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The Role of Minimal Access Surgery in the Treatment of Spinal Metastatic Tumors.

Study designLiterature review.ObjectiveTo provide an overview of the recent advances in minimal access surgery (MAS) for spinal metastases.MethodsLiterature review.ResultsExperience gained from MAS in the trauma, degenerative and deformity settings has paved the road for MAS techniques for spinal cancer. Current MAS techniques for the treatment of spinal metastases include percutaneous instrumentation, mini-open approaches for decompression and tumor resection with or without tubular/expandable retractors and thoracoscopy/endoscopy. Cancer care requires a multidisciplinary effort and adherence

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… Of note, since kyphoplasty may result in retropulsion of fracture fragments and tumor into the spinal canal, thereby exacerbating the epidural tumor extension, kyphoplasty should be avoided in patients with high-grade epidural tumors. … It is important to inject the cement under fluoroscopic, real-time, guidance to avoid cement leak into the spinal canal, foramen or distal embolus. …

Rapid Fire Presentations

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… This study specifically focuses on parameters such as anterior disc height (ADH), posterior disc height (PDH), segmental disc angle (SDA), and measures of spinal canal decompression. … Conclusion: This study's findings demonstrate no significant differences between expandable and static cages regarding DH restoration, SDA correction, or indirect decompression as measured by spinal canal expansion. …

The advancement and utility of multimodal imaging in the diagnosis of degenerative disc disease.

Degenerative disc disease (DDD) is a common spinal condition characterized by the deterioration of intervertebral discs, leading to chronic back pain and reduced mobility. While magnetic resonance imaging (MRI) has long been the standard for late-stage DDD diagnosis, its limitations in early-stage detection prompt the exploration of advanced imaging methods. Positron emission tomography/computed tomography (PET/CT) using 18F- fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) has shown promise in identifying metabolic imbalances and age-related spinal degeneration, thereby complementing CT

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… If degenerated discs result in spinal canal stenosis or nerve root impingement, additional symptoms like leg pain, numbness, or weakness may occur ( 12 ). … Myelography can also be a useful technique as an adjunct to CT, especially if constrictions of the spinal canal that would block the flow of the contrast medium are suspected ( 17 , 30 ). …

Does the Pathologic Fracture Predict Severe Paralysis in Patients with Metastatic Epidural Spinal Cord Compression (MESCC)?-A Retrospective, Single-Center Cohort Analysis.

Currently, there is uncertainty about the predictive factors for metastatic epidural spinal cord compression (MESCC) and consecutive symptomatology in tumor patients. Prognostic algorithms for identifying patients at risk for paralysis are missing. The influence of the pathologic fracture on the patient's symptoms is widely discussed in the literature and we hypothesize that pathologic fractures contribute to spinal cord compression and are therefore predictive of severe paralysis. We tested this hypothesis in 136 patients who underwent surgery for spinal metastases. The most common primary ca

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… Additional pathologic vertebral fractures, mostly compression fractures, may contribute independently to the development of subsequent sensorimotor impairments by causing spinal instability or the extrusion of the metastasis to the spinal canal ( Figure 1 ) [ 6 , 7 ]. … We hypothesize that pathologic fractures contribute to spinal cord compression by extrusion of the vertebral metastasis to the spinal canal and therefore cause more severe impairments in patients with MESCC [ 9 , 10 ]. 2. Materials and Methods 2.1. …

Nuances in the treatment of malignant tumors of the clival and petroclival region.

Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnost

Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty.

BACKGROUND: In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function.The combination of fluoroscopic guided radiofrequency ablation (RFA) and kyphoplasty may fulfill these criteria. METHODS: We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic he

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… The plain x rays (Fig 3a ) and the MR imaging of the lumbar spine showed a pathologic fracture of the L4 vertebral body, mainly involving the superior epiphyseal plate, without extension into the spinal canal. … The plain x-rays and the MR image show the malignant fracture at T12 level with moderate posterior bulging into spinal canal (Fig 4a,b ). An additional secondary deposit is shown in the T11 vertebral body. RFA and BKP of the lesion was performed. …

Advances in Imaging for Metastatic Epidural Spinal Cord Compression: A Comprehensive Review of Detection, Diagnosis, and Treatment Planning.

