RÉSUMÉ
INTRODUCTION: The management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices. METHODS: We conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery. RESULTS: The study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery. CONCLUSIONS: Our 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.
Sujet(s)
Sarcomes , Tumeurs du rachis , Humains , Adulte d'âge moyen , Études rétrospectives , Mâle , Femelle , Adulte , Sarcomes/chirurgie , Sarcomes/mortalité , Tumeurs du rachis/chirurgie , Tumeurs du rachis/mortalité , Résultat thérapeutique , Procédures de neurochirurgie/méthodes , Sujet âgé , Sarcome synovial/chirurgie , Sarcome synovial/mortalité , Chondrosarcome/chirurgie , Chondrosarcome/mortalité , Chondrosarcome/anatomopathologie , Sarcome d'Ewing/chirurgie , Sarcome d'Ewing/mortalité , Complications postopératoires/étiologie , Équipe soignanteRÉSUMÉ
PURPOSE: Patients with spinal metastases undergoing surgical treatment face challenges related to preoperative anemia, intraoperative blood loss, and frailty, emphasizing the significance of perioperative blood management. This retrospective analysis aimed to assess the correlation between hemoglobin-related parameters and outcomes, identifying key markers to aid in blood management. METHODS: A retrospective review was performed to identify patients who underwent surgical treatment for spinal metastases. Hb-related parameters, including baseline Hb, postoperative nadir Hb, predischarge Hb, postoperative nadir Hb drift, and predischarge Hb drift (both in absolute values and percentages) were subjected to univariate and multivariate analyses. These analyses were conducted in conjunction with other established variables to identify independent markers predicting patient outcomes. The outcomes of interest were postoperative short-term (6-week) mortality, long-term (1-year) mortality, and postoperative 30-day morbidity. RESULTS: A total of 289 patients were included. Our study demonstrated that predischarge Hb (OR 0.62, 95% CI 0.44-0.88, P = 0.007) was an independent prognostic factor of short-term mortality, while baseline Hb (OR 0.76, 95% CI 0.66-0.88, P < 0.001) was identified as an independent prognostic factor of long-term mortality. Additionally, nadir Hb drift (OR 0.82, 95% CI 0.70-0.97, P = 0.023) was found to be an independent prognostic factor for postoperative 30-day morbidity. CONCLUSIONS: This study demonstrated that predischarge Hb, baseline Hb, and nadir Hb drift are prognostic factors for outcomes. These findings provide a foundation for precise blood management strategies. It is crucial to consider Hb-related parameters appropriately, and prospective intervention studies addressing these markers should be conducted in the future.
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Hémoglobines , Tumeurs du rachis , Humains , Mâle , Femelle , Études rétrospectives , Adulte d'âge moyen , Hémoglobines/analyse , Sujet âgé , Tumeurs du rachis/secondaire , Tumeurs du rachis/chirurgie , Tumeurs du rachis/sang , Tumeurs du rachis/mortalité , Perte sanguine peropératoire/statistiques et données numériques , Perte sanguine peropératoire/prévention et contrôle , Résultat thérapeutique , Anémie/sang , Anémie/diagnostic , Adulte , Pronostic , Transfusion sanguine/statistiques et données numériques , Marqueurs biologiques/sang , Complications postopératoires/sang , Complications postopératoires/étiologie , Complications postopératoires/diagnostic , Complications postopératoires/épidémiologieRÉSUMÉ
BACKGROUND: This systematic review and meta-analysis aimed to consolidate the existing evidence regarding the comparison between en-bloc resection surgery and debulking surgery for spinal tumors, including both primary and metastatic tumors. MATERIALS AND METHODS: The databases of PubMed, Embase, Cochrane database, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database was carried out and included all studies that directly compared en-bloc resection surgery with debulking surgery for spinal tumors in patients through March 2024. The primary outcomes included recurrence rate, postoperative metastasis rate, mortality rate, overall survival (OS), recurrence-free survival (RFS), complication, and so on. The statistical analysis was conducted using Review Manager 5.3. RESULTS: We systematically reviewed 868 articles and included 27 studies involving 1135 patients who underwent either en-bloc resection surgery (37.89%) or debulking surgery (62.11%). Our meta-analysis demonstrated significant advantages of en-bloc resection over debulking surgery. Specifically, the en-bloc resection group had a lower recurrence rate (OR = 0.19, 95%CI: 0.13-0.28, P < 0.00001), lower postoperative metastasis rate (P = 0.002), and lower mortality rate (P < 0.00001). Additionally, en-bloc resection could improve OS and RFS (HR = 0.45, 95%CI: 0.32-0.62, P < 0.00001 and HR = 0.37, 95%CI: 0.17-0.80, P = 0.01, respectively). However, en-bloc resection required longer operative times and was associated with a higher overall complication rate compared to debulking surgery (P = 0.0005 and P < 0.00001, respectively). CONCLUSION: The current evidence indicates that en-bloc surgical resection can effectively control tumor recurrence and mortality, as well as improve RFS and OS for patients with spinal tumors. However, it is crucial not to overlook the potential risks of perioperative complications. Ultimately, these findings should undergo additional validation through multi-center, double-blind, and large-scale randomized controlled trials (RCTs).
