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Hu P, Wu X, Li Y, Wei F, Zeng S, Xiao Y, Liu X, Liu Z. Survival outcomes and prognostic factors of breast cancer spinal metastases: a retrospective study. Discov Oncol 2025; 16:825. [PMID: 40392351 PMCID: PMC12092879 DOI: 10.1007/s12672-025-02668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 05/12/2025] [Indexed: 05/22/2025] Open
Abstract
PURPOSE To investigate survival-related factors in patients with breast cancer spinal metastases (BCSM) within the context of multidisciplinary treatment. METHODS A retrospective cohort of 78 cases from July 2010 to December 2021 was recruited. These patients underwent surgery-based multidisciplinary treatment. Collected data included demographics, pathologies, symptoms, surgery-related data, adjuvant therapies, postoperative events, and survival data. The primary outcome was overall survival (OS). Kaplan-Meier survival curves were plotted. Univariate analysis employed the log-rank test, and post-hoc multivariate analysis utilized the Cox regression model. RESULTS The mean age was 50.9 years. 72 cases (92.3%) reported locoregional pain, and 30 cases (38.5%) presented with neurological dysfunction. The primary pathological subtype was invasive ductal carcinoma (83.3%). SURGICAL PROCEDURES total en-bloc spondylectomy (6.4%), debulking surgery (61.5%), palliative surgery (32.1%). Postoperatively, both pain and neurological function significantly improved (P < 0.05). Radiotherapy, endocrine therapy, chemotherapy/targeted therapy were given to 56.4%, 60.3%, 61.5% patients, respectively. The estimated OS was 50.0 months. Tomita's scores (P = 0.355) and Tokuhashi's scores (P = 0.461) showed no significant OS association. Univariate analysis indicated that preoperative neurological dysfunction (P = 0.003), postoperative neurological dysfunction (P = 0.051), adjuvant endocrine therapy (P = 0.025), and hormone receptor expression status (P = 0.009) were associated with patient survival. Multivariate analysis identified endocrine therapy as an independent protective factor for prognosis (aHR = 0.070, 95% CI 0.007-0.727, P = 0.026). CONCLUSIONS Patients with BCSM have experienced prolonged survival. Neurological status, adjuvant anti-drugs, and expression of hormone receptors played crucial roles in predicting survival. Conventional prognostic systems may require modification to incorporate these factors. However, this study has limitations inherent to its retrospective design, single-center cohort, and relatively small sample size, which may affect generalizability.
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Affiliation(s)
- Panpan Hu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Xin Wu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
- Department of Orthopaedics, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yan Li
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Feng Wei
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
| | - Shengxin Zeng
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Yu Xiao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Zhongjun Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China
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Ghaith AK, Yang X, Khalilullah T, Wang X, Alfonzo Horowitz M, Khalifeh J, Ahmed AK, Azad T, Weinberg J, Al-Mistarehi AH, Foster C, Bhimreddy M, Menta AK, Redmond KJ, Theodore N, Lubelski D. Histology-Specific Treatment Strategies and Survival Prediction in Lung Cancer Patients with Spinal Metastases: A Nationwide Analysis. Cancers (Basel) 2025; 17:1374. [PMID: 40282550 PMCID: PMC12025767 DOI: 10.3390/cancers17081374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/07/2025] [Accepted: 04/09/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES Spinal metastases are a common and severe complication of lung cancer, particularly in small cell lung cancer (SCLC), and are associated with poor survival. Despite advancements in treatment, optimal management strategies remain unclear, with significant differences between non-small cell lung cancer (NSCLC) and SCLC. This study evaluates treatment patterns, survival outcomes, and prognostic factors in lung cancer patients with spinal metastases, integrating deep learning survival prediction models. METHODS This retrospective cohort study analyzed the National Cancer Database (NCDB) to identify NSCLC and SCLC patients diagnosed with spinal metastases. Demographics and treatment modalities were analyzed and adjusted for age, sex, and comorbidities. Kaplan-Meier analysis and Cox proportional hazards models assessed overall survival (OS). Five advanced survival prediction models estimated 1-year and 10-year mortality, with feature importance determined via permutation analysis. RESULTS Among 428,919 lung cancer patients, 5.1% developed spinal metastases, with a significantly higher incidence in SCLC (13.6%) than in NSCLC (5.1%). SCLC patients had poorer OS. Radiation therapy alone was the predominant treatment, and stereotactic body radiation therapy (SBRT) predicted better short- and long-term survival compared to other radiation techniques. High-dose radiation (71-150 Gy BED) improved OS in NSCLC, while reirradiation benefited NSCLC but had a limited impact in SCLC. SurvTrace demonstrated the highest predictive accuracy for 1-year and 10-year mortality, identifying age, radiation dose, reirradiation, and race as key prognostic factors. CONCLUSIONS The management of spinal metastases requires a histology-specific approach. Radiation remains the primary treatment, with SBRT predicting better short- and long-term survival. High-dose radiation and reirradiation should be considered for NSCLC, while the benefits are limited in SCLC. These findings support histology-specific treatment strategies to improve survival of patients with metastatic lung cancer to the spine.
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Affiliation(s)
- Abdul Karim Ghaith
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Xinlan Yang
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Taha Khalilullah
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Xihang Wang
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Melanie Alfonzo Horowitz
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Jawad Khalifeh
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - A. Karim Ahmed
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Tej Azad
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Joshua Weinberg
- Department of Neurosurgery, School of Medicine, Ohio State University, Columbus, OH 43210, USA;
| | - Abdel-Hameed Al-Mistarehi
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Chase Foster
- Department of Neurosurgery, School of Medicine, George Washington University, Washington, DC 20052, USA;
| | - Meghana Bhimreddy
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Arjun K. Menta
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Kristin J. Redmond
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Nicholas Theodore
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
| | - Daniel Lubelski
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.K.G.); (X.Y.); (T.K.); (X.W.); (M.A.H.); (J.K.); (A.K.A.); (T.A.); (A.-H.A.-M.); (M.B.); (A.K.M.); (K.J.R.); (N.T.)
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Amelot A, Terrier LM, Cognacq G, Benboubker L, Destrieux C, Zemmoura I, Francois P, Aggad M, Mathon B. Spinal manifestations of diffuse large B-cell lymphoma. Spine J 2025:S1529-9430(25)00169-X. [PMID: 40154628 DOI: 10.1016/j.spinee.2025.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 03/22/2025] [Accepted: 03/23/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND CONTEXT Spinal diffuse large B-cell lymphoma (DLBCL) can be divided into 2 categories: primary non-Hodgkin's lymphoma (PNHL) and metastases from disseminated DLBCL. Prognostic factors of spinal DLBCL metastases seem to differ from those of other spine metastases and PNHL, although the data in the literature remains scarce. PURPOSE This study aims at investigating prognostic factors associated with overall survival (OS) in patients with spine DLBCL metastases. STUDY DESIGN A retrospective study. PATIENT SAMPLE 371 patients treated for DLBCL, including 62 cases of spine DLBCL metastases. OUTCOME MEASURES Patient demographics were collected with survival. METHODS This study is based on consecutive prospective population of, between January 2015 and 2019. RESULTS The median age of the 371 patients was 68.4 years (range 19.1-94.0 years) and 58.8% were males (218 patients). The median OS for our whole series was 82.06 months (SD 11.2.), and 53.0 months (SD 41.2, p=.622) for the 62 patients with spine DLBCL metastases. The mean duration between DLBCL diagnosis and development of spine metastases (SpM) was 9.0 months (range 0.0-160.8 months). Cox multivariate proportional hazard model identified ECOG <2 [HR: 0.O59, 95 % CI 0.019-0.075; p<.0001], age <40 years [HR: 0.206, 95 % CI 0.08-0.506; p=.001], and IPI score ≤2 [HR: 0.472, 95 % CI 0.03-2.104; p=.001] as predictors of longer survival. In contrast, age >80 years [HR: 2.198, 95 % CI 1.481-3.261; p<.0001], IPI score >4 [HR: 3.232, 95 % CI 1.765-4.654; p=.008] were independent poor prognostic factors of survival. CONCLUSION Spinal lesions in DLBCL are metastatic in nature whereas spine PNHL, similar to multiple myeloma, appears to be a primary spinal malignancy. The main prognostic factors of DLBCL spine metastases are those of the primary disease itself, and should be considered before spinal surgery.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, 2 boulevard de Tonnelle, 37000 Tours, France.
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, 317 boulevard du Redon, 13009 Marseille, France
| | | | - Lotfi Benboubker
- Department of Neurosurgery, CHRU de Tours, 2 boulevard de Tonnelle, 37000 Tours, France; Department of Clinical Hematology, 2 boulevard de Tonnelle, CHRU de Tours, 37000 Tours, France
| | - Christophe Destrieux
- Department of Neurosurgery, CHRU de Tours, 2 boulevard de Tonnelle, 37000 Tours, France
| | - Ilyess Zemmoura
- Department of Neurosurgery, CHRU de Tours, 2 boulevard de Tonnelle, 37000 Tours, France
| | - Patrick Francois
- Department of Neurosurgery, CHRU de Tours, 2 boulevard de Tonnelle, 37000 Tours, France
| | - Mourad Aggad
- Department of Neurosurgery, CHRU de Tours, 2 boulevard de Tonnelle, 37000 Tours, France
| | - Bertrand Mathon
- Department of Neurosurgery, Hopital La Pitié-Salpêtrière, APHP, 80 boulevard de l'Hôpital, 75013 Paris, France
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Toivonen LA, Ponkilainen V, Repo JP, Mattila VM. Incidence of and survival after surgery for metastatic spine disease: a nationwide register-based study between 1997 and 2020 from Finland. Acta Orthop 2025; 96:250-255. [PMID: 40059767 PMCID: PMC11894730 DOI: 10.2340/17453674.2025.43264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 02/21/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND AND PURPOSE Information on metastatic spine disease (MSD) based on nationwide data on trends and postoperative survival is limited but is needed to optimize treatment in this population. We aimed to assess the incidence of and survival rates after MSD surgery. METHODS This retrospective nationwide register-based study combined data from the Finnish Cancer Registry, Finnish Care Register for Health Care, and the Finnish Cause of Death Register from 1997 to 2020. Surgeries were identified using diagnosis and procedural codes, with primary spine pathologies excluded. Incidence rates were calculated per 100,000 inhabitants and adjusted for age and sex. Survival analysis was conducted using the Kaplan-Meier estimator. RESULTS 1,845 patients underwent 1,992 surgeries, with a mean age of 65 years; 58% were men. The most common primary cancers were prostate cancer (15.1%), breast cancer (11.6%), and myeloma (10.6%). The incidence of MSD surgery increased by 87%, from 1.05 to 1.97 per 100,000 person-years. Surgery increased most among patients aged 70-79 years. Over the same period, the 6-month survival remained fairly stable. The overall survival probabilities were 57% (95% confidence interval [CI] 54-59) at 1 year, 44% (CI 42-46) at 2 years, 28% (CI 26-30) at 5 years, and 18% (CI 16-20) at 10 years. The 1-year survival was highest in patients with breast cancer at 75% (CI 69-81) and lowest in patients with kidney cancer at 45% (CI 38-53) and prostate cancer at 47% (CI 42-53). CONCLUSION Finnish nationwide data showed an increase in MSD surgery between 1997 and 2020 with a stable postoperative survival of 57% (CI 48-69) to 76% (CI 66-89) at 6 months.
