Risk Factors Associated with Postoperative Infection in Cancer Patients Undergoing Spine Surgery

OBJECTIVES: To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS: All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS: We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS: Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.

Research Progress on Assessment of Blood Supply of Spinal Tumors and Methods of Reducing Intraoperative Blood Loss / 肿瘤防治研究

In order to avoid the intra- and post-operative risks caused by massive blood loss, there are various clinical methods for evaluating the blood supply of the tumor and the distribution of blood vessels around the tumor before surgery, such as dynamic enhanced CT, dynamic enhanced magnetic resonance imaging, digital subtraction angiography, etc. And there are a variety of pre- and intra-operative methods to reduce tumor bleeding, such as transarterial vertebral tumor embolization, percutaneous or transpedicular injection of Onyx/NBCA, antifibrinolytic drugs, controlled deliberate hypotension, etc. This article reviews on spinal tumor blood supply assessment and the methods to reduce the amount of surgical bleeding.

Surgical Extent of Metastatic Spine Tumor Excision and Its Effects on Postoperative Ambulatory Function: Comparison of Extensive Wide versus Palliative Excision Surgery / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs). SUMMARY OF LITERATURE REVIEW: Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported. MATERIALS AND METHODS: Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed. RESULTS: The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively). CONCLUSIONS: The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival.

The Effect of Perioperative Radiation Therapy on Spinal Bone Fusion Following Spine Tumor Surgery

INTRODUCTION: Perioperative irradiation is often combined with spine tumor surgery. Radiation is known to be detrimental to healing process of bone fusion. We tried to investigate bone fusion rate in spine tumor surgery cases with perioperative radiation therapy (RT) and to analyze significant factors affecting successful bone fusion. METHODS: Study cohort was 33 patients who underwent spinal tumor resection and bone graft surgery combined with perioperative RT. Their medical records and radiological data were analyzed retrospectively. The analyzed factors were surgical approach, location of bone graft (anterior vs. posterior), kind of graft (autologous graft vs. allograft), timing of RT (preoperative vs. postoperative), interval of RT from operation in cases of postoperative RT (within 1 month vs. after 1 month) radiation dose (above 38 Gy vs. below 38 Gy) and type of radiation therapy (conventional RT vs. stereotactic radiosurgery). The bone fusion was determined on computed tomography images. RESULT: Bone fusion was identified in 19 cases (57%). The only significant factors to affect bony fusion was the kind of graft (75% in autograft vs. 41 in allograft, p=0.049). Other factors proved to be insignificant relating to postoperative bone fusion. Regarding time interval of RT and operation in cases of postoperative RT, the time interval was not significant (p=0.101). CONCLUSION: Spinal fusion surgery which was combined with perioperative RT showed relatively low bone fusion rate (57%). For successful bone fusion, the selection of bone graft was the most important.

Thoracic Spine Tumor Mimicking Cauda Equina Syndrome / 계명의대학술지

Cauda equina syndrome (CES) is one of the typical symptoms condition requires emergency operation. This syndrome is always accompanied by sciatica. Because schwannomas rarely cause sciatica, it is seldom considered as a pain source in the patient with radiculopathy. A 74-year-old male patient presented with lumbar radiculopathy symptoms with, mild stenosis on lumbar MRI scan. All conservative treatment including medication failed to subside the symptoms. Thoracic spine MRI revealed a large tumor in the thoracic region. The symptoms disappeared after excision of the tumor. The tumor was diagnosed as a schwannoma.

Chordoma of the Cervical Spine: A Case Report and Review of Literaturre.

Chordomas are rare low to intermediate grade malignant tumours derived from the notochordal remnants. Their location in the cervical spine is exceptional. The clinic radiologic features, anatomopathologic aspects, diagnostic difficulties, therapeutic methods and prognostic factors are discussed through a case report of a cervical spine chordoma with a literature review.