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Interventions chirurgicales de cytoréduction , Tumeurs du rachis , Humains , Tumeurs du rachis/chirurgie , Tumeurs du rachis/secondaire , Tumeurs du rachis/mortalité , Interventions chirurgicales de cytoréduction/méthodes , Interventions chirurgicales de cytoréduction/mortalité , Interventions chirurgicales de cytoréduction/effets indésirables , Taux de survie , Pronostic , Récidive tumorale locale/chirurgie , Récidive tumorale locale/anatomopathologie , Complications postopératoires/épidémiologieRÉSUMÉ
OBJECTIVE: Intradural spinal metastases are considered rare. At present, limited information is available on incidence, surgical management, and outcomes. METHODS: We conducted a retrospective patient chart review from 2002 to 2024, identifying all patients surgically treated for intradural spinal metastases. Clinical, surgical and survival data were collected and compared to literature data for patients surgically treated for extradural spinal metastases. RESULTS: A total of 172 patients with spinal metastases were identified with 13 patients meeting inclusion criteria (7.6%). The mean age at diagnosis of intradural spinal metastases was 52 ± 22 years, with diverse primaries including lung (n = 3), breast (n = 2), sarcoma (n = 2), and six unique entities. Intradural spinal metastasis was diagnosed on average of 3.3 years after primary diagnosis. In total, we observed five (38%) intradural-extramedullary and eight (62%) intramedullary metastases, located in the cervical (38.5%), thoracic (46.1%) and lumbar spine (15.4%). The most common preoperative symptoms were pain, sensory changes, and gait ataxia (each 76.9%). Gross total resection was achieved in 54%, and local tumor control in 85%. Postoperatively, 92% exhibited clinical improvement or stability. Most frequent adjuvant treatment was radio- and/or chemotherapy in 85%. The average survival after operation for spinal intradural metastases was 5 months, ranging from 1 month to 120 months. The location of the intradural metastasis in the cervical spine was associated with a significantly more favorable survival outcome (compared to thoracic/lumbar location, p = 0.02). CONCLUSIONS: Intradural location of spinal metastases is rare (7.6%). Even so, surgical resection is safe and effective for neurological improvement, and survival appears lower compared to the reported survival of extradural spinal metastases.
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Tumeurs de la moelle épinière , Humains , Études rétrospectives , Adulte d'âge moyen , Femelle , Mâle , Adulte , Tumeurs de la moelle épinière/chirurgie , Tumeurs de la moelle épinière/secondaire , Sujet âgé , Résultat thérapeutique , Tumeurs du rachis/chirurgie , Tumeurs du rachis/secondaireRÉSUMÉ
CASE: A 71-year-old man with castration-resistant Stage IVB prostate cancer developed symptomatic oligometastatic disease in the lumbar spine and bilateral proximal femurs. He was treated with a single-position L2-L4 kyphoplasty with concomitant prone left-sided femoral prophylactic cephalomedullary nailing. Six months later when he again lost the ability to ambulate, he was treated with a single-position L4-L5 laminectomy for an epidural tumor with prone right-sided femoral prophylactic cephalomedullary nailing. CONCLUSION: Single-position prone surgery of the spine and prone femoral nailing is feasible and improves on traditional multiposition approaches, eliminating the need to reposition or change tables during management.