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Affiliation(s)
- Leevi A Toivonen
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Diseases, Tampere University Hospital and Tampere University, Tampere, Finland.
| | - Ville Ponkilainen
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Diseases, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jussi P Repo
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Diseases, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Diseases, Tampere University Hospital and Tampere University, Tampere, Finland
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Kreatsoulas D, George A, Kolawole S, Damante M, Cua S, Chakravarthy VB, Elder JB. Early versus late construct failure in spine metastatic disease: implications for surgical strategy and oncologic outcome. J Neurooncol 2025; 171:705-714. [PMID: 39576287 DOI: 10.1007/s11060-024-04884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 11/04/2024] [Indexed: 01/15/2025]
Abstract
PURPOSE This study aimed to identify variables that portend early construct failure requiring surgical revision in patients undergoing instrumented fusion for spine metastases. METHODS A detailed retrospective chart review was performed. Demographic, surgical, and oncologic variables were collected and analyzed via independent samples t-testing, chi-square testing, and Kaplan-Meier method with log-rank testing. Significance was determined as p < 0.05. RESULTS 482 spinal fusion operations for solid tumor metastases were performed between 2012 and 2022. Of these, 24 (5.0%) required revision surgery for construct failure. There were no major differences between the revision and non-revision patients in terms of several surgical characteristics. Thirteen (54.1%) were revised within 3 months of index surgery. These early construct failures were more likely to have functional neurological deficits at surgery (6/13 vs. 0/11 [p = 0.009]), longer constructs (mean 6.4±2.4 vs. 4.2 ± 1.4 levels [p = 0.015]), and cement-augmented pedicle screws (4/13 vs. 0/11 [p = 0.044)) compared to late construct failures (> 3 months after index surgery). Additionally, 17 symptomatic failures were identified, compared to 7 asymptomatic failures which were identified incidentally with routine follow-up imaging. All 7 asymptomatic construct failures occurred in the early revisions group [p = 0.004]. Revision surgery for early construct failure was associated with significantly reduced median overall survival compared to late failure (p = 0.010). CONCLUSION Construct failures in our cohort were not associated with any classical characteristics of patients undergoing revision spine surgery. Early revision (< 3 months) portends a reduction in overall survival when compared with late revisions, and early revised patients were more likely to have had more extensive surgery and poorer neurological status at the time of index cases.
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Affiliation(s)
- Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N1052 Doan Hall, Columbus, OH, 43210, USA
| | - Andrew George
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samuel Kolawole
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N1052 Doan Hall, Columbus, OH, 43210, USA
| | - Santino Cua
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N1052 Doan Hall, Columbus, OH, 43210, USA
| | - Vikram B Chakravarthy
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N1052 Doan Hall, Columbus, OH, 43210, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N1052 Doan Hall, Columbus, OH, 43210, USA.
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Liu K, Ning J, Qin S, Xu J, Hao D, Lang N. Identifying Primary Sites of Spinal Metastases: Expert-Derived Features vs. ResNet50 Model Using Nonenhanced MRI. J Magn Reson Imaging 2025. [PMID: 39868626 DOI: 10.1002/jmri.29720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/10/2025] [Accepted: 01/13/2025] [Indexed: 01/28/2025] Open
Abstract
BACKGROUND The spinal column is a frequent site for metastases, affecting over 30% of solid tumor patients. Identifying the primary tumor is essential for guiding clinical decisions but often requires resource-intensive diagnostics. PURPOSE To develop and validate artificial intelligence (AI) models using noncontrast MRI to identify primary sites of spinal metastases, aiming to enhance diagnostic efficiency. STUDY TYPE Retrospective. POPULATION A total of 514 patients with pathologically confirmed spinal metastases (mean age, 59.3 ± 11.2 years; 294 males) were included, split into a development set (360) and a test set (154). FIELD STRENGTH/SEQUENCE Noncontrast sagittal MRI sequences (T1-weighted, T2-weighted, and fat-suppressed T2) were acquired using 1.5 T and 3 T scanners. ASSESSMENT Two models were evaluated for identifying primary sites of spinal metastases: the expert-derived features (EDF) model using radiologist-identified imaging features and a ResNet50-based deep learning (DL) model trained on noncontrast MRI. Performance was assessed using accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (ROC-AUC) for top-1, top-2, and top-3 indicators. STATISTICAL TESTS Statistical analyses included Shapiro-Wilk, t tests, Mann-Whitney U test, and chi-squared tests. ROC-AUCs were compared via DeLong tests, with 95% confidence intervals from 1000 bootstrap replications and significance at P < 0.05. RESULTS The EDF model outperformed the DL model in top-3 accuracy (0.88 vs. 0.69) and AUC (0.80 vs. 0.71). Subgroup analysis showed superior EDF performance for common sites like lung and kidney (e.g., kidney F1: 0.94 vs. 0.76), while the DL model had higher recall for rare sites like thyroid (0.80 vs. 0.20). SHapley Additive exPlanations (SHAP) analysis identified sex (SHAP: -0.57 to 0.68), age (-0.48 to 0.98), T1WI signal intensity (-0.29 to 0.72), and pathological fractures (-0.76 to 0.25) as key features. DATA CONCLUSION AI techniques using noncontrast MRI improve diagnostic efficiency for spinal metastases. The EDF model outperformed the DL model, showing greater clinical potential. PLAIN LANGUAGE SUMMARY Spinal metastases, or cancer spreading to the spine, are common in patients with advanced cancer, often requiring extensive tests to determine the original tumor site. Our study explored whether artificial intelligence could make this process faster and more accurate using noncontrast MRI scans. We tested two methods: one based on radiologists' expertise in identifying imaging features and another using a deep learning model trained to analyze MRI images. The expert-based method was more reliable, correctly identifying the tumor site in 88% of cases when considering the top three likely diagnoses. This approach may help doctors reduce diagnostic time and improve patient care. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ke Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Jinlai Ning
- Department of Informatics, King's College London, London, UK
| | - Siyuan Qin
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Jun Xu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Dapeng Hao
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
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Ishino Y, Kato S, Yokogawa N, Shimizu T, Kawai M, Uto T, Nanpo K, Kawai M, Demura S. Intratumoral Flow Void Diameter as a Predictor of High Intraoperative Blood Loss in Palliative Excisional Surgery for Metastatic Spinal Tumors. Cancers (Basel) 2024; 16:4124. [PMID: 39766025 PMCID: PMC11674744 DOI: 10.3390/cancers16244124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 11/26/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Objectives: Massive intraoperative blood loss (IBL) is one of the major complications in metastatic spinal tumor surgery (MSTS), and understanding the predictors of this risk is essential. This study aimed to determine the impact of the intratumoral flow void (IFV) observed on standard magnetic resonance imaging (MRI) and its association with IBL in palliative surgery for metastatic spinal tumors. Methods: This retrospective analysis included 88 palliative excisional surgeries performed at a single hospital between 2010 and 2024. Factors such as age, sex, body mass index, tumor location, histological tumor type, spinal instability neoplastic score, revised Tokuhashi score, preoperative radiation, presence of IFV, and IFV diameter were assessed in addition to surgical details such as the number of resected and instrumented vertebrae and surgical duration. Results: Of the 88 patients, 71 (80.7%) exhibited IFV, with a mean IFV diameter of 1.8 ± 1.3 mm. The univariate analysis identified a significant association between IBL and several factors, including the presence of IFV, IFV diameter, hypervascular tumor type, number of instrumented vertebrae, and surgical duration. The multivariate analysis indicated that IFV diameter had the highest standardized coefficient among the examined variables, suggesting its strong potential as a predictor of IBL. Conclusions: This is the first study to identify the IFV diameter as a critical and independent predictor of IBL in MSTS. IFV diameter, which can be easily assessed using standard MRI, should be considered in surgical planning to effectively manage bleeding.
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Affiliation(s)
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan; (Y.I.); (N.Y.); (T.S.); (M.K.); (T.U.); (K.N.); (M.K.); (S.D.)
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Xu H, Ke W, Zhang D, Miao J, Wang B, Yang C. Biomechanical Effects of Different Prosthesis Types and Fixation Ranges in Multisegmental Total En Bloc Spondylectomy: A Finite Element Study. Orthop Surg 2024; 16:2488-2498. [PMID: 39101231 PMCID: PMC11456706 DOI: 10.1111/os.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/29/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVE Multi-segmental total en bloc spondylectomy (TES) gradually became more commonly used by clinicians. However, the choice of surgical strategy is unclear. This study aims to investigate the biomechanical performance of different prosthesis types and fixation ranges in multisegmental TES. METHODS In this study, a validated finite element model of T12-L2 post-spondylectomy operations were carried out. The prostheses of these models used either 3D-printed artificial vertebrae or titanium mesh cages. The fixed range was two or three segment levels. Range of motion, stress distribution of the endplate and internal fixation system, intervertebral disc pressure, and facet joint surface force of four postoperative models and intact model in flexion and extension, as well as lateral bending and rotation were analyzed and compared. RESULTS The type of prosthesis used in the anterior column reconstruction mainly affected the stress of the adjacent endplate and the prosthesis itself. The posterior fixation range had a greater influence on the overall range of motion (ROM), the ROM of the adjacent segment, the stress of the screw-rod system, and adjacent facet joint surface force. For the model of the same prosthesis, the increase of fixed length resulted in an obvious reduction of ROM. The maximal decrease was 70.23% during extension, and the minimal decrease was 30.19% during rotation. CONCLUSION In three-segment TES, the surgical strategy of using 3D-printed artificial prosthesis for anterior column support and pedicle screws for posterior fixation at both two upper and lower levels respectively can reduce the stress on internal fixation system, endplates, and adjacent intervertebral discs, resulting in a reduced risk of internal fixation failure, and ASD development.
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Affiliation(s)
- Hanpeng Xu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencan Ke
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongzhe Zhang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Bingjin Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Reyes Soto G, Cacho-Díaz B, Vilchis-Sámano H, Diaz-Sanabria I, Baeza-Velia B, Ayala-Garduño D, García-Ramos C, Rosales-Olivarez LM, Alpízar-Aguirre A, Mukengeshay JN, Reyes-Sánchez A, Ramirez MDJE, Montemurro N. Mexican Multicenter Experience of Metastatic Spinal Disease. Cureus 2024; 16:e58546. [PMID: 38957823 PMCID: PMC11218424 DOI: 10.7759/cureus.58546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 07/04/2024] Open
Abstract
Background Spinal metastatic disease is a silent progressive cancer complication with an increasing prevalence worldwide. The spine is the third most common site where solid tumors metastasize. Complications involved in spinal metastasis include root or spinal cord compression, progressing to a declining quality of life as patient autonomy reduces and pain increases. The main objective of this study is to report the incidence of patients and typology of spinal metastases in three reference centers in Mexico. Methodology Retrospective cohorts of patients diagnosed with spinal metastases from January 2010 to February 2017 at the National Cancer Institute, National Rehabilitation Institute, and the Traumatology and Orthopedics Hospital "Lomas Verdes" in Mexico City were analyzed. Results A total of 326 patients (56% males) with spinal metastases were reported. The mean age was 58.06 ± 14.05 years. The main sources of spinal metastases were tumors of unknown origin in 53 (16.25%) cases, breast cancer in 67 (20.5%) cases, prostate cancer in 59 (18%) cases, myeloma in 24 (7.4%) cases, and lung cancer in 23 (7.1%) cases. Conclusions The data obtained in this analysis delivers an updated standpoint on Mexico, providing the opportunity to distinguish the current data from global references. Collecting more epidemiological information for better recording of cancer and its associated complications, as well as further studies on them, is necessary.