Metastatic epidural spinal cord compression (MESCC) is a critical oncologic emergency caused by the invasion of metastatic tumors into the spinal epidural space, leading to compression of the spinal cord. If not promptly diagnosed and treated, MESCC can result in irreversible neurological deficits, including paralysis, significantly impacting the patient's quality of life. Early detection and timely intervention are crucial to prevent permanent damage. Imaging modalities play a pivotal role in the diagnosis, assessment of disease extent, and treatment planning for MESCC. Magnetic resonance ima

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… The vertebral venous plexus plays a pivotal role in this process, offering a direct pathway for tumor cells to invade the spinal canal due to its high vascularity and lack of valves, facilitating the retrograde flow of tumor cells from distant sites [ 12 ]. … Anatomically, understanding MESCC requires knowledge of the spinal canal and epidural space. The spinal canal, which houses the spinal cord, is encased by bony structures, making it vulnerable to compression from extrinsic sources like tumors [ 14 ]. …

Safety and Efficacy of Anterior Cervical Corpectomy and Reconstruction With Expandable Cages for Treatment of Cervical Myelopathy-Focusing on Stand-Alone Cages: A Systematic Review and Meta-Analysis.

Study DesignSystematic review and Meta-analysis.ObjectivesThis study aims to evaluate the efficacy, postoperative outcomes, and potential complications of using expandable cages in cervical spine surgery.MethodsA comprehensive search was performed across Medline, Scopus, Web of Science, Cochrane, and Embase up to May 22, 2023. Meta-analyses and subgrouping analyses were performed using "OpenMetaAnalyst" and R software to analyze efficacy outcomes and complications. The assessment of heterogeneity utilized the i2 and chi-squared tests, applying the random effect model.ResultsThirty studies were

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… Spinal canal stenosis with myelopathy (46 or 53.5%) 2. Metastasis (24 or 27.9%) 3. Spondylodiscitis (12 or 14%) 4. Fracture (4 or 4.6%). | Anterior corpectomy and reconstruction with expandable cage: 1. … Degenerative spinal canal stenosis in 31 patients 2. Metastatic lesions in 7 patients 3. …

Электронные постеры

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… The Japanese Orthopaedic Association (JOA) Score, JOA recovery rate, spinal canal enlargement rate, cervical range of motion (ROM), and spinal cord area (SCA) were measured to evaluate and compare the clinical outcomes between the two groups. … There was no significant difference in cervical ROM within or between the two groups during the 2-year follow-up period, nor was there significant difference in spinal canal enlargement between the two groups. …

[Case control study on two different surgical approaches combined fixation with lumbar interbody fusion for the treatment of single segmental lumbar vertebra diseases].

OBJECTIVE: To discuss the advantages and disadvantages of two different surgical approaches combined fixation with lumbar interbody fusion in treating single segmental lumbar vertebra diseases. METHODS: The clinical data of 86 patients with single segmental lumbar vertebra diseases treated from June 2011 to June 2013 was retrospectively analyzed. There were 33 males and 53 females, aged from 28 to 76 years old with an average of 53.0 years. Among them, there were 39 cases of lumbar disc degeneration, 22 cases of lumbar disc herniation complicated with spinal canal stenosis, 9 cases of huge lu…

Percutaneous Vertebral Reconstruction (PVR) Technique of Pathological Compression Fractures: An Innovative Combined Treatment of Microwave Ablation, Bilateral Expandable Titanium SpineJack Implants Followed by Vertebroplasty.

