With increase in the elderly population and improved survival among patients with malignancies, the rates of patients presenting with metastatic involvement of the spine is on the rise. Surgical management of spinal metastasis requires a multidisciplinary approach and surgery is a key component of multimodality management of metastatic spinal lesions. A PubMed search of relevant articles was performed and a narrative review of available pertinent literature in English language is presented.
{"title":"Outcomes of surgical treatment in spinal metastasis","authors":"Nischal Ghimire, Venkatesh Krishnan","doi":"10.4103/isj.isj_16_22","DOIUrl":"https://doi.org/10.4103/isj.isj_16_22","url":null,"abstract":"With increase in the elderly population and improved survival among patients with malignancies, the rates of patients presenting with metastatic involvement of the spine is on the rise. Surgical management of spinal metastasis requires a multidisciplinary approach and surgery is a key component of multimodality management of metastatic spinal lesions. A PubMed search of relevant articles was performed and a narrative review of available pertinent literature in English language is presented.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"193 - 198"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46570980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of spinal metastatic disease aims to improve the quality of remaining life in patients who have potentially limited survival. The treatment strategy necessitates multimodality, multidisciplinary involvement. Systemic therapies primarily aim to control systemic spread of the primary cancer. The armamentarium of systemic therapies includes traditional chemotherapy, bone-modifying agents, hormonal therapy, targeted molecular therapy, immunotherapy, and radioisotopes. The newer systemic therapies have resulted in a significant increase in overall survival of patients with metastatic disease. Consequently, treatment strategies must aim to achieve lasting local control of the spinal metastasis. The overall treatment strategy for an individual patient is planned based on a careful consideration of the anticipated survival, medical comorbidities, and the general condition of the patient.
{"title":"Systemic therapies for the management of cancers with spinal metastases","authors":"Mohan Menon, G. Zaveri","doi":"10.4103/isj.isj_78_21","DOIUrl":"https://doi.org/10.4103/isj.isj_78_21","url":null,"abstract":"Management of spinal metastatic disease aims to improve the quality of remaining life in patients who have potentially limited survival. The treatment strategy necessitates multimodality, multidisciplinary involvement. Systemic therapies primarily aim to control systemic spread of the primary cancer. The armamentarium of systemic therapies includes traditional chemotherapy, bone-modifying agents, hormonal therapy, targeted molecular therapy, immunotherapy, and radioisotopes. The newer systemic therapies have resulted in a significant increase in overall survival of patients with metastatic disease. Consequently, treatment strategies must aim to achieve lasting local control of the spinal metastasis. The overall treatment strategy for an individual patient is planned based on a careful consideration of the anticipated survival, medical comorbidities, and the general condition of the patient.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"145 - 149"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42491806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Vijayan, Christopher Gerber, Anindya Basu, Garga Basu, Radhika Mhatre
Spinal angiolipomas (SALs) are very rare benign extradural neoplasms, representing 0.14%–1.2% of all spinal tumors. Andersson lesion is a localized vertebral or disco-vertebral lesion in ankylosing spondylitis. Co-occurrence of these lesions is very rare and has never been reported. We are reporting one such case of a 61-year-old man presented with features of dorsal compressive myelopathy. On magnetic resonance imaging (MRI), he was diagnosed to have a SAL at D6–D9 and Andersson lesion at D7–D8 and L1–L2. He was managed surgically with a long-segment fixation and decompression and gross total excision of the tumor. Diagnosis of a SAL was confirmed in a biopsy, and postoperatively, he showed good clinical improvement. In conclusion, given the rarity of co-occurrence of these pathologies, a strong clinical suspicion is required. MRI and CT scan help in diagnosis. Both these pathologies warrant surgical management. When diagnosed early and managed appropriately, they have a good prognosis.