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Affiliation(s)
- Gervith Reyes Soto
- Neurosurgical Oncology, Mexico National Cancer Institute, Mexico City, MEX
| | - Bernardo Cacho-Díaz
- Head and Neck Surgery Department, Instituto Nacional de Cancerología, Mexico City, MEX
| | - Hugo Vilchis-Sámano
- Spine Surgery, Hospital de Traumatología y Ortopedia "Lomas Verdes", Mexico City, MEX
| | - Ignacio Diaz-Sanabria
- Spine Surgery, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, MEX
| | - Beatriz Baeza-Velia
- Spine Surgery, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, MEX
| | - David Ayala-Garduño
- Spine Surgery, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, MEX
| | - Carla García-Ramos
- Spine Surgery, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, MEX
| | | | - Armando Alpízar-Aguirre
- Spine Surgery, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, MEX
| | | | - Alejandro Reyes-Sánchez
- Spine Surgery, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, MEX
| | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, ITA
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10
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Miyazaki K, Kanda Y, Sakai Y, Yoshikawa R, Yurube T, Takeoka Y, Hara H, Akisue T, Kuroda R, Kakutani K. Effect of Bone Metastasis Cancer Board on Spinal Surgery Outcomes: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2087. [PMID: 38138190 PMCID: PMC10744340 DOI: 10.3390/medicina59122087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Bone metastasis cancer boards (BMCBs) focusing on the management of bone metastases have been gathering much attention. However, the association of BMCBs with spinal surgery in patients with spinal metastases remains unclear. In this retrospective single-center observational study, we aimed to clarify the effect of a BMCB on spinal metastasis treatment. Materials and Methods: We reviewed consecutive cases of posterior decompression and/or instrumentation surgery for metastatic spinal tumors from 2008 to 2019. The BMCB involved a team of specialists in orthopedics, rehabilitation medicine, radiation oncology, radiology, palliative supportive care, oncology, and hematology. We compared demographics, eastern cooperative oncology group performance status (ECOGPS), Barthel index (BI), number of overall versus emergency surgeries, and primary tumors between patients before (2008-2012) and after (2013-2019) BMCB establishment. Results: A total of 226 patients including 33 patients before BMCB started were enrolled; lung cancer was the most common primary tumor. After BMCB establishment, the mean patient age was 5 years older (p = 0.028), the mean operating time was 34 min shorter (p = 0.025), the mean hospital stay was 34.5 days shorter (p < 0.001), and the mean BI before surgery was 12 points higher (p = 0.049) than before. Moreover, the mean number of surgeries per year increased more than fourfold to 27.6 per year (p < 0.01) and emergency surgery rates decreased from 48.5% to 29.0% (p = 0.041). Patients with an unknown primary tumor before surgery decreased from 24.2% to 9.3% (p = 0.033). Postoperative deterioration rates from 1 to 6 months after surgery of ECOGPS and BI after BMCB started were lower than before (p = 0.045 and p = 0.027, respectively). Conclusion: The BMCB decreased the emergency surgery and unknown primary tumor rate despite an increase in the overall number of spinal surgeries. The BMCB also contributed to shorter operation times, shorter hospital stays, and lower postoperative deterioration rates of ECOGPS and BI.
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Affiliation(s)
- Kunihiko Miyazaki
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yutaro Kanda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Ryo Yoshikawa
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Takashi Yurube
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiki Takeoka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hitomi Hara
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kenichiro Kakutani
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Hu TY, Zhang G, Ye H, An CL, Wang K, Xia L, Zhou XX, Zhang SS, Lu YH. Pain Relief and Safety of Microwave Ablation Combined with Percutaneous Vertebroplasty for Vertebral Metastasis: A Pilot Study. J Neurol Surg A Cent Eur Neurosurg 2023; 84:513-520. [PMID: 36495242 DOI: 10.1055/s-0042-1758121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We investigate the pain relief and safety of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of metastatic vertebral tumors. METHODS This prospective pilot study enrolled patients with metastatic vertebral tumors treated between January 2018 and October 2019. The participants were randomized to the PVP and MWA + PVP groups. Clinical parameters, pain visual analog scale (VAS), analgesic use scores (AUS), and quality-of-life score (QLS) were compared between groups. RESULTS Sixty-seven participants were enrolled (PVP: n = 35; MWA + PVP: n = 32). There were no differences in bone cement injection volume, extravasation, and X-ray exposure time between the two groups (p > 0.05), but treatment costs were higher for the MWA + PVP group (26,418 ± 194 vs. 15,606 ± 148 yuan; p < 0.05). There were no significant improvements in VAS from baseline to 24 hours, 72 hours, 7 days, 1 month, and 3 months in the two groups (p > 0.05); at 6 and 12 months after the operation, the improvement from baseline was significant in the two groups (p < 0.05). The VAS was lower at 6 months (2.7 ± 0.7 vs. 3.2 ± 0.7) and 12 months (3.5 ± 0.8 vs. 4.0 ± 0.7) in the MWA + PVP group (both p < 0.01 vs. PVP). The AUS and QLS were improved with PVP at 6 and 12 months (p < 0.05) and with MWA + PVP at 12 months (p < 0.05). The AUS was lower at 6 and 12 months in the MWA + PVP group (p < 0.05 vs. PVP). CONCLUSION MWA combined with PVP might be a safe and effective palliative treatment for pain from metastatic vertebral tumors.
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Affiliation(s)
- Ting-Ye Hu
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Gan Zhang
- Department of General Surgery, Anhui Hanbo Group Hospital, Chuzhou, Anhui, China
| | - Hong Ye
- Department of Orthopedics, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Cheng-Ling An
- Digital Subtraction Angiography, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Kai Wang
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Lei Xia
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Xiao-Xing Zhou
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Shan-Shan Zhang
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
| | - Yu-He Lu
- Department of Interventional Vascular Surgery, Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Municipal First People's Hospital, Chuzhou, Anhui, China
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12
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Compagnone D, Cecchinato R, Pezzi A, Langella F, Damilano M, Redaelli A, Vanni D, Lamartina C, Berjano P, Boriani S. Diagnostic Approach and Differences between Spinal Infections and Tumors. Diagnostics (Basel) 2023; 13:2737. [PMID: 37685273 PMCID: PMC10487270 DOI: 10.3390/diagnostics13172737] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
STUDY DESIGN A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. BACKGROUND AND PURPOSE The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. METHODS A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. RESULTS A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. CONCLUSION Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.
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Affiliation(s)
| | | | - Andrea Pezzi
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
| | | | - Marco Damilano
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | | | - Daniele Vanni
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | | | - Pedro Berjano
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
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13
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Li J, Zhang J, Zhang X, Lun D, Li R, Ma R, Hu Y. Quantile regression-based prediction of intraoperative blood loss in patients with spinal metastases: model development and validation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2479-2492. [PMID: 37115280 DOI: 10.1007/s00586-023-07653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To develop and evaluate a quantile regression-based blood loss prediction model for open surgery of spinal metastases. METHODS This was a multicenter retrospective cohort study. Over a 11-year period, patients underwent open surgery for spinal metastases at 6 different institutions were reviewed. The outcome measure is intraoperative blood loss (in mL). The effects of baseline, histology of primary tumor and surgical procedure on blood loss were evaluated by univariate and multivariate analysis to determine the predictors. Multivariate ordinary least squares (OLS) regression and 0.75 quantile regression were used to establish two prediction models. The performance of the two models was evaluated in the training set and the test set, respectively. RESULTS 528 patients were included in this study. Mean age was 57.6 ± 11.2 years, with a range of 20-86 years. Mean blood loss was 1280.1 ± 1181.6 mL, with a range of 10 ~ 10,000 mL. Body mass index (BMI), tumor vascularization, surgical site, surgical extent, total en bloc spondylectomy and microwave ablation use were significant predictors of intraoperative blood loss. Hypervascular tumor, higher BMI, and broader surgical extent were related with massive blood loss. Microwave ablation is more beneficial in surgery with substantial blood loss. Compared to the OLS regression model, the 0.75 quantile regression model may decrease blood loss underestimate. CONCLUSION In this study, we developed and evaluated a prediction model for blood loss in open surgery for spinal metastases based on 0.75 quantile regression, which may minimize blood loss underestimate.
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Affiliation(s)
- Jikai Li
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, 300000, MD, China
| | - Jingyu Zhang
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, 300000, MD, China
| | | | - Dengxing Lun
- Department of Bone Oncology, Weifang People's Hospital, Weifang, China
| | - Ruifeng Li
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Rongxing Ma
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yongcheng Hu
- Department of Bone and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, 300000, MD, China.
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14
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Pennington Z, Porras JL, Larry Lo SF, Sciubba DM. International Variability in Spinal Metastasis Treatment: A Survey of the AO Spine Community. Global Spine J 2023; 13:1622-1634. [PMID: 34565202 PMCID: PMC10448098 DOI: 10.1177/21925682211046904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN International survey. OBJECTIVES To assess variability in the treatment practices for spinal metastases as a function of practice setting, surgical specialty, and fellowship training among an international group of spine surgeons. METHODS An anonymous internet-based survey was disseminated to the AO Spine membership. The questionnaire contained items on practice settings, fellowship training, indications used for spinal metastasis surgery, surgical strategies, multidisciplinary team use, and postoperative follow-up priorities and practice. RESULTS 341 gave complete responses to the survey with 76.3% identifying spinal oncology as a practice focus and 95.6% treating spinal metastases. 80% use the Spinal Instability Neoplastic Score (SINS) to guide instrumentation decision-making and 60.7% recruit multidisciplinary teams for some or all cases. Priorities for postoperative follow-up are adjuvant radiotherapy (80.9%) and systemic therapy (74.8%). Most schedule first follow-up within 6 weeks of surgery (62.2%). Significant response heterogeneity was seen when stratifying by practice in an academic or university-affiliated center, practice in a cancer center, completion of a spine oncology fellowship, and self-identification as a tumor specialist. Respondents belonging to any of these categories were more likely to utilize SINS (P < .01-.02), recruit assistance from plastic surgeons (all P < .01), and incorporate radiation oncologists in postoperative care (P < .01-.03). CONCLUSIONS The largest variability in practice strategies is based upon practice setting, spine tumor specialization, and completion of a spine oncology fellowship. These respondents were more likely to use evidenced-based practices. However, the response variability indicates the need for consensus building, particularly for postoperative spine metastasis care pathways and multidisciplinary team use.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jose L. Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
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15
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Tsuang FY, Jeon JP, Huang AP, Chai CL. Overall Survival of Non-Small Cell Lung Cancer With Spinal Metastasis: A Systematic Review and Meta-Analysis. Neurospine 2023; 20:567-576. [PMID: 37401075 PMCID: PMC10323357 DOI: 10.14245/ns.2245026.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/22/2023] [Accepted: 03/23/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE The long-term survival data of lung cancer patients with spinal metastases are crucial for informed treatment decision-making. However, most studies in this field involve small sample sizes. Moreover, survival benchmarking and an analysis of changes in survival over time are required, but data are unavailable. To meet this need, we performed a metaanalysis of survival data from small studies to obtain a survival function based on largescale data. METHODS We performed a single-arm systematic review of survival function following a published protocol. Data of patients who received surgical, nonsurgical, and mixed modes of treatment were meta-analyzed separately. Survival data were extracted from published figures with a digitizer program and then processed in R. Median survival time was used as an effect size for moderator analysis to explain the heterogeneity. RESULTS Sixty-two studies with 5,242 participants were included for pooling. The survival functions showed a median survival of 6.72 months for surgery (95% confidence interval [CI], 61.9-7.01; 2,367 participants; 36 studies), 5.99 months for nonsurgery (95% CI, 5.33-6.47; 891 participants; 12 studies), and 5.96 months for mixed (95% CI, 5.67-6.43; 1,984 participants; 18 studies). Patients enrolled since 2010 showed the highest survival rates. CONCLUSION This study provides the first large-scale data for lung cancer with spinal metastasis that allows survival benchmarking. Data from patients enrolled since 2010 had the best survival and thus may more accurately reflect current survival. Researchers should focus on this subset in future benchmarking and remain optimistic in the management of these patients.