The Comparision of the Radiofrequency Ablasion Therapy with Vertebroplasty and Radiotherapy in Metastatic Spine Tumor / 대한정형외과학회잡지

PURPOSE: To evaluation the availability of combined treatment with radiofrequency (RF) ablation with vertebroplasty in patients with metastatic spine tumor. MATERIALS AND METHODS: Between March 2007 and March 2009, 34 patients with the metastatic spine tumor, RF ablation with vertebroplasty was performed in 17 patients, and radiotherapy in the other 17 patients. Cumulative 1-year patient survival rate were compared with the both groups. Pain relief and quality of life were evaluated with use of the visual analogue scale (VAS) and Roland Moris Questionnaire (RMQ). RESULTS: Nine of 17 patients with the RF ablasion therapy with vertebroplasty and 8 of 17 patients with radiotherapy were died. Tumor necrosis was observed in 61.2+/-22.4% (range 28-100%) of the tumor volume. In terms of pain relief, VAS score of preoperative, 1 week and 4 weeks following were 7.12, 3.82 and 3.65 in RF ablation with vertebroplasty group, and 7.00, 5.39 and 4.94 in radiotherapy group(p-value <0.001, <0.001). The score of RMQ score was improved from 12.94 to 7.18 in operation group (p-value <0.001), and 14.11 to 10.89 in radiotherapy group(p-value 0.001). But in terms of pain relief (score of VAS) and quality of life (score of RMQ), RF with vertebroplasty group showed significantly better than the radiotheray group (VAS, p for intercation 0.004, RMQ, p for interaction 0.024). CONCLUSION: RF with vertebroplasty is thought to be a useful method to improve the pain relief and quality of life in patients with metastatic spine tumor.

Chondroblastoma of the Lumbar Spine: A Case Report and Review of the Literature

We report a case of chondroblastoma arising in the lumbar spine in a 25-year-old man who presented with low back pain of 5 years duration. Plain radiography and computed tomography revealed a well-defined osteolytic mass surrounded by marginal sclerosis in the third lumbar vertebra. The mass encroached on the left neural foramen on magnetic resonance imaging. Histologically, the tumor consisted of round to oval cells with eosinophilic cytoplasm and randomly scattered osteoclastic type giant cells. There were characteristic chicken-wire calcification and aneurysmal bone cyst-like changes. Chondroblastomas of the lumbar spine are extremely rare, and only nine cases have been reported. Spinal chondroblastoma should be distinguished from other benign bone tumors, because it tends to show aggressive biological behavior with high recurrence and mortality rates.

Tumor de células gigantes na coluna torácica: relato de caso / Giant cell tumor of thoracic vertebra: case report

Objetivo: Relatar e discutir o caso de um paciente com tumor de células gigantes da nona vértebra torácica com evolução peculiar. Relato do caso: Paciente com dor torácica radicular, detectada lesão na nona vértebra torácica, foi operado e recebeu diagnóstico anatomopatológico de tumor de células gigantes (TCG). Apresentou três recorrências locais, sendo a primeira manejada com reintervenção cirúrgica em dois tempos, na segunda também foi realizada reintervenção cirúrgica, porém com fenolização do sítio cirúrgico, preenchimento com metilmetacrilato e radioterapia pós-operatória. Apresentou semeadura de tumor retroesternal, o qual foi ressecado cirurgicamente, não tendo sido realizada terapia complementar. Uma terceira recorrência foi detectada durante procedimento de correção de falência da artrodese posterior, sendo realizada ressecção da lesão e quimioterapia pós-operatória. Durante o tratamento, desenvolveu imunossupressão e evoluiu para óbito em decorrência de suas complicações. Conclusão: O TCG acometendo a coluna torácica é pouco frequente. Trata-se de uma lesão benigna, agressiva localmente e com comportamento incerto. A ressecção cirúrgica com margens amplas é o tratamento padrão-ouro, porém nem sempre factível, em decorrência da localização da lesão.

