumours arising from the ependymal lining of the ventricles and central canal of the spinal cord. Intradural extramedullary (IDEM) ependymomas which are multifocal, and/or anaplastic (WHO grade III) at presentation are exceedingly rare. We present the second case of multifocal anaplastic IDEM ependymoma in the literature. A 47-year old female presented with left gluteal and thigh pain radiating to the groin associated with paraesthesiae. She had a normal neurological examination...
December 2017: Journal of Spine Surgery (Hong Kong)
Ji Yoon Kim, Young Seok Lee, Dong Ho Kang, Min Hye Kim, Jeong Hee Lee, Chul Hee Lee, In Sung Park
Thymoma and thymic carcinoma are rare epithelial tumors that originate from the thymus gland. Extrathoracic metastases occur in the liver, kidney, and bone in 1% to 15% of patients. Although thymoma and thymic carcinoma exhibit highly aggressive biological behavior, spinal metastasis is rare. We describe a 78-year-old man with left wrist and grasp weakness that occurred 7 days before admission. The patient underwent thymoma surgery 7 years ago and was cured. Magnetic resonance images showed a rim-enhanced mass in the C6-7-T1 epidural space...
December 2017: Korean Journal of Spine
Triantafyllos Bouras, Fahed Zairi, Ala Arikat, Marie-Hélène Vieillard, Mohamed Allaoui, Richard Assaker
BACKGROUND: A wide spectrum of treatment choices is proposed for poor-prognosis patients with vertebral metastases. The continuous increase of this population and the propagation of less invasive techniques necessitate further study concerning which patients could benefit from palliative surgery. METHODS: All patients with a Tokuhashi score ≤8 who had undergone palliative surgical treatment for vertebral metastasis within 4 years were retrospectively reviewed...
December 27, 2017: World Neurosurgery
Morenikeji A Buraimoh, Charles C Yu, Michael P Mott, Gregory P Graziano
Background: The sacrum is a rare location for spinal metastasis. These lesions are typically large and destructive by the time of diagnosis, making treatment difficult. When indicated, surgical stabilization offers pain relief and preserves independence in patients with impending and acute pathological sacral fractures. Case Description: Three consecutive patients presented with sacral metastases. After either failing radiation therapy or presenting with acute fracture and instability, the patients underwent intralesional excision, bilateral L4 to ilium fusion with instrumentation, and sacroiliac (SI) screw fixation...
2017: Surgical Neurology International
Wenjiao Wu, Dequan Zhong, Zhan Zhao, Wentao Wang, Jun Li, Wei Zhang
BACKGROUND: Glioblastoma is the most common primary malignant brain tumor. Extraneural metastases are rarely reported in the literature. CASE PRESENTATION: We report a case of a 38-year-old patient who was diagnosed with glioblastoma in 2015. Four months after surgery, local relapse was found and the patient received a second surgery. After another 4 months, we found a hard mass in the right posterior neck when she admitted to our department for fourth cycle of adjuvant chemotherapy...
December 29, 2017: World Journal of Surgical Oncology
Chunying Shen, Hongmei Ying, Xueguan Lu, Chaosu Hu
RATIONALE: Central nervous system (CNS) metastases are rarely seen in patients with nasopharyngeal carcinoma (NPC). PATIENT CONCERNS: Two NPC patients developed CNS metastases were collected in Fudan University Shanghai Cancer Center. The medical records were reviewed to document patients' characteristics, treatment, and outcomes. In addition, we also provide an overview of the literature concerning this scenario. DIAGNOSES: Both patients were staged T4N1M0 with pathologically confirmed CNS metastases from nasopharyngeal carcinoma...
December 2017: Medicine (Baltimore)
Panagiotis Tsagozis, Henrik C F Bauer
Background and purpose - A significant number of patients with spinal metastases are treated non-surgically, but may need surgical treatment at a later stage due to progression of symptoms. Therefore, we investigated the need for late surgical decompression in patients with spinal metastasis who were initially deemed as non-surgical candidates, as well as the outcome of late surgery. Patients and methods - 116 patients who were referred to the orthopedic oncology department between 2002 and 2011 due to spinal metastasis with neurologic symptoms were deemed to be non-surgical candidates...
December 12, 2017: Acta Orthopaedica
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