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Affiliation(s)
- Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - An-Ping Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung Liang Chai
- Department of Neurosurgery, Yee Zen General Hospital, Taoyuan, Taiwan
- School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
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Kumar N, Alathur Ramakrishnan S, Lopez KG, Wang N, Madhu S, Vellayappan BA, Tpd Hallinan J, Fuh JYH, Kumar AS. Design and 3D printing of novel titanium spine rods with lower flexural modulus and stiffness profile with optimised imaging compatibility. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1953-1965. [PMID: 37052651 DOI: 10.1007/s00586-023-07674-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To manufacture and test 3D printed novel design titanium spine rods with lower flexural modulus and stiffness compared to standard solid titanium rods for use in metastatic spine tumour surgery (MSTS) and osteoporosis. METHODS Novel design titanium spine rods were designed and 3D printed. Three-point bending test was performed to assess mechanical performance of rods, while a French bender was used to assess intraoperative rod contourability. Furthermore, 3D printed spine rods were tested for CT & MR imaging compatibility using phantom setup. RESULTS Different spine rod designs generated includes shell, voronoi, gyroid, diamond, weaire-phelan, kelvin, and star. Tests showed 3D printed rods had lower flexural modulus with reduction ranging from 2 to 25% versus standard rod. Shell rods exhibited highest reduction in flexural modulus of 25% (~ 77.4 GPa) and star rod exhibited lowest reduction in flexural modulus of 2% (100.8GPa). 3D printed rod showed reduction in stiffness ranging from 40 to 59%. Shell rod displayed highest reduction in stiffness of 59% (179.9 N/mm) and gyroid had least reduction in stiffness of 40% (~ 259.2 N/mm). Rod bending test showed that except gyroid, other rod designs demonstrated lesser bending difficulty versus standard rod. All 3D printed rods demonstrated improved CT/MR imaging compatibility with reduced artefacts versus standard rod. CONCLUSION By utilising novel design approach, we successfully generated a spine rod design portfolio with lower flexural modulus/stiffness profile and better CT/MR imaging compatibility for potential use in MSTS/other conditions such as osteoporosis. Thus, exploration of new rod designs in surgical application could enhance treatment outcome and improve quality of life for patients.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore.
| | - Sridharan Alathur Ramakrishnan
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Niyou Wang
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Balamurugan A Vellayappan
- Department of Radiation Oncology, National University Health System, Level 7 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - James Tpd Hallinan
- Department of Diagnostic Imaging, National University Hospital, Level 2 National University Hospital Main Building, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, #04-18 Block EA, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - A Senthil Kumar
- Department of Mechanical Engineering, National University of Singapore, #05-26 Block EA, 9 Engineering Drive 1, Singapore, 117575, Singapore
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Liu K, Qin S, Ning J, Xin P, Wang Q, Chen Y, Zhao W, Zhang E, Lang N. Prediction of Primary Tumor Sites in Spinal Metastases Using a ResNet-50 Convolutional Neural Network Based on MRI. Cancers (Basel) 2023; 15:cancers15112974. [PMID: 37296938 DOI: 10.3390/cancers15112974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
We aim to investigate the feasibility and evaluate the performance of a ResNet-50 convolutional neural network (CNN) based on magnetic resonance imaging (MRI) in predicting primary tumor sites in spinal metastases. Conventional sequences (T1-weighted, T2-weighted, and fat-suppressed T2-weighted sequences) MRIs of spinal metastases patients confirmed by pathology from August 2006 to August 2019 were retrospectively analyzed. Patients were partitioned into non-overlapping sets of 90% for training and 10% for testing. A deep learning model using ResNet-50 CNN was trained to classify primary tumor sites. Top-1 accuracy, precision, sensitivity, area under the curve for the receiver-operating characteristic (AUC-ROC), and F1 score were considered as the evaluation metrics. A total of 295 spinal metastases patients (mean age ± standard deviation, 59.9 years ± 10.9; 154 men) were evaluated. Included metastases originated from lung cancer (n = 142), kidney cancer (n = 50), mammary cancer (n = 41), thyroid cancer (n = 34), and prostate cancer (n = 28). For 5-class classification, AUC-ROC and top-1 accuracy were 0.77 and 52.97%, respectively. Additionally, AUC-ROC for different sequence subsets ranged between 0.70 (for T2-weighted) and 0.74 (for fat-suppressed T2-weighted). Our developed ResNet-50 CNN model for predicting primary tumor sites in spinal metastases at MRI has the potential to help prioritize the examinations and treatments in case of unknown primary for radiologists and oncologists.
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Affiliation(s)
- Ke Liu
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Siyuan Qin
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Jinlai Ning
- Department of Informatics, King's College London, London WC2B 4BG, UK
| | - Peijin Xin
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Yongye Chen
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Weili Zhao
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Enlong Zhang
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
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18
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Zheng DX, Soldozy S, Mulligan KM, Levoska MA, Cohn EF, Finberg A, Alsaloum P, Cwalina TB, Hanft SJ, Scott JF, Rothermel LD, Nambudiri VE. Epidemiology, management, and treatment outcomes of metastatic spinal melanoma. World Neurosurg X 2023; 18:100156. [PMID: 36875322 PMCID: PMC9976572 DOI: 10.1016/j.wnsx.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/29/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Metastatic spinal melanoma is a rare and aggressive disease process with poor prognosis. We review the literature on metastatic spinal melanoma, focusing on its epidemiology, management, and treatment outcomes. Demographics of metastatic spinal melanoma are similar to those for cutaneous melanoma, and cutaneous primary tumors tend to be most common. Decompressive surgical intervention and radiotherapy have traditionally been considered mainstays of treatment, and stereotactic radiosurgery has emerged as a promising approach in the operative management of metastatic spinal melanoma. While survival outcomes for metastatic spinal melanoma remain poor, they have improved in recent years with the advent of immune checkpoint inhibition, used in conjunction with surgery and radiotherapy. New treatment options remain under investigation, especially for patients with disease refractory to immunotherapy. We additionally explore several of these promising future directions. Nevertheless, further investigation of treatment outcomes, ideally incorporating high-quality prospective data from randomized controlled trials, is needed to identify optimal management of metastatic spinal melanoma.
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Affiliation(s)
- David X Zheng
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.,Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Miami, Miami, FL, United States.,Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Kathleen M Mulligan
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Melissa A Levoska
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Erin F Cohn
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Ariel Finberg
- Department of Neurological Surgery, University of Miami, Miami, FL, United States
| | - Peter Alsaloum
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Thomas B Cwalina
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Simon J Hanft
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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19
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Zaborovskii N, Schlauch A, Shapton J, Denisov A, Ptashnikov D, Mikaylov D, Masevnin S, Smekalenkov O, Murakhovsky V, Kondrashov D. Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1010-1020. [PMID: 36708397 DOI: 10.1007/s00586-023-07548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics. METHODS The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan-Meier method. RESULTS 12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24 months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24 months following spine surgery. CONCLUSION Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time. LEVEL OF EVIDENCE Level IV (retrospective cohort study).
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Affiliation(s)
- Nikita Zaborovskii
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Adam Schlauch
- San Francisco Orthopaedic Residency Program/ Saint Mary's Medical Center, San Francisco, CA, USA
| | - John Shapton
- San Francisco Orthopaedic Residency Program/ Saint Mary's Medical Center, San Francisco, CA, USA
| | - Anton Denisov
- Traumatología Elgeadi/Hospital Quirónsalud Valle del Henares, Madrid, Spain
- Traumatología Elgeadi/Hospital Quirónsalud San José, Madrid, Spain
- Hospital 12 de Octubre Health Research Institute, Madrid, Spain
| | - Dmitrii Ptashnikov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- North-Western State Medical University named after I.I.Mechnikov, Saint-Petersburg, Russia
| | - Dmitrii Mikaylov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Sergei Masevnin
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Oleg Smekalenkov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Vladislav Murakhovsky
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program/ Saint Mary's Medical Center, San Francisco, CA, USA.
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20
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Shiber M, Kimchi G, Knoller N, Harel R. The Evolution of Minimally Invasive Spine Tumor Resection and Stabilization: From K-Wires to Navigated One-Step Screws. J Clin Med 2023; 12:jcm12020536. [PMID: 36675466 PMCID: PMC9865379 DOI: 10.3390/jcm12020536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
Minimization of the surgical approaches to spinal extradural metastases resection and stabilization was advocated by the 2012 Oncological Guidelines for Spinal Metastases Management. Minimally invasive approaches to spine oncology surgery (MISS) are continually advancing. This paper will describe the evolution of minimally invasive surgical techniques for the resection of metastatic spinal lesions and stabilization in a single institute. A retrospective analysis of patients who underwent minimally invasive extradural spinal metastases resection during the years 2013-2019 by a single surgeon was performed. Medical records, imaging studies, operative reports, rates of screw misplacement, operative time and estimated blood loss were reviewed. Detailed description of the surgical technique is provided. Of 138 patients operated for extradural spinal tumors during the study years, 19 patients were treated in a minimally invasive approach and met the inclusion criteria for this study. The mortality rate was significantly improved over the years with accordance of improve selection criteria to better prognosis patients. The surgical technique has evolved over the study years from fluoroscopy to intraoperative 3D imaging and navigation guidance and from k-wire screw insertion technique to one-step screws. Minimally invasive spinal tumor surgery is an evolving technique. The adoption of assistive devices such as intraoperative 3D imaging and one-step screw insertion systems was safe and efficient. Oncologic patients may particularly benefit from the minimization of surgical decompression and fusion in light of the frailty of this population and the mitigated postoperative outcomes associated with MIS oncological procedures.
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Affiliation(s)
- Mai Shiber
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Gil Kimchi
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Nachshon Knoller
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Ran Harel
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +972-3-5302650
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21
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Avila MJ, Orenday-Barraza JM, Cavagnaro MJ, Strouse IM, Farhadi DS, Khan N, Hussein A, Baaj AA. Antifibrinolytics use during surgery for oncological spine diseases: A systematic review. Surg Neurol Int 2022; 13:567. [PMID: 36600747 PMCID: PMC9805626 DOI: 10.25259/sni_837_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Data exist of the benefits of antifibrinolytics such as tranexamic acid (TXA) in general spine surgery. However, there are limited data of its use in oncological spine patients. Methods A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, OVID, and Embase databases were searched. Search terms: "tranexamic acid", "aprotinin," "aminocaproic acid," "spine surgery," "spine tumors," and "spine oncology." Included studies were full text publications written in English with patients treated with either agent or who had surgery for oncological spine disease (OSD). Results Seven hundred results were reviewed form the different databases, seven were selected. A total of 408 patients underwent spine surgery for OSD and received antifibrinolytics. There was a male predominance (55.2%) and mean age ranged from 43 to 62 years. The most common tumor operated was metastatic renal cancer, followed by breast and lung. Most studies administered TXA as a bolus followed by an infusion during surgery. Median blood loss was of 667 mL (253.3-1480 mL). Patients with TXA required 1-2 units less of transfusion and had 56-63 mL less of postoperative drainage versus no TXA. The median incidence of deep venous thrombosis (DVT) was 2.95% (0-7.9%) and for pulmonary embolism (PE) was 4.25% (0-14.3%). The use of TXA reduced intraoperative blood loss, transfusions and reduced postoperative surgical drainage output compared to no TXA use in patients with OSD. Conclusion In this review, we found that TXA may diminish intraoperative blood loss, the need for transfusion and postoperative drainage from surgical drains when used in OSD without major increase in rates of DVT or PE.