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Tumeurs du rachis , Humains , Mâle , Sujet âgé , Tumeurs du rachis/secondaire , Tumeurs du rachis/chirurgie , Tumeurs du rachis/imagerie diagnostique , Tumeurs de la prostate/anatomopathologie , Tumeurs de la prostate/chirurgie , Tumeurs du fémur/chirurgie , Tumeurs du fémur/secondaire , Tumeurs du fémur/imagerie diagnostique , Ostéosynthese intramedullaire/méthodes , Décubitus ventral , Vertèbres lombales/chirurgie , Vertèbres lombales/imagerie diagnostiqueRÉSUMÉ
PURPOSE: There is no consensus on how to identify patients with multiple-level spinal metastases who would benefit from surgery. Previous studies have revealed that patients with hematologic malignancies have a significantly longer median survival time than those with solid tumor spinal metastases. We aimed to compare predictors and survival data between patients with spinal metastases, including hematologic malignancies (all-malignancies group), with only those with nonhematologic malignancies (nonhematologic malignancies group). MATERIALS AND METHODS: This single-center retrospective study included all patients age >18 years who underwent surgery to treat spinal metastases in our department from 2008 to 2018. The patients' baseline characteristics, treatment modalities, and laboratory results were analyzed. Survival was calculated from the date of surgery to the date of confirmed death. Cox regression analysis was used to identify independent predictors of survival. RESULTS: The study cohort comprised 186 patients with a mean age of 57.1 ± 13.4 years, 101 of whom were male and 18 of whom had hematologic malignancies. The median survival time was 201 days in the all-malignancies group and 168 days in the nonhematologic malignancies group. Independent predictors of survival differed between the two groups. Eastern Cooperative Oncology Group status and response to preoperative chemotherapy were identified as independent factors in both groups. However, radiosensitivity and CNS metastases were identified only in the all-malignancies group, and tumor growth potential, albumin status, and number of vertebrae were identified only in the nonhematologic malignancies group. The receiver operating characteristics were comparable in the two groups: 0.75 in the all-malignancies group and 0.77 in the nonhematologic malignancies group. CONCLUSION: Longer survival in patients with hematologic malignancies influences the overall prediction of survival. Tumor-specific prognostic factors may improve the prediction of survival in patients with spinal metastases.
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Tumeurs hématologiques , Tumeurs du rachis , Humains , Mâle , Adulte d'âge moyen , Femelle , Tumeurs du rachis/secondaire , Tumeurs du rachis/mortalité , Tumeurs du rachis/chirurgie , Études rétrospectives , Tumeurs hématologiques/mortalité , Tumeurs hématologiques/thérapie , Tumeurs hématologiques/chirurgie , Tumeurs hématologiques/anatomopathologie , Sujet âgé , Adulte , PronosticRÉSUMÉ
The spine is a common site for metastatic tumors, with 5%-10% of patients developing epidural spinal cord compression (ESCC), which significantly reduces their quality of life and accelerates the process of death. When total en-bloc spondylectomy (TES) radical surgery does not achieve the desired tumor control, palliative care remains the primary treatment option. Traditional laminar decompression or partial tumor resection can only relieve local compression. Although the surgical trauma and complications are less, these methods cannot effectively address tumor recurrence and secondary compression. Therefore, separation surgery combined with radiofrequency ablation and bone cement strengthening was used to treat thoracolumbar metastatic tumors, aiming to achieve good clinical results. In this protocol, the steps and key points of separation surgery combined with radiofrequency ablation and bone cement reinforcement for thoracolumbar metastatic tumors are introduced in detail. Meanwhile, the clinical data of 67 cases of thoracolumbar metastatic tumors in our hospital meeting the inclusion criteria were retrospectively analyzed. Different treatment methods divided the patients into two groups: separation surgery combined with radiofrequency ablation and bone cement strengthening (group A, 33 cases) and the radiotherapy group (group B, 34 cases). All patients were evaluated using improved Tokuhashi, Tomita, SINS, and ESCC scores before treatment. VAS score, Frankel grading, and Karnofsky scores during different periods of the two treatments were compared to assess the clinical outcomes. Studies have shown that separation surgery combined with radiofrequency ablation and bone cement strengthening can significantly reduce pain, promote neurological function recovery, enhance mobility, and improve quality of life in treating thoracolumbar metastatic tumors.