{"title":"Epidural angiolipoma and Andersson lesion: A rare co-occurence—A case report and literature review","authors":"S. Vijayan, Christopher Gerber, Anindya Basu, Garga Basu, Radhika Mhatre","doi":"10.4103/isj.isj_47_21","DOIUrl":"https://doi.org/10.4103/isj.isj_47_21","url":null,"abstract":"Spinal angiolipomas (SALs) are very rare benign extradural neoplasms, representing 0.14%–1.2% of all spinal tumors. Andersson lesion is a localized vertebral or disco-vertebral lesion in ankylosing spondylitis. Co-occurrence of these lesions is very rare and has never been reported. We are reporting one such case of a 61-year-old man presented with features of dorsal compressive myelopathy. On magnetic resonance imaging (MRI), he was diagnosed to have a SAL at D6–D9 and Andersson lesion at D7–D8 and L1–L2. He was managed surgically with a long-segment fixation and decompression and gross total excision of the tumor. Diagnosis of a SAL was confirmed in a biopsy, and postoperatively, he showed good clinical improvement. In conclusion, given the rarity of co-occurrence of these pathologies, a strong clinical suspicion is required. MRI and CT scan help in diagnosis. Both these pathologies warrant surgical management. When diagnosed early and managed appropriately, they have a good prognosis.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"235 - 240"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43123963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Selvin Prabhakar, Christopher Gerber, Anindya Basu, Dipendra Pradhan, S. Purkayastha
Background: This study includes management of aggressive vertebral hemangioma (VH). VH is the most common primary tumor affecting the vertebral column. In 0.9–1.2% of patients, VH can become symptomatic and is termed as “aggressive vertebral hemangiomas.” They usually require surgery along with adjuvant modalities. Due to its relatively low incidence, there is sparse reporting in the open literature and lack of universal consensus on treatment protocol. We would like to present our institutional experience in managing aggressive VH by surgery along with adjuvant modalities and a comprehensive review of the literature. Materials and Methods: A retrospective review of records of VH cases managed surgically in the past 3 years at our institute was done. All the relevant records and imaging of the patients were retrieved. Results: Five patients were included in the study. All were male with four dorsal and one lumbar lesion. All were treated with surgery along with an adjuvant therapy. Selective arterial embolization was used in one patient, alcohol ablation in three, and vertebroplasty in one. Only one patient had gross total resection, and others had only decompression. Fixation was done in all. All showed good clinical improvement without any complications, except in one. Conclusion: Aggressive VH often requires surgery. Currently, a decompression surgery is preferred due to less morbidity with good clinical outcomes. Various adjuvant therapies have been described in literature to be used perioperatively; yet there is no universal consensus on a standard protocol. Each of them has its own advantages and limitations and thus needs to be carefully selected on an individual basis. Alcohol ablation is an established adjuvant modality, but has to be used with caution.
{"title":"Surgical management of aggressive vertebral hemangioma: Case series and review of literature","authors":"Selvin Prabhakar, Christopher Gerber, Anindya Basu, Dipendra Pradhan, S. Purkayastha","doi":"10.4103/isj.isj_48_21","DOIUrl":"https://doi.org/10.4103/isj.isj_48_21","url":null,"abstract":"Background: This study includes management of aggressive vertebral hemangioma (VH). VH is the most common primary tumor affecting the vertebral column. In 0.9–1.2% of patients, VH can become symptomatic and is termed as “aggressive vertebral hemangiomas.” They usually require surgery along with adjuvant modalities. Due to its relatively low incidence, there is sparse reporting in the open literature and lack of universal consensus on treatment protocol. We would like to present our institutional experience in managing aggressive VH by surgery along with adjuvant modalities and a comprehensive review of the literature. Materials and Methods: A retrospective review of records of VH cases managed surgically in the past 3 years at our institute was done. All the relevant records and imaging of the patients were retrieved. Results: Five patients were included in the study. All were male with four dorsal and one lumbar lesion. All were treated with surgery along with an adjuvant therapy. Selective arterial embolization was used in one patient, alcohol ablation in three, and vertebroplasty in one. Only one patient had gross total resection, and others had only decompression. Fixation was done in all. All showed good clinical improvement without any complications, except in one. Conclusion: Aggressive VH often requires surgery. Currently, a decompression surgery is preferred due to less morbidity with good clinical outcomes. Various adjuvant therapies have been described in literature to be used perioperatively; yet there is no universal consensus on a standard protocol. Each of them has its own advantages and limitations and thus needs to be carefully selected on an individual basis. Alcohol ablation is an established adjuvant modality, but has to be used with caution.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"222 - 230"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43228143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the rapid evolution of systemic therapies and significant advances in surgical techniques, radiation therapy by itself or as an adjuvant to surgery remains the modality of choice for local control of spinal metastasis. Radiation can be used with an ablative intent for lasting local control of spinal metastasis or with a palliative intent to ameliorate pain, prevent pathological fractures, and relieve epidural spinal cord compression. This article aims to review the various modalities of radiotherapy. The lack of precision with conventional external beam radiotherapy (cEBRT) poses a significant radiation hazard to vital structures adjacent to the spine. This necessitates lowering of the radiation dosage, which may not be adequate to treat certain resistant tumors. Currently, the use of cEBRT is recommended for radiosensitive histologies only. Stereotactic body radiotherapy (SBRT) allows tumoricidal doses of radiation to be safely delivered to the tumor tissue. SBRT has been shown to provide durable local control, even for spine metastasis from tumors with radioresistant histologies. SBRT can also be offered as a reirradiation technique for tumor progression following a course of cEBRT. Currently, SBRT alone is recommended for radioresistant spinal metastasis limited to 1–2 spinal segments, with limited paraspinal spread and mild-to-moderate spinal cord compression in a stable spine. Charged particle therapy is useful for resistant histologies and further reduces the dose to normal structures within the vicinity of the tumor.