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Affiliation(s)
- Mauricio J. Avila
- Department of Neurosurgery, University of Arizona, Tucson, United States.,Corresponding author: Mauricio J. Avila, Department of Neurosurgery, University of Arizona, Tucson, Arizona, United States.
| | | | | | - Isabel M. Strouse
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Dara S. Farhadi
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Naushaba Khan
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Amna Hussein
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, United States
| | - Ali A. Baaj
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, United States
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22
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Fomchenko EI, Bayley JC, Alvarez-Breckenridge C, Rhines LD, Tatsui CE. Spinal Metastases and the Evolving Role of Molecular Targeted Therapy, Chemotherapy, and Immunotherapy. Neurospine 2022; 19:978-993. [PMID: 36597635 PMCID: PMC9816609 DOI: 10.14245/ns.2244290.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 12/27/2022] Open
Abstract
Metastatic involvement of the spine is a common complication of systemic cancer progression. Surgery and external beam radiotherapy are palliative treatment modalities aiming to preserve neurological function, control pain and maintain functional status. More recently, with development of image guidance and stereotactic delivery of high doses of conformal radiation, local tumor control has improved; however recurrent or radiation refractory disease remains a significant clinical problem with limited treatment options. This manuscript represents a narrative overview of novel targeted molecular therapies, chemotherapies, and immunotherapy treatments for patients with breast, lung, melanoma, renal cell, prostate, and thyroid cancers, which resulted in improved responses compared to standard chemotherapy. We present clinical examples of excellent responses in spinal metastatic disease which have not been specifically documented in the literature, as most clinical trials evaluate treatment response based on visceral disease. This review is useful for the spine surgeons treating patients with metastatic disease as knowledge of these responses could help with timing and planning of surgical interventions, as well as promote multidisciplinary discussions, allowing development of an individualized treatment strategy to patients presenting with widespread multifocal progressive disease, where surgery could lead to suboptimal results.
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Affiliation(s)
| | - James C. Bayley
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Claudio E. Tatsui
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA,Corresponding Author Claudio E. Tatsui Department of Neurosurgery, MD Anderson Cancer Center, Houston, 1515 Holcombe Blvd, Houston, TX, USA
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23
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Bergin S, Than KD. Advances in the Treatment of Spinal Metastasis: Commentary on "Spinal Metastases and the Evolving Role of Molecular Targeted Therapy, Chemotherapy, and Immunotherapy". Neurospine 2022; 19:994-995. [PMID: 36597636 PMCID: PMC9816590 DOI: 10.14245/ns.2245044.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephen Bergin
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA
| | - Khoi D. Than
- Department of Neurosurgery, Division of Spine, Duke University, Durham, NC, USA,Corresponding Author Khoi Than Department of Neurosurgery, Division of Spine, Duke University, 3480 Wake Forest Rd Suite 310, Raleigh, NC 27609, USA
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24
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Shin HK, Kim M, Lee S, Lee JJ, Park D, Jeon SR, Roh SW, Park JH. Surgical strategy for metastatic spinal tumor patients with surgically challenging situation. Medicine (Baltimore) 2022; 101:e29560. [PMID: 35801761 PMCID: PMC9259146 DOI: 10.1097/md.0000000000029560] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The incidence of spinal metastasis is increasing as cancer patients live longer owing to the improvement of cancer treatments. However, traditional surgery (TS) which fixates at least 2 levels above and 2 levels below the affected vertebrae is sometimes difficult to perform as it is burdensome to the patients. In this article, we introduce our experience and strategy in treating spinal metastasis, focusing particularly on challenging cases. We retrospectively reviewed the data of 110 patients who underwent spinal surgery for metastatic spinal tumors from April 2018 to March 2020. Among them, 5 patients who received anterior approach surgery were excluded. The remaining 105 patients were enrolled. In addition to TS, we also performed cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, depending on the characteristics of the tumor. The overall survival was analyzed, and the local tumor control rate was evaluated using magnetic resonance imaging. Perioperative clinical characteristics including Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score were also investigated. The overall survival rate was 57.9% at 1 year, and the local tumor control rate was 81.1% after surgery. There was a statistically significant difference according to the type of the tumor in the survival analysis: the overall survival rates were 72.7% for favorable tumors and 48.6% for unfavorable tumors at 12 months after surgery (P = .04). Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score was improved after surgery. All surgical methods, including TS, cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, showed good clinical and radiological outcomes. Optimized surgical methods show similarly good clinical outcomes in managing spinal metastasis as TS.
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Affiliation(s)
- Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myeongjong Kim
- Department of Neurosurgery, Seongnam Citizens Medical Center, Seongnam, Republic of Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Jae Lee
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Danbi Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * Correspondence: Jin Hoon Park, MD, PhD, Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
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25
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Furlan JC, Wilson JR, Massicotte EM, Sahgal A, Fehlings MG. Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: a scoping review of registered clinical studies from 2000 to 2020. Neuro Oncol 2022; 24:1-13. [PMID: 34508647 PMCID: PMC8730766 DOI: 10.1093/neuonc/noab214] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The field of spinal oncology has substantially evolved over the past decades. This review synthesizes and appraises what was learned and what will potentially be discovered from the recently completed and ongoing clinical studies related to the treatment of primary and secondary spinal neoplasms. This scoping review included all clinical studies on the treatment of spinal neoplasms registered in the ClinicalTrials.gov website from February 2000 to December 2020. The terms "spinal cord tumor," "spinal metastasis," and "metastatic spinal cord compression" were used. Of the 174 registered clinical studies on primary spinal tumors and spinal metastasis, most of the clinical studies registered in this American registry were interventional studies led by single institutions in North America (n = 101), Europe (n = 43), Asia (n = 24), or other continents (n = 6). The registered clinical studies mainly focused on treatment strategies for spinal neoplasms (90.2%) that included investigating stereotactic radiosurgery (n = 33), radiotherapy (n = 21), chemotherapy (n = 20), and surgical technique (n = 11). Of the 69 completed studies, the results from 44 studies were published in the literature. In conclusion, this review highlights the key features of the 174 clinical studies on spinal neoplasms that were registered from 2000 to 2020. Clinical trials were heavily skewed toward the metastatic population as opposed to the primary tumors which likely reflects the rarity of the latter condition and associated challenges in undertaking prospective clinical studies in this population. This review serves to emphasize the need for a focused approach to enhancing translational research in spinal neoplasms with a particular emphasis on primary tumors.
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Affiliation(s)
- Julio C Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Eric M Massicotte
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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26
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Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, Strouse IM, Dowell A, Kisana H, Khan N, Ravinsky R, Baaj AA. 10-Year Trends in the Surgical Management of Patients with Spinal Metastases: A Scoping Review. World Neurosurg 2022; 157:170-186.e3. [PMID: 34655822 DOI: 10.1016/j.wneu.2021.10.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spinal metastases are present in approximately 20% of patients with cancer, giving a risk for neurologic dysfunction and instability. In already frail patients, surgeons strive to improve quality of life. Our goal was to review a 10-year trend in the surgical management of spinal metastases. METHODS A scoping review was performed systematically using PubMed to assess trends in surgical treatment for spinal metastases. The search terms used were: metastas∗, "neoplasm metastasis"[Mesh], "Spine"[Mesh], spine, spinal, "vertebral column," "vertebral body," laser, robot, radiofrequency, screws, fixation, "separation surgery," corpectomy, vertebrectomy, spondylectomy, vertebroplasty, kyphoplasty, surgery, "open surgery," "mini open surgery," "minimally invasive surgery," endoscopy, thoracoscopy, corpectom∗, vertebrectom∗, spondylectom∗, "en bloc," and MIS. The variables of interest were neurologic improvement, tumor recurrence, reoperation, and overall survival. RESULTS A total of 2132 articles were found within the primary query. Fifty-six studies were selected for final review. The results were organized into main surgical practices: decompression, mechanical stabilization, and pain management. For separation surgery, clinical outcomes were overall 1-year survival, 40.7%-78.4%; recurrence rate, 4.3%-22%; reoperation, 5%; and complications, 5.4%-14%. For corpectomy, clinical outcomes were overall 1-year survival, 30%-92%; reoperation, 1.1%-50%; and recurrence rate, of 1.1%-28%. Complications and reoperations with spinal instrumentation were 0%-13.6% and 0%-15%, respectively. Cement augmentation achieved pain reduction rates of 56%-100%, neurologic improvement/stability 84%-100%, and complication rates 6%-56%. Laser achieved local tumor control rate of 71%-82% at 1 year follow-up, reoperation rate of 15%-31%, and complication rate of 5%-26%. CONCLUSIONS Minimally invasive techniques for decompression and stabilization seem to be the preferred method to surgically treat metastatic spine disease, with good outcomes. More research with high level of evidence is required to support the long-term outcomes of these approaches.
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Affiliation(s)
| | - María José Cavagnaro
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Mauricio J Avila
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Isabel M Strouse
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Aaron Dowell
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Haroon Kisana
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Naushaba Khan
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Robert Ravinsky
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Ali A Baaj
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
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27
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Luksanapruksa P, Santipas B, Ruangchainikom M, Korwutthikulrangsri E, Pichaisak W, Wilartratsami S. Epidemiologic Study of Operative Treatment for Spinal Metastasis in Thailand : A Review of National Healthcare Data from 2005 to 2014. J Korean Neurosurg Soc 2021; 65:57-63. [PMID: 34897262 DOI: 10.3340/jkns.2020.0330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To study the factors relating to operative treatment for spinal metastasis in Thailand during 2005-2014 and to determine the hospital costs, mortality rate, and incidence of perioperative complication. Methods Inpatient reimbursement data from 2005 to 2014 was reviewed from three national healthcare organizations, including the National Health Security Office, the Social Security Office, and the Comptroller General's Department. The search criteria were secondary malignant neoplasm of bone and bone marrow patients (International Classification of Diseases 10th revision, Thai modification codes [ICD 10-TM], C79.5 and C79.8) who underwent spinal surgical treatment (ICD 9th revision, clinical modification procedure with extension codes [ICD 9-CM], 03.0, 03.4, 03.09, and 81.0) during 2005-2014. Epidemiology, comorbidity, and perioperative complication were analyzed. Results During the study period, the number of spinal metastasis patients who underwent operative treatment was significantly increased from 0.30 to 0.59 per 100000 (p<0.001). More males (56.14%) underwent surgical treatment for spinal metastasis than females. The most common age group was 45-64 (55.1%). The most common primary tumor sites were the unknown origin, lung, breast, prostate, and hepatocellular/bile duct. Interestingly, the proportion of hepatocellular/bile duct, breast, and lung cancer was significantly increased (p<0.001). The number of patients who had comorbidity or in-hospital complication significantly increased over time (p<0.01); however, the in-hospital mortality rate decreased. Conclusion During the last decade, operative treatment for spinal metastasis increased in Thailand. The overall in-hospital complication rate increased; however, the in-hospital mortality rate decreased.
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Affiliation(s)
- Panya Luksanapruksa
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Borriwat Santipas
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Monchai Ruangchainikom
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkapoj Korwutthikulrangsri
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Witchate Pichaisak
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Pérez-Bovet J, Buxó M, Rimbau Muñoz J. Clinical Practice in Spine Surgery: An International Survey. J Neurol Surg A Cent Eur Neurosurg 2021; 83:451-460. [PMID: 34897620 DOI: 10.1055/s-0041-1739223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings. METHODS An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence. RESULTS The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals. CONCLUSION We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.