Objective: To report and discuss the case of a patient with giant cell tumor of the ninth thoracic vertebra with peculiar evolution. Case report: A 32 year-old male patient, with chest root pain due to a lesion detected at the ninth thoracic vertebra underwent surgery and received pathological diagnosis of giant cell tumor (GCT). He presented three local recurrences: the first being managed with surgical intervention in two stages, the second was also performed with surgical intervention with fenolization of surgical site, filled with methyl methacrylate and postoperative radiotherapy; later, presented retrosternal tumor implant, which was surgically resected without complementary therapy; a third recurrence was detected during correction procedure of bankruptcy of posterior arthrodesis, and resection of the lesion and postoperative chemotherapy. During treatment he developed immunosuppression and died due to complications. Conclusion: GCT involving the thoracic spine is a rare disorder. It is a benign, locally and uncertain aggressive behavior. Surgical resection with wide margins is the gold standard treatment, but not always feasible due to the location of the lesion.

Osteosarcoma of the spine- A dilemma in diagnosis and management

Osteosarcoma of the spine accounts for 1 to 3 percent of osteosarcoma. When this afflication of the spine occurs, it is often fraught with diagnostic dilemmas and treatment challenges.OBJECTIVE: This manuscript reports on the cases reported over a 15- year period from the UP Musculoskeletal Tumor Unit. Only 2 of the 3 cases were available for review.RESULTS: Both patients were initially misdiagnosed. This delay in diagnosis led to a delay in instituting appropriate chemotheraphy inevitable causing poor outcomes of treatment.CONCLUSION: This report highlights the dilemma of treating a difficult site. Spinal osteosarcoma presents with numerous diagnostics and management obstacles. Unless clinician awareness is improved and these treatment options become available to patients, prognosis will not improve.

Hemangioma vertebral del arco posterior con extensión extraósea y sintomatología neurológica: informe de un caso y revisión de la literatura / Vertebral hemangioma of the posterior arch with subsequent extraosseous extension and neurological symptoms: case report and literature review

Introducción: El hemangioma vertebral es el tumor más común de la columna vertebral, se identifica hasta en 11 % de las autopsias. Es tipificado como una malformación benigna vascular de crecimiento lento; en ocasiones involucra los elementos posteriores, asociándose a compromiso neurológico. Por lo general es asintomático, encontrándose de forma incidental al estudiar el dolor de origen espinal en busca de otra patología; ocasionalmente produce manifestación neurológica. La extensión extraósea intrarraquídea con compromiso neurológico ha sido poco informada y representa un reto terapéutico. Caso clínico: Adolescente femenina con hemangioma vertebral de tamaño inusual del arco posterior con extensión hacia el conducto raquídeo que ocasionó manifestaciones neurológicas y ameritó tratamiento quirúrgico para su resección y fijación transpedicular. Conclusiones: El hemangioma vertebral es una lesión asintomática que no requiere tratamiento específico. Solo en algunos casos es necesario el tratamiento quirúrgico, que debe llevarse a cabo oportunamente cuando hay compresión neurológica, para evitar secuelas permanentes. El crecimiento extraóseo intrarraquídeo con deterioro neurológico es una presentación inusitada.

BACKGROUND: Vertebral hemangioma is the most common benign spinal tumor and is found in 11% of postmortem studies as a slow-growing benign vascular malformation. It usually involves the vertebral body and sometimes the posterior vertebral elements. When the posterior elements are involved, spinal cord compression with neurological symptoms are seen more often. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to the rare compression lesion. Extraosseous extension of vertebral hemangioma with cord compression and neurological symptoms is a rare condition and represents a treatment challenge. Surgical options are open resection, embolization or vertebroplasty. CLINICAL CASE: We report a case of a vertebral hemangioma with extraosseous extension to the spinal canal with an unusual size and osseous component in the posterior elements. This tumor caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods. Clinical outcome was good. CONCLUSIONS: Vertebral hemangioma is normally an asymptomatic benign lesion not requiring specific treatment. Only in a few cases is surgical treatment required. When neurological compromise is present, early treatment should be carried out before the presence of permanent paralysis.