(1) Background: to retrospectively evaluate safety and efficacy of combined microwave ablation (MWA) and bilateral expandable titanium SpineJack (SJ) implants followed by vertebroplasty (VP) for the treatment of painful thoracolumbar pathological vertebral compression fracture. (2) Methods: from July 2017 to October 2022, twenty-eight patients (13 women and 15 men; mean age 68 ± 11 years) with a history of primary neoplasm and thirty-six painful vertebral metastases with vertebral compression fracture underwent combined MWA and bilateral expandable titanium SpineJack implants with vertebroplas

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… The exclusion criteria were the presence of a primary spinal tumor, complete vertebral collapse, extensive epidural and spinal canal infiltration (more than a third of the extension of the circumference of the epidural space), severe vertebral canal stenosis, and moderate-severe neurologic deficits. … The angle of kyphosis resulting in less dislocation of bone fragments in the spinal canal, and the vertebral height was restored (angle (lines 1-1) 16° before treatment ( E ) vs. 14° after treatment ( H )). …

Imaging Evaluation of Bone Tumors in the Cervical Spine: A Comprehensive Review.

The cervical spine, a critical junction between the head and torso, is a rare but significant site for both primary and metastatic tumors. While primary tumors of the cervical spine are uncommon, certain types, such as chordomas and giant cell tumors, are particularly notable for their potential to affect this region. Metastatic lesions, although more frequent, present unique diagnostic and therapeutic challenges due to the complex anatomy of the cervical spine. Imaging is indispensable for the evaluation of cervical spine tumors, serving as the foundation for diagnosis, treatment planning, an

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… On CT scans, CMF appears as expansile, septated, cystic bone destruction with extensive cortical bone involvement. 15 Cortical breakthrough involving the soft tissue or spinal canal often indicates aggressive behavior. … Soft tissue masses are visible and often grow around the spinal canal. Histologically, solitary plasmacytoma are composed of sheets and clusters of plasma cells ( Figure 5I ). …

Leptomeningeal carcinomatosis in gastric cancer: A Review.

Gastric cancer is the fifth most common cancer worldwide and leptomeningeal carcinomatosis (LM) occurs in 0.06% of gastric cancers. As such, trials are difficult to power and quantitative analyses difficult to standardize. We composed a review and analysis of 47 recent cases to be used as a comprehensive resource for an oncologist faced with managing this highly morbid, rapidly fatal disease. Gold-standard of diagnosis of LM is through cerebral spinal fluid (CSF) cytology; MRI is the preferred imaging modality to identify LM. However, repeated lumbar punctures and imaging studies are often req

Когда уши болеют больше: отомастоидитные двусторонние краниальные Neurophies в иммунокомпрометированном пациенте.

Отомастоидит — это инфекция и воспаление как отитной среды (мидлушное ухо), так и мастоидной воздушной клетки. Если инфекция проходит мимо среднего уха, чтобы повлиять на прилежащие структуры, то могут быть задействованы мастоидные воздушные элементы. Фунгальный мастоидит очень редкий и почти исключительно наблюдается у иммунокомпромиссированных пациентов. Мы представляем необычный случай типа 2 диабетик с грибковым отомастоидитом, проявляющимся как боль в левом ухе, а также нейропатия левого черепного нерва VII и правого черепного нерва III. Хотя паралич лицевого нерва часто объясняется идиоп

Spinal Cord Compression as a Consequence of Spinal Plasmacytoma in a Patient with Multiple Myeloma: A Case Report.

Multiple myeloma (MM) is a B cell malignancy resulting in osteolytic lesions. Pathological fracture of the vertebral body resulting in spinal cord compression is a common complication and accounts for approximately 5% of patients with MM. To date, there are no definitive guidelines for the treatment of spinal cord compression as a consequence of MM. Radiotherapy has frequently been the preferred form of treatment. Some surgeons, however, feel that spinal lesions in multiple myeloma should be treated in the same manner as spinal metastases from solid organs. I report the management of a 46-year

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… Vertebral collapse and soft tissue extension of tumour into the spinal canal in multiple myeloma may cause neurological deficit and mechanical instability leading to pain and deformity. … Tuberculosis can present similarly to MSCC, in that spinal canal involvement can cause radiating pain and limb weakness [ 7 ]. It was, however, an unlikely differential diagnosis. …

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer.