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Affiliation(s)
- Jordi Pérez-Bovet
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Maria Buxó
- Department of Statistics, Girona Biomedical Research Institute, Salt, Girona, Spain
| | - Jordi Rimbau Muñoz
- Department of Neurosurgery, University Hospital Dr. Josep Trueta, Girona, Spain.,Department of Neurosurgery, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Tabourel G, Terrier LM, Dubory A, Cristini J, Nail LRL, Cook AR, Buffenoir K, Pascal-Moussellard H, Carpentier A, Mathon B, Amelot A. Are spine metastasis survival scoring systems outdated and do they underestimate life expectancy? Caution in surgical recommendation guidance. J Neurosurg Spine 2021; 35:527-534. [PMID: 34298515 DOI: 10.3171/2020.12.spine201741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Survival scoring systems for spine metastasis (SPM) were designed to help surgical practice. The authors sought to validate the prognostic accuracy of the main preoperative scoring systems for SPM. METHODS It was hypothesized that true patient survival in SPM was better than that predicted using prognosis scores. To investigate this hypothesis, the authors designed a French national retrospective study of a prospectively collected multicenter database involving 739 patients treated for SPM between 2014 and 2017. RESULTS In this series, the median survival time for all patients from an SPM diagnosis was 17.03 ± 1.5 months. Sensitivity and specificity were estimated using the area under the curve (AUC). The AUC of Tomita's prognosis score was the lowest and poorest (0.4 ± 0.023, range 0.35-0.44), whereas the AUC of the Tokuhashi score was the highest (0.825). The Lei score presented an AUC of 0.686 ± 0.022 (range 0.64-0.7), and the Rades score showed a weaker AUC (0.583 ± 0.020, range 0.54-0.63). Differences among AUCs were all statistically significant (p < 0.001). The modified Bauer score and the Rades score had the highest rate of agreement in predicting survival, with a weighted Cohen's kappa of 0.54 and 0.41, respectively, indicating a moderate agreement. The revised Tokuhashi and Lei scores had a fair rate of agreement (weighted Cohen's kappa = 0.24 and 0.22, respectively). The van der Linden and Tomita scores demonstrated the worst performance, with only a "slight" rate of agreement (weighted Cohen's kappa = 0.19 and 0.16, respectively) between what was predicted and the actual survival. CONCLUSIONS The use of prognostic scoring systems in the estimation of survival in patients with SPM has become obsolete and therefore underestimates survival. Surgical treatment decisions should no longer be based on survival estimations alone but must also take into account patient symptoms, spinal instability, and quality of life.
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Affiliation(s)
- Gaston Tabourel
- 1Department of Neurosurgery, Bretonneau Hospital, Tours
- 2Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes
| | | | - Arnaud Dubory
- 3Department of Orthopedic Surgery, Mondor Hospital-APHP, Créteil
| | - Joseph Cristini
- 2Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes
| | | | - Ann-Rose Cook
- 1Department of Neurosurgery, Bretonneau Hospital, Tours
| | - Kévin Buffenoir
- 2Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes
| | | | | | - Bertrand Mathon
- 6Neurosurgery, La Pitié-Salpêtrière Hospital-APHP, Paris, France
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Regarding “Surgical Metastasectomy in the Spine: A Review Article”. Oncologist 2021; 26:e2097. [DOI: 10.1002/onco.13937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
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Kumar N, Lopez KG, Alathur Ramakrishnan S, Hallinan JTPD, Fuh JYH, Pandita N, Madhu S, Kumar A, Benneker LM, Vellayappan BA. Evolution of materials for implants in metastatic spine disease till date - Have we found an ideal material? Radiother Oncol 2021; 163:93-104. [PMID: 34419506 DOI: 10.1016/j.radonc.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/30/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022]
Abstract
"Metastatic Spine Disease" (MSD) often requires surgical intervention and instrumentation with spinal implants. Ti6Al4V is widely used in metastatic spine tumor surgery (MSTS) and is the current implant material of choice due to improved biocompatibility, mechanical properties, and compatibility with imaging modalities compared to stainless steel. However, it is still not the ideal implant material due to the following issues. Ti6Al4V implants cause stress-shielding as their Young's modulus (110 gigapascal [GPa]) is higher than cortical bone (17-21 GPa). Ti6Al4V also generates artifacts on CT and MRI, which interfere with the process of postoperative radiotherapy (RT), including treatment planning and delivery. Similarly, charged particle therapy is hindered in the presence of Ti6Al4V. In addition, artifacts on CT and MRI may result in delayed recognition of tumor recurrence and postoperative complications. In comparison, polyether-ether-ketone (PEEK) is a promising alternative. PEEK has a low Young's modulus (3.6 GPa), which results in optimal load-sharing and produces minimal artifacts on imaging with less hinderance on postoperative RT. However, PEEK is bioinert and unable to provide sufficient stability in the immediate postoperative period. This issue may possibly be mitigated by combining PEEK with other materials to form composites or through surface modification, although further research is required in these areas. With the increasing incidence of MSD, it is an opportune time for the development of spinal implants that possess all the ideal material properties for use in MSTS. Our review will explore whether there is a current ideal implant material, available alternatives and whether these require further investigation.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore.
| | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | | | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, Singapore
| | - Naveen Pandita
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Aravind Kumar
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore
| | - Lorin M Benneker
- Department of Orthopaedics, Spine Surgery, Sonnenhofspital, Bern, Switzerland
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Kato S, Demura S, Tsuchiya H. In Reply. Oncologist 2021; 26:e2098. [PMID: 34396627 DOI: 10.1002/onco.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Amelot A, Terrier LM, Cook AR, Borius PY, Mathon B. Letter to the Editor. Metastatic spine disease and outcome predictions. J Neurosurg Spine 2021; 34:818. [PMID: 33578385 DOI: 10.3171/2020.12.spine202209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Amelot A, Terrier LM, Le Nail LR, Cristini J, Cook AR, Buffenoir K, Pascal-Moussellard H, Carpentier A, Dubory A, Mathon B. Spine metastasis in patients with prostate cancer: Survival prognosis assessment. Prostate 2021; 81:91-101. [PMID: 33064325 DOI: 10.1002/pros.24084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients presenting spine metastasis (SpM) from prostate cancer (PC) form a heterogeneous population, through this study, we aimed to clarify and update their prognostic assessment. METHODS The patient data used in this study was obtained from a French national multicenter database of patients treated for PC with SpM between 2014 and 2017. A total of 72 patients and 365 SpM cases were diagnosed. RESULTS The median overall survival time for all patients following the event of SpM was 28.8 months. First, we identified three significant survival prognostic factors of PC patients with SpM: good Eastern Cooperative Oncology Group/World Health Organization personnel status (Status 0 hazard ratio [HR]: 0.031, 95% confidence interval [CI]: 0.008-0.127; p < .0001) or (Status 1 HR: 0.163, 95% CI: 0.068-0.393; p < .0001) and SpM radiotherapy (HR: 2.923, 95% CI: 1.059-8.069; p < .0001). Secondly, the presence of osteolytic lesions of the spine (vs. osteoblastic) was found to represent an independent prognosis factor for longer survival [HR: 0.424, 95% CI: 0.216-0.830; p = .01]. Other factors including the number of SpM, surgery, extraspinal metastasis, synchrone metastasis, metastasis-free survival, and SpM recurrence were not identified as being prognostically relevant to the survival of patients with PC. CONCLUSION Survival and our ability to estimate it in patients presenting PC with SpM have improved significantly. Therefore, we advocate the relevance of updating SpM prognostic scoring algorithms by incorporating data regarding the timeline of PC as well as the presence of osteolytic SpM to conceive treatments that are adapted to each patient.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital-APHP, Paris, France
- Department of Neurosurgery, Bretonneau Hospital, Tours, France
| | | | | | - Joseph Cristini
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | - Ann-Rose Cook
- Department of Neurosurgery, Bretonneau Hospital, Tours, France
| | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | | | | | - Arnaud Dubory
- Department of Orthopaedic Surgery, Mondor Hospital-APHP, Créteil, France
| | - Bertrand Mathon
- Department of Neurosurgery, La Pitié Salpétrière Hospital-APHP, Paris, France
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Denisov AA, Zaborovsky NS, Ptashnikov DA, Mikhailov DA, Masevnin SV, Smekalenkov OA. Comparison of prognostic scales for patients with metastatic spine disease. Orthop Rev (Pavia) 2021; 12:8822. [PMID: 33585023 PMCID: PMC7874951 DOI: 10.4081/or.2020.8822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022] Open
Abstract
This is one-centre retrospective study with the aim to identify the scale, which provides the most accurate prediction of life expectancy in patients with metastatic lesions in spine. A retrospective analysis of clinical data of 138 patients with metastatic spinal tumors. Patients underwent spinal cord decompression and instrumented stabilization of affected area. We evaluated the general condition according to the Karnofsky and ECOG scales, the presence of metastases in the visceral organs, spine and other bones, the neurological status and conduction of the medical therapy before spinal surgery. Observed clinical parameters were converted to Tokuhashi, Tomita, and Katagiri scales. For statistical analysis, software environment R 3.4.1 was used. Assessment of prognostic accuracy was performed using ROC analysis. The Tokuhashi scale showed AUC 0.605 (95% CI 0.586-0.616), Tomita scale showed AUC 0.708 (95% CI 0.573-0.842), Katagiri scale showed AUC 0.650 (95% CI 0.508-0.792). The best results for survival rate predicting after surgical treatment for metastatic spinal lesions were shown the Tomita scale.
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Affiliation(s)
- Anton A Denisov
- National Medical Research Center of Traumatology and Orthopedics n.a. Vreden R.R., St. Petersburg
| | - Nikita S Zaborovsky
- National Medical Research Center of Traumatology and Orthopedics n.a. Vreden R.R., St. Petersburg
| | - Dmitry A Ptashnikov
- National Medical Research Center of Traumatology and Orthopedics n.a. Vreden R.R., St. Petersburg.,Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation
| | - Dmitry A Mikhailov
- National Medical Research Center of Traumatology and Orthopedics n.a. Vreden R.R., St. Petersburg
| | - Sergey V Masevnin
- National Medical Research Center of Traumatology and Orthopedics n.a. Vreden R.R., St. Petersburg
| | - Oleg A Smekalenkov
- National Medical Research Center of Traumatology and Orthopedics n.a. Vreden R.R., St. Petersburg
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He LM, Ma X, Chen C, Zhang HY. Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review. World J Clin Cases 2021; 9:644-650. [PMID: 33553403 PMCID: PMC7829725 DOI: 10.12998/wjcc.v9.i3.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy. The purpose was to reduce the risk and trauma of spondylectomy.
CASE SUMMARY A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo. Preoperative diagnosis was C4 metastasis of thyroid cancer. Preoperative visual analogue scale score was 5. American Spinal Cord Injury Association (ASIA) grade was E. Tomita classification was 7. Weinstein-Boriani-Biagini (WBB) classification was A-D, 3-9. Tomita score was 5. Modified Tokuhashi score was 9. Spinal instability neoplastic score (SINS) was 13. The patient underwent minimally invasive cervical spondylectomy on September 28, 2017. The operative time was 200 min; the estimated blood loss was 1200 mL. The operation was successful, without complications. The postoperative visual analogue scale score was 0. The patient remained classified as ASIA grade E at the last follow-up. She accepted regular iodine-131 therapy postoperatively. The serum thyroglobulin (Tg) level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/mL at the last follow-up. There was no local recurrence at the 25-mo follow-up, according to images, single-photon emission computed tomography, and serum Tg levels. Obvious ossification and solid fusion of C3-C5 were found at the last follow-up.
CONCLUSION Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma, intraoperative traction injury, and paraspinal muscle injury, accelerating postoperative recovery. This technique requires a rich experience in cervical spine surgery with tubular retractors, so that surgeons can visualize the anatomical structure in a small field.
