Revision surgery for tumors of the thoracic and lumbar spine: causes, prevention, and treatment strategy

Berjano, Pedro; Cecchinato, Riccardo; Pun, Alvin; Boriani, Stefano

doi:10.1007/s00586-019-06276-8

Cited by 4 publications

(6 citation statements)

References 44 publications

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“…Furthermore, the ability to intraoperatively refine the VBR end surface obliquity and restore lordosis or kyphosis helps to match spino-pelvic parameters 30,31 and avoid significant loss of sagittal balance. 27 More importantly custom contouring of the VBR intraoperatively allowed for improved press fit into the anatomical planned spaces. Additional stability was achieved through the pedicle reconstruction, which allowed for the VBR to be translated towards the rod and created additional bony endplate engagement and compression across the VBR as well.…”

Section: Discussionmentioning

confidence: 99%

“…The management of patients with tumors to the spine remains a clinical challenge 7,9,10,26,27 . Although spinal tumors frequently present predominantly in the anterior column, involvement of the posterior elements through direct pedicle extension, or epidural erosion is not uncommon.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, these defects necessitate a 360° reconstruction. However, early implant failure still remains common 17,25,27 . In a systematic literature review on reconstructive technique after spine tumor excision, Glennie et al 12 identified that cage subsidence occurred in more than 50% of the cases with consequent loss of sagittal alignment and/or failure of the posterior implant systems, and sometimes associated with severe neurological complications.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to understand that, unlike expandable cages, there is no ultimate limit to the total length available in PEEK/CF VBR system. Furthermore, the ability to intraoperatively refine the VBR end surface obliquity and restore lordosis or kyphosis helps to match spino-pelvic parameters 30,31 and avoid significant loss of sagittal balance 27 . More importantly custom contouring of the VBR intraoperatively allowed for improved press fit into the anatomical planned spaces.…”

Section: Discussionmentioning

confidence: 99%

“…The management of patients with tumors to the spine remains a clinical challenge. 7,9,10,26,27 Although spinal tumors frequently present predominantly in the anterior column, involvement of the posterior elements through direct pedicle extension, or epidural erosion is not uncommon. Resection of these lesions can result in large defects of both bone and soft tissue due to the desire to obtain wide margins at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

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Integrated Custom Composite Polyetheretherketone/Carbon fiber (PEEK/CF) Vertebral Body Replacement (VBR) in the Treatment of Bone Tumors of the Spine

Shen

Gasbarrini

Lui³

et al. 2021

Spine

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Study Design. Retrospective, multicenter chart, and radiologic review. Objective. To present the first case series of bone tumors of the spine surgically reconstructed with a new custom, fully radiolucent, polyetheretherketone/carbon fiber (PEEK/CF) vertebral body replacement (VBR) integrated system. Summary of Background Data. Surgical resections of spinal tumors result in large defects and local recurrence remains a concern. Current titanium-based implants adversely affects postoperative imaging, directly affects ability to identify tumor recurrence, and for delivery of radiotherapy treatments. PEEK/CF spinal implants allows for improved tumor surveillance, precise pre-radiation Computed Tomography planning, and reduces interference with post-reconstructive adjuvant radiotherapy. Method. Thirteen patients with spinal tumors underwent vertebral body resection and reconstruction with an integrated, fully radiolucent, custom PEEK/CF vertebral body replacement, and radiolucent posterior PEEK/CF screw-rod system and/or radiolucent anterior PEEK/CF plate system. Clinical and radiographic data were tabulated. Need for adjuvant radiotherapy determined based on final tissue histology and extent of surgical margins.Postoperative surveillance imaging were reviewed for local tumor recurrence.Results. The ability to integrate the PEEK/CF VBR connected to either the posterior screw-rod system, or anterior plate system provided immediate stability. The VBR was placed directly on cancellous vertebral body surface in 46.2% of cases. Loosening of the distal, or proximal, aspect of posterior system was seen in 15.4% of cases. There was no clinical or radiographic evidence of VBR migration and subsidence at latest follow up. Local recurrence occurred in one (7.7%) patient. Conclusion. This is the first series to describe the use of a fully-radiolucent, integrated, PEEK/CF implant system for spinal tumor reconstruction. The use of a PEEK/CF VBR system integrated to either the anterior plate, or posterior screw-rod system is feasible and allows for superior postoperative surveillance imaging and effective delivery of postoperative adjuvant radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Integrated Custom Composite Polyetheretherketone/Carbon fiber (PEEK/CF) Vertebral Body Replacement (VBR) in the Treatment of Bone Tumors of the Spine

Shen

Gasbarrini

Lui³

et al. 2021

Spine

Self Cite

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Management of Spine Tumors in the Young Children

Arkader

Boriani

2022

The Growing Spine

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Complications in spinal tumor surgery (review of literature)

Zaborovskii

Пташников

Mikhaylov

et al. 2022

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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Combined anterior and posterior approaches are required in spinal tumor surgery and considered highly invasive. Anatomical and physiological features of the surgical intervention area should be taken into consideration as well. Thus, these criteria reflect the severity of intraoperative complications during the surgical treatment of spinal tumors. The authors reviewed the scientific literature on the frequency and nature of complications in surgical interventions for spinal tumors.The most significant risk factors for intraoperative complications have been considered, the main of which are: the proximity of the location of the main vessels and viscera, the development of postoperative liquorrhea, as well as surgical site infection. Based on the studied information, we presented the methods of prevention and surgical tactics options in complications.

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Revision surgery for tumors of the thoracic and lumbar spine: causes, prevention, and treatment strategy

Cited by 4 publications

References 44 publications

Integrated Custom Composite Polyetheretherketone/Carbon fiber (PEEK/CF) Vertebral Body Replacement (VBR) in the Treatment of Bone Tumors of the Spine

Integrated Custom Composite Polyetheretherketone/Carbon fiber (PEEK/CF) Vertebral Body Replacement (VBR) in the Treatment of Bone Tumors of the Spine

Management of Spine Tumors in the Young Children

Complications in spinal tumor surgery (review of literature)

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