Combined en Bloc Spondylectomy and Chest Wall Resection for Malignant Tumors Invading Spinal Column and Chest Wall

We performed combined spondylectomy for 2 patients of malignant tumors invading spinal column and chest wall. For one patient with Pancoast tumor, anterolateral thoracotomy, apical lobectomy, chest wall resection, and hemispondylectomy were performed. For another patient with solitary metastatic tumor from nasopharyngeal cancer, posterolateral thoracotomy, chest wall resection, and total en bloc spondylectomy were performed with anterior and posterior instrumentation. The tumor including invaded chest wall and spinal column werewas removed completely in both patients. No local recurrence was found at 18 months follow-up evaluation in both patients.

Atypical Presentation of Spinal Tuberculosis Misadiagnosed as Metastatic Spine Tumor

We present a case of a 68-year-old female with an atypical form of spinal tuberculosis, which involved posterior elements with multiple foci in two noncontiguous vertebral levels. The lesions caused spastic paraparesis and urinary hesitation. There was no evidence of pulmonary or other extrapulmonary tuberculous disease. Based on clinical and radiographic findings, this atypical spinal tuberculosis was preoperatively misdiagnosed as metastatic spine tumor. The histopathologic finding confirmed tuberculosis and the patient was treated successfully with surgery and antituberculous therapy. In case of a spinal lesion of unknown origin, it is important to be aware that atypical spinal tuberculosis can mimic metastatic spine tumor and tuberculosis should always be considered.

A Case of Thoracic Vertebral Chondroblastoma, Treated with 3-D Image Guided Resection and Reconstruction

We present a case of chondroblastoma in the thoracic vertebra. A 40-year-old patient with upper back pain and lower extremity weakness was admitted to our clinic. On neurological examination, the patient exhibited lower extremity spastic paraparesis. Magnetic resonance imaging revealed a mass infiltrating the 7th thoracic vertebra and its adjacent structures with concomitant compression of the epidural space. After right upper lung tuberculoma was resected through the transthoracic approach, T7 total corpectomy was done with anterior stabilization using a MESH cage and T7 rib bone graft. Two weeks after the first operation, remained part of vertebra was removed and posterior stabilization was performed using a pedicle screw fixation and cross linkage bar with the assistance of the navigation system. The final pathologic diagnosis of the vertebral lesion was benign chondroblastoma.

A Survival Analysis of Surgically Treated Metastatic Spine Tumors

OBJECTIVE: The purpose of this study is to assess the survival and prognostic factors of surgically treated metastatic spine tumors. METHODS: A retrospective review of 68 patients who underwent the surgical treatment of metastatic spine tumors from 1988 to 2001 was conducted. The survival of each patient was confirmed on Feb 2002. The survival rates were calculated and several variables were examined for prognostic factors. RESULTS: Postoperative mean survival time was 21.1 months. Three month and 2 year cumulative survival was 70.3% and 21.4%, respectively. The patients who survived less than 3 months after operation were 23(33.8%). The significant prognostic factors were the category of primary tumors, postoperative ambulation, preoperative functional status, and the interval between initial diagnosis and spine metastasis. CONCLUSION: The postoperative survival was related with the biologic behavior of primary tumor and general physical condition. High mortality rate in postoperative three months suggests that more sophisticated selection criterion is needed.

Osteochondroma of the Lumbar Spines without Clear Demarcation from Surrounding Normal bone Tissues

Spinal osteochondroms are very rare, and are thought to arise through a process of progressive endochondral ossification of aberrant cartilage of a growth plate, as a consequence of congenital defect or trauma. A case of diffuse type osteochondroma involving the posterior elements of L1-L5 that progressed after laminectomy in a 33-year-old man is reported. Usually, the spinal osteochondroma shows clear demarcation between tumor margin and normal spine elements, and can be exised completely. However, there was no clear demarcation between tumor and normal spine element in our case and therefore it was not possible to removal completely.