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Affiliation(s)
- Li-Ming He
- Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Xun Ma
- Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Chen Chen
- Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Hong-Yi Zhang
- Department of Orthopedics, Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
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Kumar N, Ramakrishnan SA, Lopez KG, Madhu S, Ramos MRD, Fuh JYH, Hallinan J, Nolan CP, Benneker LM, Vellayappan BA. Can Polyether Ether Ketone Dethrone Titanium as the Choice Implant Material for Metastatic Spine Tumor Surgery? World Neurosurg 2021; 148:94-109. [PMID: 33508491 DOI: 10.1016/j.wneu.2021.01.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/08/2023]
Abstract
Instrumentation during metastatic spine tumor surgery (MSTS) provides stability to the spinal column in patients with pathologic fracture or iatrogenic instability produced while undergoing extensive decompression. Titanium is the current implant material of choice in MSTS. However, it hinders radiotherapy planning and generates artifacts, with magnetic resonance imaging and computed tomography scans used for postoperative evaluation of tumor recurrence and/or complications. The high modulus of elasticity of titanium (110 GPa) results in stress shielding, which may lead to construct failure at the bone-implant interface. Polyether ether ketone (PEEK), a thermoplastic polymer, is an emerging alternative to titanium for use in MSTS. The modulus of elasticity of PEEK (3.6 GPa) is close to that of cortical bone (17-21 GPa), resulting in minimal stress shielding. Its radiolucent and nonmetallic properties cause minimal interference with magnetic resonance imaging and computed tomography scans. PEEK also causes low-dose perturbation for radiotherapy planning. However, PEEK has reduced bioactivity with bone and lacks sufficient rigidity to be used as rods in MSTS. The reduced bioactivity of PEEK may be addressed by 1) surface modification (introducing porosity or bioactive coating with hydroxyapatite [HA] or titanium) and 2) forming composites with HA/titanium. The mechanical properties of PEEK may be improved by forming composites with HA or carbon fiber. Despite these modifications, all PEEK and PEEK-based implants are difficult to handle and contour intraoperatively. Our review provides a comprehensive overview of PEEK and modified PEEK implants, with a description of their properties and limitations, potentially serving as a basis for their future development and use in MSTS.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore.
| | | | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, Singapore
| | - James Hallinan
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Colum P Nolan
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Lorin M Benneker
- Department of Orthopaedics, Spine Surgery, Sonnenhofspital, Bern, Switzerland
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Li XM, Jin LB. Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature. World J Clin Cases 2021; 9:379-388. [PMID: 33521105 PMCID: PMC7812883 DOI: 10.12998/wjcc.v9.i2.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal metastases are common in patients with malignancies, but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis. Knowledge of surgical complications, particularly perioperative mortality, in patients with spinal metastases from unidentified sources is still insufficient. CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra (T7). Radiographic examinations, as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion, resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion. Therefore, spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis. Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma. As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery, the origin of this metastasis was undetermined. We discuss this case with respect to reported perioperative mortality in similar cases. CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.
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Affiliation(s)
- Xiu-Mao Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Li-Bin Jin
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Kumar N, Thomas AC, Ramos MRD, Tan JYH, Shen L, Madhu S, Lopez KG, Villanueva A, Tan JH, Vellayappan BA. Readmission-Free Survival Analysis in Metastatic Spine Tumour Surgical Patients: A Novel Concept. Ann Surg Oncol 2021; 28:2474-2482. [PMID: 33393052 DOI: 10.1245/s10434-020-09404-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Outcomes commonly used to ascertain success of metastatic spine tumour surgery (MSTS) are 30-day complications/mortality and overall/disease-free survival. We believe a new, effective outcome indicator after MSTS would be the absence of unplanned hospital readmission (UHR) after index discharge. We introduce the concept of readmission-free survival (ReAFS), defined as 'the time duration between hospital discharge after index operation and first UHR or death'. The aim of this study is to identify factors influencing ReAFS in MSTS patients. PATIENTS AND METHODS We retrospectively analysed 266 consecutive patients who underwent MSTS between 2005 and 2016. Demographics, oncological characteristics, procedural, preoperative and postoperative details were collected. ReAFS of patients within 2 years or until death was reviewed. Perioperative factors predictive of reduced ReAFS were evaluated using multivariate regression analysis. RESULTS Of 266 patients, 230 met criteria for analysis. A total of 201 had UHR, whilst 1 in 8 (29/230) had no UHR. Multivariate analysis revealed that haemoglobin ≥ 12 g/dL, ECOG score of ≤ 2, primary prostate, breast and haematological cancers, comorbidities ≤ 3, absence of preoperative radiotherapy and shorter postoperative length of stay significantly prolonged the time to first UHR. CONCLUSIONS Readmission-free survival is a novel concept in MSTS, which relies on patients' general condition, appropriateness of interventional procedures and underlying disease burden. Additionally, it may indicate the successful combination of a multi-disciplinary treatment approach. This information will allow oncologists and surgeons to identify patients who may benefit from increased surveillance following discharge to increase ReAFS. We envisage that ReAFS is a concept that can be extended to other surgical oncological fields.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
| | - Andrew Cherian Thomas
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | | | - Joel Yong Hao Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Andre Villanueva
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
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Zhao C, Wang Y, Cai X, Xu W, Wang D, Wang T, Jia Q, Gong H, Sun H, Wu Z, Xiao J. Prognostic Significance of a Novel Score Model Based on Preoperative Indicators in Patients with Breast Cancer Spine Metastases (BCSM). Cancer Manag Res 2020; 12:11501-11513. [PMID: 33204161 PMCID: PMC7667004 DOI: 10.2147/cmar.s273785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/20/2022] Open
Abstract
Background Surgery remains the mainstay of treatment for breast cancer spinal metastasis (BCSM) to relieve symptoms and improve the quality of life of BCSM patients. Therefore, it is important to effectively predict the prognosis of patients to determine whether they can undergo surgical operation. However, the prevalent methods for prognosis evaluation lack specificity and sensitivity for indicated malignancies like breast cancer because they are built on a relatively small number of heterogeneous types of primary tumors. The aim of the present study was to explore a novel predictive model based on the clinical, pathological and blood parameters obtained from BCSM patients before they received surgical intervention. Methods Altogether, 144 patients were included in this study. Univariate and multivariate analyses were performed to investigate the significance of preoperative parameters and identify independent factors for prognostic prediction of BCSM. A nomogram for survival prediction was then established and validated. Time-dependent ROC (TDROC) curves were graphed to evaluate the accuracy of the novel model vs other scoring systems including Tomita Score, revised Tokuhashi Score, modified Bauer Score and New England Spinal Metastasis Score. P values <0.05 were considered statistically significant. Results Independent factors, including preoperative postmenopausal (P=0.034), visceral metastasIs (P=0.021), preoperative Frankel Score (P=0.001), estrogen receptor status (P=0.014), platelet-to-lymphocyte ratio (P=0.012), lymphocyte-monocyte ratio (P<0.001) and albumin-globulin ratio (P=0.017), were selected into the nomogram model with the C-index of 0.834 (95% CI, 0.789–0.890). TDROC curves showed that the Changzheng Hospital (CZ) Score system had the best performance and exhibited the largest IAUC value in comparison with the other scoring systems. Conclusion We constructed a nomogram model known as CZ Score based on the significant factors to predict the prognosis for BCSM patients. The result showed that CZ Score had a better value for prognostic evaluation and surgical decision-making as compared with the other scoring systems.
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Affiliation(s)
- Chenglong Zhao
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yao Wang
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Xiaopan Cai
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Wei Xu
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Dongsheng Wang
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Ting Wang
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Qi Jia
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Haiyi Gong
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Haitao Sun
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Zhipeng Wu
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Jianru Xiao
- Spine Tumor Center, Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China
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Westbroek EM, Pennington Z, Ahmed AK, Xia Y, Boone C, Gailloud P, Sciubba DM. Comparison of complete and near-complete endovascular embolization of hypervascular spine tumors with partial embolization. J Neurosurg Spine 2020; 33:245-251. [PMID: 32244203 DOI: 10.3171/2020.1.spine191337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Preoperative endovascular embolization of hypervascular spine tumors can reduce intraoperative blood loss. The extent to which subtotal embolization reduces blood loss has not been clearly established. This study aimed to elucidate a relationship between the extent of preoperative embolization and intraoperative blood loss. METHODS Sixty-six patients undergoing preoperative endovascular embolization and subsequent resection of hypervascular spine tumors were retrospectively reviewed. Patients were divided into 3 groups: complete embolization (n = 22), near-complete embolization (≥ 90% but < 100%; n = 22), and partial embolization (< 90%; n = 22). Intraoperative blood loss was compared between groups using one-way ANOVA with post hoc comparisons between groups. RESULTS The average blood loss in the complete embolization group was 1625 mL. The near-complete embolization group had an average blood loss of 2021 mL in surgery. Partial embolization was associated with a mean blood loss of 4009 mL. On one-way ANOVA, significant differences were seen across groups (F-ratio = 6.81, p = 0.002). Significant differences in intraoperative blood loss were also seen between patients undergoing complete and partial embolization (p = 0.001) and those undergoing near-complete and partial embolization (p = 0.006). Pairwise testing showed no significant difference between complete and near-complete embolization (p = 0.57). Analysis of a combined group of complete and near-complete embolization also showed a significantly decreased blood loss compared with partial embolization (p < 0.001). Patient age, tumor size, preoperative coagulation parameters, and preoperative platelet count were not significantly associated with blood loss. CONCLUSIONS Preoperative endovascular embolization is associated with decreased intraoperative blood loss. In this series, blood loss was significantly less in surgeries for tumors in which preoperative complete or near-complete embolization was achieved than in tumors in which preoperative embolization resulted in less than 90% reduction of tumor vascular blush. These findings suggest that there may be a critical threshold of efficacy that should be the goal of preoperative embolization.
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Affiliation(s)
| | | | | | | | - Christine Boone
- 2Department of Interventional Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Philippe Gailloud
- 3Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Choi SH, Koo JW, Choe D, Kang CN. The Incidence and Management Trends of Metastatic Spinal Tumors in South Korea: A Nationwide Population-based Study. Spine (Phila Pa 1976) 2020; 45:E856-E863. [PMID: 32097275 DOI: 10.1097/brs.0000000000003445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Population-based study. From 2008 to 2017, data from the national database of the Korean Health Insurance Review & Assessment Service were analyzed. The national insurance system and all medical expense bill data of the entire population are included in the database. OBJECTIVE The aim of this study was to elucidate the incidence and management trends of metastatic spinal tumors in South Korea. SUMMARY OF BACKGROUND DATA The spine is the most common location of bone metastases. However, population-based studies in this topic are limited. METHODS The International Classification of Disease, 10th revision, medical behavior, and examination codes were used to identify the incidence and management trends of metastatic spinal tumors. The Cochran-Armitage trend test was used in statistical analysis. RESULTS Overall, 38,007 patients (average age, 61 years) diagnosed with metastatic spinal tumors were analyzed. Metastatic tumors were most common in patients in their 60s (25.7%). The 10-year incidence of spinal metastases in South Korea was 6.68 cases per 100,000 population. The age-adjusted incidence per 100,000 population decreased from 8.16 cases in 2008 to 6.18 in 2017 (P = 0.03). Sex-adjusted incidence rates in men increased from 8.60 per 100,000 persons in 2008 to 8.70 in 2017 (P < 0.001); those of women decreased from 8.20 per 100,000 persons in 2008 to 4.15 in 2017 (P < 0.05). The most common primary tumor site was the lung (26.9%), followed by the breast (16.9%), prostate (10.8%), and liver (8.1%). Radiation therapy was constant at about 3500 cases per annum (P = 0.62); surgical treatment increased from 1158 to 1382 cases (P < 0.001). Resection and instrumentation surgeries increased significantly (P < 0.001), whereas cementation decreased continuously. Total healthcare costs increased significantly from $19,925,296 in 2008 to $30,268,217 in 2017 (P < 0.001). CONCLUSION The incidence of metastatic spinal tumors decreased in South Korea. Resection and instrumentation procedures increased, and total healthcare costs increased rapidly. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Sung Hoon Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
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Zhang HR, Qiao RQ, Yang XG, Hu YC. A multicenter, descriptive epidemiologic survey of the clinical features of spinal metastatic disease in China. Neurol Res 2020; 42:749-759. [PMID: 32497469 DOI: 10.1080/01616412.2020.1773630] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Spinal metastases have unique epidemiological features and treatment methods. Unfortunately, the relative scarcity of spinal metastases has limited the widespread development of descriptive epidemiological studies, especially in Asian countries. The purpose of this study was to describe the epidemiological characteristics of patients with metastatic spinal tumors in China between 2007 and 2019. METHODS From January 2007 and July 2019, data on patients with spinal metastases were collected from five cancer centers in China, and demographic characteristics, primary tumor types, segments and numbers of vertebral lesions, disease-related scores, and treatment methods were reviewed. RESULTS A total of 2228 patients with spinal metastases were reviewed in this study, including 1279 male patients and 949 female patients, and the male to female ratio was 1.35: 1. More than half of patients developed metastatic diseases between the ages of 50 years and 69 years (64%). Overall, lung cancer (824 cases, 37%) was the most common primary tumor type and the most common level of spinal involvement was multi-level of metastases (860 cases, 39%). 705 patients (32%) had undergone surgical treatments, 1028 patients (46%) had undergone radiotherapy for metastatic vertebrae, and 855 patients (38%) had received systemic treatments. The age, primary tumor type, number of involved vertebrae, Frankel grade, and spinal instability neoplastic score would affect the surgical decision-making. DISCUSSION This study provides insight into the epidemiological characteristics of spinal metastasis and health care service utilization in spinal metastasis patients in China. ABBREVIATIONS ICD-10: International Classification of Disease, Tenth Revision; VAS: Visual Analogue Scale; KPS: Karnofsky Performance Status; SINS: Spinal Instability Neoplastic Score; SOSG: Spine Oncology Study Group; MRI: Magnetic Resonance Imaging; CT: Computed Tomography; ECT: Emission Computed Tomography.