Sujet(s)
Ciments osseux , Vertèbres lombales , Ablation par radiofréquence , Tumeurs du rachis , Vertèbres thoraciques , Humains , Tumeurs du rachis/chirurgie , Tumeurs du rachis/secondaire , Vertèbres thoraciques/chirurgie , Vertèbres lombales/chirurgie , Ablation par radiofréquence/méthodes , Mâle , Adulte d'âge moyen , Femelle , Sujet âgé , Études rétrospectivesRÉSUMÉ
CASE: A healthy, 19-year-old woman was incidentally found to have a large, destructive tumor of T11 without neurologic symptoms. Biopsy demonstrated fibrocartilaginous mesenchymoma (FCM). The patient was treated with resection including subtotal corpectomy and T8-L1 fusion with use of cage and allograft strut construct. The patient remained without recurrence over 3 years of follow-up. CONCLUSION: FCM arising from the spine is a rare tumor, of which this is the sixth report. FCM affects primarily young adults and is benign but locally aggressive, requiring complete excision to prevent recurrence.
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Mésenchymome , Tumeurs du rachis , Humains , Femelle , Jeune adulte , Mésenchymome/chirurgie , Mésenchymome/anatomopathologie , Mésenchymome/imagerie diagnostique , Tumeurs du rachis/chirurgie , Tumeurs du rachis/imagerie diagnostique , Tumeurs du rachis/anatomopathologie , Vertèbres thoraciques/chirurgie , Vertèbres thoraciques/imagerie diagnostique , Vertèbres thoraciques/anatomopathologieRÉSUMÉ
OBJECTIVE: The purpose was to investigate the risk factors for unexpected malignant diagnoses in patients with vertebral compression fractures (VCF). METHODS: The clinical data were retrospectively collected from 1396 patients who underwent vertebral augmentation and biopsy between 2012 and 2022. According to the imaging results, the preoperative diagnoses were benign VCF (BVCF) in all these cases. Based on the histological findings, the patients were divided into two groups. In group A, unexpected malignant VCF (MVCF) was identified, while benign VCF (BVCF) was verified in group B. Logistic regression analysis was performed to analyze the risk and protective factors for unexpected malignant diagnoses. RESULTS: There were 44 patients in group A and 1352 in group B. The incidence of unexpected MVCF was 3.2â¯%. Age was significantly lower in group A compared to group B. Additionally, none of the patients in group A were older than 75. Age was associated with unexpected malignant diagnoses, according to the univariate logistic analysis. The multivariate logistic analysis showed that age was a protective factor for unexpected malignant diagnoses (odds ratioâ¯=â¯0.849, 95â¯% confidence interval: 0.809-0.891, pâ¯<â¯0.01). CONCLUSION: Age was a protective factor for unexpected malignant diagnoses in patients with preoperative diagnosis of BVCF. A routine biopsy is recommended to be performed during vertebral augmentation in young patients without preoperative imaging evidence of MVCF.