OBJECTIVE: Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. MATERIALS AND METHODS: Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain reli

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… With these features, even in case of leakage inside the spinal canal, the potential of neurological damage is low. With its lower viscosity, contrary to PMMA, it does not break the trabecule of the spongious bone but diffuse between them and interdigitate when it is hardened ( Fig. 3 ). …

The Debut Signal of Bone Metastasis and Stealthy Gastric Cancer Unmasked in a Young Male: A Case Report.

Gastric cancer is the fifth leading cause of cancer-related deaths in the world. The occurrence of bone metastases (BM) in gastric cancer without prior gastrointestinal (GI) symptoms is a rare phenomenon that has been sporadically documented in the existing literature. We report a case of a 27-year-old male presenting with chief complaints of severe backache for one month. After an upper gastrointestinal endoscopy and biopsy, the primary source of cancer was identified as a solitary gastric adenocarcinoma, supporting the diagnosis of bony metastases on the magnetic resonance imaging (MRI) of t

Contemporary treatment with radiosurgery for spine metastasis and spinal cord compression in 2015.

With the progress of image-guided localization, body immobilization system, and computerized delivery of intensity-modulated radiation delivery, it became possible to perform spine radiosurgery. The next question is how to translate the high technology treatment to the clinical application. Clinical trials have been performed to demonstrate the feasibility of spine radiosurgery and efficacy of the treatment in the setting of spine metastasis, leading to the randomized trials by a cooperative group. Radiosurgery has also demonstrated its efficacy to decompress the spinal cord compression in sel

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… At the level of the cauda, an epidural lesion is deemed grade II when less than 50% of the spinal canal is compressed, and grade IV when more than 50% of the canal is compressed. The neurological grade is based on the neurological symptoms and the status of the patient at the time of presentation. …

Intradural plasmacytoma originating from the filum terminale in the setting of multiple myeloma: illustrative case.

BackgroundMultiple myeloma (MM) has the propensity to spread to vertebral bodies; however, extramedullary plasmacytomas involving the central nervous system are extremely rare.ObservationsThe authors report the first intradural extramedullary plasmacytoma in the lumbar region of the spine in a patient with preexisting MM. They present a 50-year-old female with severe back and radicular pain and progressive neurological deficit.LessonsMM is typically treated with chemotherapy and radiation therapy. However, in this unique case, resection proved to be a key part of treatment.

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… The tumor filled the spinal canal ( Fig. 2 ) with the nerve roots draped around the periphery of the tumor ( Fig. 3 ). FIG. 1. Enhanced T1-weighted sagittal MRI of the lumbar spine reveals a large intradural tumor behind the body of L3. FIG. 2. … T2-weighted axial MRI at the level of the mass shows tumor nearly filling the entire spinal canal. FIG. 3. T2-weighted sagittal MRI of the lumbar spine shows the relationship of the tumor to the cauda equina. Operation An L3 and partial L4 laminectomy was performed. …

Е-постеры.

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… The canal-to-body ratio (CBR) was determined by dividing the anteroposterior diameter of the spinal canal by that of the vertebral body at each lamina on cervical neutral lateral X-ray. LC was defined as a CBR decrease of 10% or more between immediately after the surgery and the final follow-up. … Kanji Sasaki 1 , Ushio Nosaka 1 , and Tetsutaro Mizuno 1 1 Seirei Hamamatsu Hospital, Hamamatsu, Japan Introduction: Cervical laminoplasty is a procedure that aims to enlarge the whole spinal canal. …