Tumors of the Osseous Spine

Sundaresan, Narayan; Boriani, Stefano; Rothman, Arthur I.; Holtzman, Robert N. N.

doi:10.1023/b:neon.0000041888.33499.03

Cited by 101 publications

(54 citation statements)

References 82 publications

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“…Thanks to advances in tumor screening and diagnostics, the number of patients who may benefit from this extensive surgical treatment continues to increase. Various authors have shown that en bloc spondylectomy, combined with multimodal therapies, can effectively reduce local recurrency rates and markedly prolong overall long-term survival [37,53,54,61,70]. However, to provide an acceptable patient outcome and quality of life, the basic knowledge of short-and long-term postoperative implant stability is a mandatory tool to carry into surgery.…”

Section: Discussionmentioning

confidence: 99%

“…While less than 5% of all primary musculoskeletal tumors are located at the spine, 5-10% of all cancer patients develop metastatic spinal lesions during the course of their disease [2,5,24,47,53,69]. For this patient group, apart from a few special cases, the chance of a curative treatment is primarily limited by the disseminated stage of disease and further tumoral spread.…”

Section: Introductionmentioning

confidence: 99%

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En bloc spondylectomy reconstructions in a biomechanical in-vitro study

et al. 2008

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Wide surgical margins make en bloc spondylectomy and stabilization a referred treatment for certain tumoral lesions. With a total resection of a vertebra, the removal of the segment's stabilizing structures is complete and the instrumentation guidelines derived from a thoracolumbar corpectomy may not apply. The influence of one or two adjacent segment instrumentation, adjunct anterior plate stabilization and vertebral body replacement (VBR) designs on post-implantational stability was investigated in an in-vitro en bloc spondylectomy model. Biomechanical in-vitro testing was performed in a six degrees of freedom spine simulator using six human thoracolumbar spinal specimens with an age at death of 64 (±20) years. Following en bloc spondylectomy eight stabilization techniques were performed using long and short posterior instrumentation, two VBR systems [(1) an expandable titanium cage; (2) a connected long carbon fiber reinforced composite VBR pedicle screw system)] and an adjunct anterior plate. Testsequences were loaded with pure moments (±7.5 Nm) in the three planes of motion. Intersegmental motion was measured between Th12 and L2, using an ultrasound based analysis system. In flexion/extension, long posterior fixations showed significantly less range of motion (ROM) than the short posterior fixations. In axial rotation and extension, the ROM of short posterior fixation was equivalent or higher when compared to the intact state. There were only small, nonsignificant ROM differences between the long carbon fiber VBR and the expandable system. Antero-lateral plating stabilized short posterior fixations, but did not markedly effect long construct stability. Following thoracolumbar en bloc spondylectomy, it is the posterior fixation of more than one adjacent segment that determines stability. In contrast, short posterior fixation does not sufficiently restore stability, even with an antero-lateral plate. Expandable verses nonexpandable VBR system design does not markedly affect stability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

et al. 2008

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“…Currently, the role of surgery can be divided into cancer treatment through oncological resection, neurological palliation, stabilization, pathological diagnosis, and pain relief. 2 of a spinal metastasis can be performed. When an oncological resection is possible, it can provide the best opportunity for long-term local control and palliation in patients with isolated metastases or radioresistant tumors.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…The goal in these select circumstances should be to achieve negative margins. 2,12 In the case of a solitary vertebral metastasis, this can be achieved through total or subtotal spondylectomy. 13 Palliation is also an important role for the surgical management of spinal metastases.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Surgical Treatment of Metastatic Spinal Tumors

Meyer¹,

Singh²,

Jenkins³

2010

Mount Sinai J Medicine

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Spinal metastases represent a significant cause of morbidity in patients diagnosed with malignancies. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. The treatment paradigm for spinal metastases involves a cohesive multidisciplinary approach that allows treatment plans to be made in the context of a patient's overall condition. There have been significant advances in the surgical treatment of spinal metastases that can significantly improve a patient's quality of life. demonstrated that vertebral metastases are found in as many as 30% of patients with malignancies. 2 Spinal metastases are most commonly seen, in decreasing order of incidence, from primary lung, prostate, kidney, liver, gastric, and colon cancers in males and primary breast, lung, uterine, thyroid, and gastric cancers in females. 3 In addition, there is a significant contribution from hematogenous disorders such as lymphoma and multiple myeloma. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. 4 Magnetic resonance imaging is the diagnostic modality of choice in the diagnosis of spinal metastases, with a sensitivity of 93% and a specificity of 97%. 5 Additional information regarding the extent of bone destruction and alignment can be obtained with computed tomography of the spine.We have found that a cohesive multidisciplinary approach to the treatment of metastases to the spine can improve outcomes as it brings the treating physicians together and allows plans to be made in the context of the patient's overall condition. The initial evaluation should involve a thorough history, including any prior history of malignancy. In some cases, symptoms related to spinal metastases are the first signs of malignancy, and a thorough metastatic workup, including standard X-rays, computed tomography of the chest, abdomen, and pelvis, positron emission tomography, and bone scans, is often necessary to identify the primary tumor. In addition, blood dyscrasias such as multiple myeloma and lymphoma need to be considered, and this requires further laboratory studies of the blood and possibly cerebrospinal fluid. Treatment paradigms involve close collaboration between the medical oncologist, radiation oncologist, and spine surgeon. The pathology of the primary tumor is important in determining the patient's life expectancy, sensitivity to adjuvant treatments, and likelihood of achieving systemic control.

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Multilevel lateral extra‐cavitary corpectomy and reconstruction for non‐contiguous metastatic lesions to the spine: Case report and literature review

Keshavarzi

Aryan

2009

Journal of Surgical Oncology

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In patients with metastatic disease to their spine and compromise of neurologic function, the challenge is to accomplish decompression of the neural elements and maintain mechanical stability but limit the risk and morbidity to the patient. In this case report the lateral extracavitary approach is employed to accomplish these tasks through a single approach in a patient with multiple non-contiguous sites of dorsal as well as ventral cord compression.

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Tumors of the Osseous Spine

Cited by 101 publications

References 82 publications

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

En bloc spondylectomy reconstructions in a biomechanical in-vitro study

Surgical Treatment of Metastatic Spinal Tumors

Multilevel lateral extra‐cavitary corpectomy and reconstruction for non‐contiguous metastatic lesions to the spine: Case report and literature review

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