A Clinical Analysis of Metastatic Spine Tumors: Analysis of Prognostic Factors and Scoring System for Prognostic Evaluation

The purpose of treatment for metastatic spine tumor is to improve the quality of life. So, it is very important to carefully select the surgical candidates to prevent unnecessary surgery-related morbidity and mortality. For this purpose, the authors have surveyed 200 cases of spinal metastasis treated by radiotherapy alone or radiotherapy plus surgery to determine prognostic factors. In this study, we attempted to examine retrospectively the four factors, e.g.,primary tumor, pretreatment neurologic status, general condition and degree of cancer extension, affecting the prognosis of metastatic spine tumors. Each factor was ranked from 1 to 3 points according to the severity and the total score for each patient was obtained by adding the these points. As a result, it was found that the total score was highly correlated to the survival period. While the patients with a total score of 6 or lower survived 100 days or less, those of 10 or higher survived 300 days or more on average. Therefore, authors believe this scoring system would be helpful to the determine treatment modalities and the selection of the most suitable operative procedures.

A Case of Thoracic Angiosarcoma

Angiosarcoma of spine is a rare neoplasm derived from vascular endothelium. Synonymous term include hemangiosarcoma and malignant hemangioendothelioma. The authors present the clinical, radiological and pathological features of a patient with angiosarcoma located in the thoracic spine. The treatment of this case is discussed.

A Clinical Analysis of Metastatic Spine Tumors

The authors analyed 27 cases of metastatic spine tumor in regard to diagnostic procedures, effects of radiation and their average survival time. Technetium-99m radiolabeled polyphosphate bone scans were superior to any other diagnostic procedures as a screening test for the early detection of spine metastases. Spinal CT scans with myelogram were useful to define the anatomic extent of destruction and cord comprssion. To prevent myelopathy, early radiation therapy was certainly helpful. The decompressive laminectomy alone have contributed little to the patients in regard to the prolongation of life and the correction of neurological deteriorations. The authors concluded that the one-stage laminectomy and adequate posterior stabilization with the use of internal fixation devices were the choice of treatment for control of pain and prevention of the complications from spinal instability in the following patients: 1) with early progressive myelopathy: 2) who were unable to move due to the pain evoked by motion; and 3) who showed the evidence of spinal instability radiologically and/or clinically.

The Status of Central Nervous System Tumors in Daegu City and Kyungbook Province

The authors analized statistically 403 cases of C.N.S. tumors confirmed by pathology in the boundary of Daegu city and Kyungbook province from January 1984 to December 1986. The results were as follows: 1) The each cases of male and female were 220(54.6%) and 183(45.4%). 2) Intracranial tumors were 288 cases(71.5%), spinal tumors 75(18.6%), and others 40(9.9%). 3) Numbers of C.N.S. tumors were 8.7/100,000 population in city and 6.3/100,000 in country. 4) Among the intracranial tumors, glioma(30.9%) was the most common and followed by meningioma(16.3%) and metastatic tumor(8.7%). Among the spinal tumors, metastatic tumors was 34.6%, neurofibroma 30.7%, and meningioma 5.3%. 5) The majority of intracranial tumors were found in supratentorial region(76.3%), in which area frequency of tumor incidence were as follows; glioma, meningioma, metastatic tumor. Among the infratentorial area(22.6%), the sequence of tumor incidence were glioma, medulloblastoma, and neurilemmoma, 6) Tumors predominantly in male were oligodendroglioma(2:1), metastatic tumor(1.8:1), and medulloblastoma(1.7:1), and in female were meningioma(1:2), neurilemmoma(1:1.7), and pituitary tumor(1:1.5). 7) Peak age incidence of glioma, meningioma, and neurilemmoma were from 40 to 60 years, pituitary tumor and oligodendroglioma were 30 to 50 years, craniopharyngioma and ependymoma were around 10 years old, and metastatic tumor was 50 to 70 years old. 8) In the spinal tumors, the most favorable site of longitudinal axis was thoracic area(62.7%) and transverse location was epidural space(45.3%). 9) The most common site of metastatic tumor were came from lung(29.1%) in brain metastasis and prostate(19.2%) in spine.