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Fractures par compression , Fractures du rachis , Tumeurs du rachis , Humains , Fractures par compression/chirurgie , Fractures par compression/imagerie diagnostique , Mâle , Femelle , Fractures du rachis/chirurgie , Fractures du rachis/imagerie diagnostique , Adulte d'âge moyen , Sujet âgé , Facteurs âges , Études rétrospectives , Tumeurs du rachis/complications , Tumeurs du rachis/chirurgie , Tumeurs du rachis/imagerie diagnostique , Sujet âgé de 80 ans ou plus , Adulte , Facteurs de risqueRÉSUMÉ
OBJECTIVE: Spinal metastases can significantly affect quality of life in patients with cancer and present complex neurosurgical challenges for surgeons. Surgery with instrumentation is often indicated to alleviate pain, preserve neurological function, and ensure mechanical stability. However, distortions in the bony anatomy due to oncological disease can decrease the accuracy of pedicle screw placement. Robotic-assisted surgery may offer an opportunity to increase screw accuracy and improve navigation of spinal lesions compared to conventional techniques. Therefore, we presented our institutional experience evaluating robotic-assisted surgical fixation for spinal metastases. METHODS: Patients undergoing robotic-assisted surgery at a large tertiary care center between January 2019 - January 2023 for the treatment of spinal metastases were identified. Patient characteristics, including demographics, tumor pathology, surgical complications, and post-operative outcomes were extracted. The Gertzbein Robbins classification system (GRS) was used to assess pedicle screw placement accuracy in patients with post-operative computed tomography. RESULTS: Twenty patients were identified, including 7 females (35â¯%), with an overall median age of 66 years (range: 39-80 years) and median BMI of 25â¯kg/m2 (range: 17-34â¯kg/m2). An average of four spinal levels were instrumented, with metastases located primarily in the thoracic (n=17, 85â¯%) spine. Common primary tumor types included prostate (n=4), lung (n=2), and plasma cell (n=2) cancers. Most pedicle screws (92â¯%) were classified as GRS A in patients with postoperative imaging. Post-operative complications were unrelated to the use of the robot, and included pulmonary embolism (n=1), deep vein thrombosis (n=2), and gastric symptoms (n=3). Three patients were readmitted at 30 days, with one reoperation due to tumor recurrence. Four patients were deceased within 6 months of surgery. CONCLUSIONS: Despite the inherent high-risk nature of these surgeries, this study underscores the safety and efficacy of robotic-assisted surgery in the management of spinal metastases. Robots can be helpful in ensuring accuracy of pedicle screw placement in patients with metastatic disease.
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Interventions chirurgicales robotisées , Tumeurs du rachis , Humains , Mâle , Tumeurs du rachis/chirurgie , Tumeurs du rachis/secondaire , Tumeurs du rachis/imagerie diagnostique , Femelle , Interventions chirurgicales robotisées/méthodes , Adulte d'âge moyen , Sujet âgé , Adulte , Sujet âgé de 80 ans ou plus , Vis pédiculaires , Résultat thérapeutique , Complications postopératoires , Arthrodèse vertébrale/méthodesRÉSUMÉ
PURPOSE: To develop a novel classification of sagittal en bloc resection (SEBR) based on anatomical locations for thoracolumbar spine tumors and assess the clinical outcomes of this surgical procedure. METHODS: 31 patients with thoracolumbar tumours treated with SEBR were enrolled in this study. The individualized surgical strategy was adopted based on our surgical classification. Demographics, perioperative outcomes, complications and postoperative outcomes were assessed. RESULTS: Based on our surgical classifications, patients were divided into four types. All bony resection margins were negative, wide resection was achieved in 25 patients, marginal resection in four, and intralesional resection in two. 18 patients underwent anterior reconstruction. Complications were encountered in five patients, and instrumentation failure occurred in one patient. The median follow-up was 24 (range, 6-72) months and recurrence was found in only one patient. CONCLUSION: SEBR is a safe and effective surgical procedure for patients with thoracolumbar spinal tumours in specific anatomical locations. The proposed surgical classification covers all SEBR types and is easy to apply, it may assist surgical decision-making in patients with spinal tumours.
