Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004‐2007

Duong, Linh M.; McCarthy, Bridget J.; McLendon, Roger E.; Dolecek, Therese A.; Kruchko, Carol; Douglas, Lynda L.; Ajani, Umed A.

doi:10.1002/cncr.27390

Cited by 208 publications

(171 citation statements)

References 11 publications

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“…The incidence of tumors of the spinal column is estimated to be 0.62 per 100,000 individuals in the US. 33,85 Metastatic spinal tumors make up the majority of spinal tumors and are found in as many as 70% of cancer patients. 48,52,65,74,86,93,98 In addition to classification by histology, spinal tumors are generally stratified by location as extradural, intradural extramedullary, or intramedullary.…”

mentioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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“…Although primary tumors of lumbosacral spinal nervous tissue (i.e., conus medullaris, and cauda equina nerve roots) are not common, myxopapillary ependymomas (MPE) originate almost exclusively from this region and comprise about 90% of all tumoral lesions in the lumbosacral canal [6,7]. Clinical presentations of cauda equina tumors (including MPE) are not specific, and they may mimic benign conditions such as spondylosis or a prolapsed intervertebral disk [8].…”

Section: Introductionmentioning

confidence: 99%

The many faces of primary cauda equina myxopapillary ependymoma: clinicoradiological manifestations of two cases and review of the literature

Mehrjardi¹,

Mirzaei²,

Haghighatkhah³

2017

Romanian Neurosurgery

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Abstract:Introduction: Myxopapillary ependymoma (MPE) is a benign and slow growing tumor that originates exclusively from the conus medullaris and cauda equina nervous tissue. It occurs more commonly in young patients. In addition, clinical presentations are non-specific and may mimic benign conditions. Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating this tumor. We hereby report on two young patients with long-lasting non-specific symptoms, which were clinically attributed to benign conditions. However, cauda equina tumor was revealed on MRI in both patients. Case report: Two cases of cauda equina MPE, a 19-year-old female and a 38-year-old male, with different clinical manifestations are reported. The first patient presented with paresis and paresthesia of the lower limbs, and the second patient's complaint was chronic low-back pain and urinary incontinence. In both cases, MRI detected a tumor originated from the cauda equina, and histopathologic examination was compatible with MPE. Conclusion: Cauda equina tumors should be considered as a differential diagnosis in the young patients presented with neurologic deficits in the lower limbs, sphincter or erectile dysfunction, and even a simple low-back pain (particularly when symptoms are long-lasting and/or progressive).

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“…The presentation frequency of spinal canal tumors according to their histological subtype classification and order of frequency [2] is as follows: meningiomas, nerve sheath tumor and ependymomas, with a 33%, 27% and 21%, respectively [3]. Because of the topographical distribution of spinal canal tumors [3], we believe that there are three facts of great importance in choosing an appropriate surgical technique meaning that: provides a low morbidity rate, great impact on the rate of complete resection of the tumor regardless of their location (intradural or extradural), and at the same time, a low postoperative instability.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the topographical distribution of spinal canal tumors [3], we believe that there are three facts of great importance in choosing an appropriate surgical technique meaning that: provides a low morbidity rate, great impact on the rate of complete resection of the tumor regardless of their location (intradural or extradural), and at the same time, a low postoperative instability. In our hospital, we have a widespread experience in developing and applying minimally invasive techniques to the spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Surgical Approach for Spinal Canal Tumors—Technique Description and Experience from a Reference Center

Berbeo¹,

Díaz²,

Pérez³

et al. 2017

JCT

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Background: Spinal canal tumors are difficult to diagnose and treat. The traditional surgical approaches for attempting a complete excision of these lesions frequently involve big incisions and tissue dissection with high risk of postop instability and cerebrospinal fluid leakage. Also, there is a risk of neurological worsening, sometimes irreversible. Methods: We present our experience in a patient series with spinal canal tumors and describe the surgical approach with minimally invasive techniques (MIS). All of them were performed by the Neurosurgery team of the Hospital Universitario San Ignacio during the period of 2011-2016. Results: We reviewed forty patients with spinal canal tumors surgically treated with MIS techniques. 15 patients (37.5%) had Meningioma diagnosis (complete resection in 11 (73.3%), subtotal in 3 (20%) and biopsy in one patient), 10 patients (25%) with Schwannomas reached complete resection in 70% and subtotal in 30%. 5 patients had spinal cord metastasis, with complete resection in 4 patients (80%) and subtotal in 1 (20%). Other included ependymoma, astrocytoma, and miscellaneous. No patient has had cerebrospinal fluid leakage and no postoperative fusion has been required. Conclusions: The minimally invasive approach allowed complete tumors removal in a high number of patients and good postoperative results. These findings are similar and in some cases, better than the reported with traditional techniques. This MIS technique provides encouraging results. It requires a wide learning curve and a high degree of surgical experience.

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Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004‐2007

Abstract: BACKGROUND: Primary tumors of the spinal cord, spinal meninges, and cauda equina are relatively rare, and a paucity of populationbased data exist on tumors in these sites. This study intends to augment the current literature by examining incidence of these tumors on a national level.

Cited by 208 publications

References 11 publications

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

The many faces of primary cauda equina myxopapillary ependymoma: clinicoradiological manifestations of two cases and review of the literature

Minimally Invasive Surgical Approach for Spinal Canal Tumors—Technique Description and Experience from a Reference Center

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