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Affiliation(s)
- Hao-Ran Zhang
- Department of Bone Tumor, Tianjin Hospital , Tianjin, China
| | - Rui-Qi Qiao
- Graduate School, Tianjin Medical University , Tianjin, China
| | - Xiong-Gang Yang
- Graduate School, Tianjin Medical University , Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone Tumor, Tianjin Hospital , Tianjin, China
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Westermann L, Eysel P, Luge H, Olivier A, Oikonomidis S, Baschera D, Zarghooni K. Quality of life and functional outcomes after surgery for spinal metastases: Results of a cohort study. Technol Health Care 2020; 28:303-314. [DOI: 10.3233/thc-191727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Leonard Westermann
- Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany
| | - Peer Eysel
- Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany
| | - Hannah Luge
- Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany
| | - Alain Olivier
- Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany
| | - Stavros Oikonomidis
- Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany
| | - Dominik Baschera
- Department of Neurosurgery, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Kourosh Zarghooni
- Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany
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Amelot A, Terrier LM, Cristini J, Buffenoir K, Pascal-Moussellard H, Carpentier A, Bonaccorsi R, Le Nail LR, Mathon B. Spinal metastases from lung cancer: Survival depends only on genotype, neurological and personal status, scarcely of surgical resection. Surg Oncol 2020; 34:51-56. [PMID: 32891353 DOI: 10.1016/j.suronc.2020.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/30/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND For patients with non-small cell lung cancer (NSCLC), the spinal column is the most common site for bone metastasis. Studies that assess survival prognostic factors associated with specific lung spinal metastases (SpM) are weak and required the incorporation of genotype mutations. METHODS A prospective French national multicenter database of patients treated for SpM between January 2014 and 2017.818 lung SpM were diagnosed over the course or at the time of diagnosis of 210 consecutive patients with NSCLC. RESULTS Median overall survival (OS) time for all patients from the lung SpM event was 5.9 months (SD 0.609). For 122 patients (61%), lung tumor and SpM were diagnosed synchronously. In univariate analysis, good World Health Organisation (WHO) status (p < 0.0001), ambulatory status (Frankel score) (p < 0.0001), the absence of spine epiduritis (p < 0.0001), immunotherapy after SpM diagnosis (p < 0.0001), ALK gene rearrangement (p < 0.0001) and EGFR mutation (p < 0.0001) were associated with longer survival, whereas spine surgery showed no association (0.141). Cox multivariate proportional hazard model identified that EGFR + status (HR: 0.339, 95% CI 0.166-0.693; p = 0.003), good WHO status (p < 0.0001) and good neurological status (Frankel E; p < 0.001 and D; p = 0.018) were associated with higher median OS. Whereas the other factors, including ALK + status, epiduritis and immunotherapy were not independent prognostic factors of survival. CONCLUSION Survival in SpM must be prognosticated from general health performance status: clinical (WHO) and neurological (Frankel) as well as the EGFR mutation status. Immunotherapy, surgery and epiduritis have not demonstrated prognostic value. Therefore, surgical prognostic scoring algorithms should incorporate genotype subtypes in NSCLC cancers to adapt surgical treatment.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France.
| | | | - Joseph Cristini
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | | | | | - Raphael Bonaccorsi
- Department of Orthopaedic Surgery, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Bertrand Mathon
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France
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Alshehri SM, Alkattan K, Abdelwarith A, Alhussain H, Shaker S, Alghamdi M, Alassaf H, Albargawi A, Naimi MA, Alomair A, Althaqfi S, Alhebshi A, Alothman M, Jazieh A. Highlights on the Management of Oligometastatic Disease. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2020; 3:34-44. [PMID: 35756179 PMCID: PMC9208385 DOI: 10.4103/jipo.jipo_24_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 12/25/2022]
Abstract
Purpose: The understanding of oligometastatic disease (OMD) is rapidly evolving and with this comes the ability to utilize a number of modalities that excel in the localized control of disease. It has been identified that there are no clear guidelines based on high-level evidence to standardized approaches toward the management of OMD. These highlights have been developed to provide a road map for all health-care professionals who are involved in the management of OMD to support standardized patient care. Methods: The Saudi Lung Cancer Guidelines Committee is a part of the Saudi Lung Cancer Association which, in turn, is part of the Saudi Thoracic Society. Considering that lung cancer constitutes a major proportion of OMD prevalence, the committee took the initiative to develop national highlights to support the management of OMD within Saudi Arabia. The committee members are national clinical leaders who collaborated with international expertise to establish these highlights to serve as a general clinical pathway in the management of OMD. Results: Standardization of the indications to diagnose oligometastases and patient selection criteria including ineligibility criteria for treatment are the basis of the highlights. Treatment approaches including surgical and the variety of radiotherapeutical options are discussed in relation to specific oligometastatic sites. Acceptable measurements for response to treatment and the future for the treatment of OMD conclude the development of the highlights. Conclusion: These are the first national highlights addressing this important disease in oncology. The implementation of these highlights as guidelines requires a robust multidisciplinary team and access to specific technology and expertise. These highlights are based on the most recent findings within the literature but will require repeated review and updating due to this rapidly evolving field in disease management.
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Affiliation(s)
- Salem M. Alshehri
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Abdelwarith
- Department of Medicine, King Saud University Hospital, Riyadh, Saudi Arabia
| | - Hussain Alhussain
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shaker Shaker
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Hossam Alassaf
- Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Albargawi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Manal Al Naimi
- Department of Radiation Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia,
| | - Ameen Alomair
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif Althaqfi
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Adnan Alhebshi
- Radiation Oncology Unit, John Hopkins Aramco Healthcare, Dharan, Saudi Arabia
| | - Majid Alothman
- Radiation Oncology Unit, John Hopkins Aramco Healthcare, Dharan, Saudi Arabia
| | - AbdulRahman Jazieh
- Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Amelot A, Terrier LM, Cristini J, Buffenoir K, Pascal-Moussellard H, Carpentier A, Bonaccorsi R, Le Nail LR, Mathon B. Survival in breast cancer patients with spine metastases: Prognostic assessment involving molecular markers. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 46:1021-1027. [PMID: 31899046 DOI: 10.1016/j.ejso.2019.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/30/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To clarify and update the prognostic assessment for heterogeneous population of patients with breast cancer and spine metastases (SpM), using molecular markers. METHODS The patient data used in this study was obtained from a French national multi-center database of patients treated for breast cancer with SpM between 2014 and 2017. 556 SpM cases were diagnosed. RESULTS Median overall survival (OS) time for all patients following the SpM event was 43.9 months. First, we confirmed 3 previously known significant prognostic factors for survival of patients with SpM: young age [HR: 2.019, 95% CI 1.343-3.037; p = 0.001], good WHO status [ Status 0 HR: 2.823, 95% CI 1.231-3.345; p < 0.0001] or [ Status 1 HR: 1.956, 95% CI 0.768-2.874; p = 0.001] and no-ambulatory neurological status: Frankel A-C [HR: 0.438, 95% CI 0.248-0.772; p = 0.004]. Secondly, we determined the effect of gene mutations on survival in patients with SpM, and we identified that HER2+ cancer subtype [HR: 1.567, 95% CI 0.946-2.557; p = 0.008] was an independent predictor of longer survival, whereas basal cancer subtype [HR: 0.496, 95% CI 0.353-0.699; p < 0.0001] was associated with a poorer prognosis. Other factors including the number of SpM, surgery, extraspinal metastases, synchrone metastases, metastasis-free survival, and SpM recurrence were not identified as prognostically relevant to survival. CONCLUSION Survival and our ability to estimate it in breast cancer patients with SpM has improved significantly. Therefore, SpM prognostic scoring algorithms should be updated and incorporate genotypic data on subtypes to make treatment more adaptive.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France.
| | | | - Joseph Cristini
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | | | | | - Raphael Bonaccorsi
- Department of Orthopaedic Surgery, La Pitié-Salpêtrière Hospital, Paris, France
| | | | - Bertrand Mathon
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France
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Wang F, Zhang H, Yang L, Yang XG, Zhang HR, Li JK, Qiao RQ, Hu YC. Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study. Orthop Surg 2019; 11:1048-1053. [PMID: 31755205 PMCID: PMC6904662 DOI: 10.1111/os.12552] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To describe the epidemiological characteristics of patients with spinal metastases between 2007 and 2019. METHODS Patients with spinal metastases were identified from several clinical centers in China between January 2007 and July 2019. Demographics, primary tumor types, spinal involvement, and Clinical indicators of each patient were reviewed. RESULTS A total of 1196 patients were included in this study, 717 males (59.95%) and 479 females (40.05%), with a male to female ratio of 1.50:1. Most patients (63.71%) were in the ages range of 50 to 69 years. The mean age was 58.6 ± 11.6 (range 13-89) years and the median age was 59.0 years. The average age of females was younger than that of males, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than that of females, and the difference was statistically significant. The most common primary tumor was lung cancer (n = 437, 36.54%), followed by unknown origin (n = 194, 16.22%), kidney cancer (n = 78, 6.52%), breast cancer (n = 76, 6.35%), and liver/biliary cancer (n = 75, 6.27%). The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. There were 730 patients (61.04%) in the subgroup of the number<3; the highest level was lumbar vertebrae, with 250 patients (34.25%). The remaining 466 patients (38.96%) were included in the subgroup of the number ≥ 3; the highest level was tumor metastasis of multiple-level of spine, with 334 patients (71.67%). Among the 1196 patients, spinal cord injury occurred in 54.01% of patients, 76.34% of patients developed moderate and above pain, 55.69% of patients had metastatic spinal cord compression, and only 26.67% of patients had a clear history of primary tumors. CONCLUSION This study provided a relatively detailed description of epidemiological characteristics in spinal metastases in China, which could assist orthopaedic surgeons to understand the clinical characteristics of spinal metastases, and is of great significance in guiding clinical diagnoses and scientific research.
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Affiliation(s)
- Feng Wang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Li Yang
- Graduate School, Tianjin Medical University, Tianjin, China
| | | | - Hao-Ran Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ji-Kai Li
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Rui-Qi Qiao
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
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Westbroek EM, Ahmed AK, Pennington Z, Goodwin ML, Xia Y, Boone C, Gailloud P, Sciubba DM. Hypervascular Metastatic Spine Tumor Angiographic Relationships with the Artery of Adamkiewicz and Other Radiculomedullary Arteries. World Neurosurg 2019; 126:e480-e485. [DOI: 10.1016/j.wneu.2019.02.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 01/05/2023]
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