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Vertèbres lombales , Tumeurs du rachis , Vertèbres thoraciques , Humains , Vertèbres thoraciques/chirurgie , Mâle , Femelle , Adulte d'âge moyen , Tumeurs du rachis/chirurgie , Tumeurs du rachis/anatomopathologie , Adulte , Vertèbres lombales/chirurgie , Jeune adulte , Adolescent , Résultat thérapeutique , Sujet âgé , Études rétrospectives , Complications postopératoires/épidémiologie , Complications postopératoires/étiologieRÉSUMÉ
OBJECTIVE: It is always difficult to obtain a comfortable surgical margin for patients with recurrent malignant or invasive benign spinal tumors. Tumor intraspinal invasion and dural adhesion are the essential reasons. There are always residual tumor cells maintained at the edge of dura. Dural resection is a key point to obtain a comfortable surgical margin for such cases. Whether such patients benefit from this risky surgical procedure is unknown. This study aims to understand better the oncological results, associated risks, and neurological function of this risky surgical procedure. METHODS: We retrospectively reviewed clinical data from six consecutive patients who registered spinal tumors in our institute and underwent dural resection during en bloc spinal resection from June 2013 to May 2020. The demographic and perioperative data, oncological outcomes, complications, and neurological status were collected and analyzed. RESULTS: All six patients were followed up for 24 to 46 months (mean follow-up time: 32.8 months). Local recurrence was detected in one patient (1/6, 16.7%) at 36 months postoperatively and in five patients with no evidence of disease at the last follow up (survival rate 83.3%). Eleven complications occurred in four patients (66.7%), and the dural resection-related complications included only four cases of cerebrospinal fluid leakage (CSFL), which accounted for 36.4% (4/11) of all complications. Neurologic status evaluated by the Frankel grade showed improvement of one grade in one case and deterioration of one to two grades in five patients immediately after surgery. All deterioration cases recovered to the preoperative level 6 months after the operation. CONCLUSION: Dural resection is significant for patients with dura matter invaded by recurrent primary malignant or invasive benign spinal tumors with the purpose of clinical cure. This study demonstrated that in strictly selected cases, intentional dural resection could provide satisfying local control and long-term disease-free survival with acceptable complications and satisfying neurological function.
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Dure-mère , Marges d'exérèse , Récidive tumorale locale , Tumeurs du rachis , Humains , Adulte d'âge moyen , Mâle , Femelle , Études rétrospectives , Dure-mère/chirurgie , Adulte , Tumeurs du rachis/chirurgie , Sujet âgé , Complications postopératoiresRÉSUMÉ
PURPOSE: Prolonged mechanical ventilation (PMV) and reintubation are among the most serious postoperative adverse events associated with malignant cervical tumors. In this study, we aimed to clarify the incidence, characteristics, and risk factors for PMV and reintubation in target patients. METHODS: This retrospective nested case-control study was performed between January 2014 and January 2020 at a large spinal tumor center in China. Univariate analysis was used to identify the possible risk factors associated with PMV and reintubation. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) with covariates of a probability < 0.05 in univariate analysis. RESULTS: From a cohort of 560 patients with primary malignant (n = 352) and metastatic (n = 208) cervical tumors, 27 patients required PMV and 20 patients underwent reintubation. The incidence rates of PMV and reintubation were 4.82% and 3.57%, respectively. Three variables (all p < 0.05) were independently associated with an increased risk of PMV: Karnofsky Performance Status < 50 compared to ≥ 80, operation duration ≥ 8 h compared to < 6 h, and C4 nerve root encased by the tumor. Longer operative duration and preoperative hypercapnia (all p < 0.05) were independent risk factors for postoperative reintubation, both of which led to longer length of stay (32.6 ± 30.8 vs. 10.7 ± 5.95 days, p < 0.001), with an in-hospital mortality of 17.0%. CONCLUSION: Our results demonstrate the risk factors for PMV or reintubation after surgery for malignant cervical tumors. Adequate assessment, early detection, and prevention are necessary for this high-risk population.
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Intubation trachéale , Ventilation artificielle , Humains , Femelle , Adulte d'âge moyen , Ventilation artificielle/statistiques et données numériques , Mâle , Études cas-témoins , Facteurs de risque , Sujet âgé , Études rétrospectives , Intubation trachéale/statistiques et données numériques , Intubation trachéale/effets indésirables , Adulte , Vertèbres cervicales/chirurgie , Tumeurs du rachis/chirurgie , Complications postopératoires/épidémiologie , Complications postopératoires/étiologieRÉSUMÉ
BACKGROUND: Sarcopenia has been purported to be a pre-operative risk factor that affects patient outcomes in oncological surgery, but no study as of yet has investigated the effect of sarcopenia in patients with spinal tumours. Psoas muscle measurements, including the psoas muscle index (PMI), are an objective way to determine sarcopenia. OBJECTIVES: We investigated if PMI could predict post-operative outcomes (length of hospital stay and post-operative complications) in surgically treated spinal tumour patients in a multi-ethnic Asian population. METHODS: We conducted a retrospective cohort study of patients with spinal tumours who underwent surgery at our tertiary institution from January 2016 to January 2020. PMI was measured on T2-weighted MRI sequences, at the middle of the L3 vertebral body and measurements were collected by 2 independent raters. The primary outcome was length of hospital stay (LOS), and the secondary outcome was post-operative complications. ROC curve was used to attain the cut-off value for PMI and the population was then stratified into 2 groups; sarcopenic if PMI was less than 1.22 and non-sarcopenic if the PMI value was more than or equal to 1.22. Multivariable linear regression was used for LOS, while multivariate logistic regression was used for complications. RESULTS: 57 patients were included with a mean length of stay of 17.8 days (SD 25.1) and the total number of patients with complications were 20 (35.1 %). Mean LOS was significantly higher in the sarcopenic group compared to the non-sarcopenic group. Univariate analysis confirmed the association of lower psoas muscle index corresponding with longer lengths of stay and this was corroborated in a multivariable linear regression model. There were no significant associations between PMI and postoperative complications. CONCLUSIONS: Lower PMI values were significantly associated with a longer LOS. PMI may be warranted for risk stratifying Asian spinal tumour patients undergoing surgery.
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Durée du séjour , Complications postopératoires , Muscle iliopsoas , Sarcopénie , Tumeurs du rachis , Humains , Muscle iliopsoas/imagerie diagnostique , Muscle iliopsoas/chirurgie , Mâle , Femelle , Adulte d'âge moyen , Complications postopératoires/épidémiologie , Complications postopératoires/étiologie , Études rétrospectives , Sarcopénie/imagerie diagnostique , Tumeurs du rachis/chirurgie , Tumeurs du rachis/imagerie diagnostique , Adulte , Sujet âgé , Asiatiques , Résultat thérapeutiqueRÉSUMÉ
Bizarre parosteal osteochondromatous proliferation (BPOP), also termed Nora lesion, is a rare, benign tumor most often located in the hands and feet. We herein present the second reported case of BPOP affecting the spine, an uncommon location. One year after surgical excision, the patient was pain-free and showed no evidence of recurrence. We reviewed a total of 323 cases of BPOP among 101 articles, providing the first systematic update on the latest knowledge of BPOP. The age of patients with BPOP ranges from 3 months to 87 years, peaking in the second and third decades of life. The hands are the most common location of BPOP (58.39%), followed by the feet (20.81%). Imaging features play a key role in the diagnosis of BPOP, but histopathologic diagnosis remains the gold standard. Differential diagnosis of BPOP should be based on the epidemiologic and clinical features as well as clinical examination findings. Surgical resection is the most extensively used treatment for BPOP. Recurrence is common (37.44%) and can be treated with re-excision. This article can deepen our understanding of BPOP and will be helpful for the diagnosis and treatment of BPOP in clinical practice.
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Ostéochondrome , Humains , Ostéochondrome/chirurgie , Ostéochondrome/anatomopathologie , Ostéochondrome/diagnostic , Ostéochondrome/imagerie diagnostique , Mâle , Femelle , Adulte , Tumeurs du rachis/chirurgie , Tumeurs du rachis/anatomopathologie , Tumeurs du rachis/diagnostic , Tumeurs du rachis/imagerie diagnostique , Imagerie par résonance magnétique , Adulte d'âge moyen , Diagnostic différentielRÉSUMÉ
Background: Intervertebral disc herniation, defined as the protrusion or extrusion of the disc mass outside the disc space, is common and easy to diagnose on conventional Magnetic Resonance imaging (MRI) or Computed Tomography (CT) scans. However, the sequestrated disc fragments are challenging to detect, and intervertebral disc mass displacement into the dural sac, which can lead to serious neurological problems such as Cauda equina syndrome (CES). The sequestrated disc fragments do not have specific clinical or radiological characteristics that can differentiate an atypical disc mass from a tumor, making the diagnosis difficult preoperatively. Herein, we describe the use of Sampling Perfection with Application Optimized Contrast using different flip angle Evolution in Magnetic Resonance Imaging (3D SPACE MRI) in the diagnosis of the intervertebral disc fragment that mimicked a tumor. Case presentation: In this study, we report two cases of sequestered lumbar disc herniation. The first case was a 37-year-old patient with a 2-year history of intermittent left lower limb pain that aggravates with exercise and is relieved at rest, while the second case was a 42-year-old patient with a history of 40 days of numbness and pain in the left lower limb. Conclusion: 3D SPACE MRI is a beneficial diagnostic imaging tool for discriminating between disc mass that mimics a tumor and a tumor before surgery. If the disc fragment mimicking a tumor can be identified before the operation, open surgical treatment won't be necessary for all patients.
Sujet(s)
Imagerie tridimensionnelle , Déplacement de disque intervertébral , Vertèbres lombales , Imagerie par résonance magnétique , Humains , Déplacement de disque intervertébral/imagerie diagnostique , Déplacement de disque intervertébral/chirurgie , Diagnostic différentiel , Adulte , Vertèbres lombales/imagerie diagnostique , Mâle , Femelle , Tumeurs du rachis/imagerie diagnostique , Tumeurs du rachis/chirurgieRÉSUMÉ
BACKGROUND: Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. METHODS: The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. RESULTS: This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. CONCLUSION: During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.
Sujet(s)
Mortalité hospitalière , Tumeurs du rachis , Humains , Tumeurs du rachis/chirurgie , Tumeurs du rachis/secondaire , Femelle , Mâle , Sujet âgé , Japon/épidémiologie , Adulte d'âge moyen , Mortalité hospitalière/tendances , Durée du séjour/statistiques et données numériques , Bases de données factuelles , Adulte , Sujet âgé de 80 ans ou plus , Complications postopératoires/épidémiologie , Arthrodèse vertébrale/méthodes , Arthrodèse vertébrale/statistiques et données numériques , Peuples d'Asie de l'EstRÉSUMÉ
BACKGROUND: Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case's uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population. CASE PRESENTATION: A 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component. CONCLUSION: This report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation.
Sujet(s)
Canal vertébral , Tumeur de Wilms , Humains , Tumeur de Wilms/chirurgie , Femelle , Canal vertébral/anatomopathologie , Canal vertébral/imagerie diagnostique , Jeune adulte , Incidence , Tumeurs du rein/chirurgie , Tumeurs du rein/anatomopathologie , Tumeurs du rein/imagerie diagnostique , Tumeurs du rachis/chirurgie , Tumeurs du rachis/imagerie diagnostiqueRÉSUMÉ
BACKGROUND: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor predominantly arising in soft tissue. We report a rare case of thoracic spinal EHE with pulmonary metastasis. METHODS: Case report and systematic review of spinal EHE. RESULTS: A 36-year-old man presented with bilateral lower extremity weakness, progressive paresthesia, and urinary incontinence. He underwent open surgical resection of the tumor and decompression of the spinal cord, with subsequent improvement in neurologic function. Systematic review identified 84 cases of spinal EHE, 73 of which were primary, and 14 of which developed extra-spinal metastases. CONCLUSION: EHE is an exceedingly rare tumor that may present with a wide swath of clinical symptoms. At present, no guidelines or formal treatment recommendations have been established. Surgical debulking has demonstrated efficacy as a front-line treatment, particularly in the setting of compressive neurologic dysfunction; data regarding adjuvant chemoradiation are less consistently reported, mandating further study.