{"title":"Radiotherapy for spinal metastasis: A narrative review","authors":"R. Balakrishnan, P. Sebastian, G. Zaveri","doi":"10.4103/isj.isj_79_21","DOIUrl":"https://doi.org/10.4103/isj.isj_79_21","url":null,"abstract":"Despite the rapid evolution of systemic therapies and significant advances in surgical techniques, radiation therapy by itself or as an adjuvant to surgery remains the modality of choice for local control of spinal metastasis. Radiation can be used with an ablative intent for lasting local control of spinal metastasis or with a palliative intent to ameliorate pain, prevent pathological fractures, and relieve epidural spinal cord compression. This article aims to review the various modalities of radiotherapy. The lack of precision with conventional external beam radiotherapy (cEBRT) poses a significant radiation hazard to vital structures adjacent to the spine. This necessitates lowering of the radiation dosage, which may not be adequate to treat certain resistant tumors. Currently, the use of cEBRT is recommended for radiosensitive histologies only. Stereotactic body radiotherapy (SBRT) allows tumoricidal doses of radiation to be safely delivered to the tumor tissue. SBRT has been shown to provide durable local control, even for spine metastasis from tumors with radioresistant histologies. SBRT can also be offered as a reirradiation technique for tumor progression following a course of cEBRT. Currently, SBRT alone is recommended for radioresistant spinal metastasis limited to 1–2 spinal segments, with limited paraspinal spread and mild-to-moderate spinal cord compression in a stable spine. Charged particle therapy is useful for resistant histologies and further reduces the dose to normal structures within the vicinity of the tumor.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"185 - 192"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45545992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The goal of treatment in patients with spinal metastasis is palliation, that is, to improve the quality of remaining life as judged by alleviation of pain, preservation or restoration of neurology, and improvement in function. Local control of the spinal metastasis not only influences the overall survival of a cancer patient but is vital to maintain treatment benefits for the duration of the patient`s survival. However, cancer therapy––both surgical and nonsurgical––carries a significant risk of complications, morbidity, and even mortality. Decision-making regarding the most appropriate treatment strategy is vital when treating terminally ill patients with spinal metastatic disease.
{"title":"Spinal metastases: Clinical scenarios","authors":"G. Zaveri, Venkatesh Krishnan","doi":"10.4103/isj.isj_98_21","DOIUrl":"https://doi.org/10.4103/isj.isj_98_21","url":null,"abstract":"The goal of treatment in patients with spinal metastasis is palliation, that is, to improve the quality of remaining life as judged by alleviation of pain, preservation or restoration of neurology, and improvement in function. Local control of the spinal metastasis not only influences the overall survival of a cancer patient but is vital to maintain treatment benefits for the duration of the patient`s survival. However, cancer therapy––both surgical and nonsurgical––carries a significant risk of complications, morbidity, and even mortality. Decision-making regarding the most appropriate treatment strategy is vital when treating terminally ill patients with spinal metastatic disease.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"199 - 208"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49221944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pawar Jayesh, B. Mihir, Gujral Amandeep, Bharat K. Patel, Upadhyay Arpit
Background: Bi-facetal cervical dislocations can be missed due to misinterpretation of clinical signs and radiographs at initial assessment. In such cases, an ensuing fibrous union makes reduction and surgical stabilization both difficult and challenging. Multiple-stage approaches are required for its management. The guidelines for the surgical treatment of neglected bi-facetal dislocation are not yet clearly defined. The aim of this retrospective case series is to discuss the operative approach for the management of neglected bi-facetal cervical dislocation and the assessment of its clinical outcomes. Methods and Materials: From 2014 to 2019, five patients with neglected bi-facetal cervical dislocation were surgically treated in two stages by the posterior-anterior approach and were followed up for one year. The average age was 47.4 years, with a mean delay of 9.8 weeks. A posterior approach was preferred first, where a reduction was achieved with the help of lateral mass reduction screws after soft tissue release and facetectomy. This was followed by anterior discectomy and stabilization. Neck pain was assessed by the neck disability index (NDI) and the Visual analogue score (VAS). Neurology was assessed by using the modified Japanese Orthopaedic Association (mJOA) score. Sagittal alignment and fusion were also recorded. Results: Anatomical reduction was achieved in all patients without neurological worsening. NDI, VAS and mJOA score were significantly improved after the surgery. In all patients, complete fusion occurred at the final follow-up and no complications were encountered. Conclusion: It is difficult to reduce a neglected bi-facetal dislocation. Liberal facetectomy and the use of reduction lateral mass screws provides for a safe and controlled reduction. The reported two-stage technique successfully achieves an anatomical reduction and a stable circumferential fusion.
{"title":"An operative technique for management of neglected bi-facetal cervical dislocations","authors":"Pawar Jayesh, B. Mihir, Gujral Amandeep, Bharat K. Patel, Upadhyay Arpit","doi":"10.4103/isj.isj_60_21","DOIUrl":"https://doi.org/10.4103/isj.isj_60_21","url":null,"abstract":"Background: Bi-facetal cervical dislocations can be missed due to misinterpretation of clinical signs and radiographs at initial assessment. In such cases, an ensuing fibrous union makes reduction and surgical stabilization both difficult and challenging. Multiple-stage approaches are required for its management. The guidelines for the surgical treatment of neglected bi-facetal dislocation are not yet clearly defined. The aim of this retrospective case series is to discuss the operative approach for the management of neglected bi-facetal cervical dislocation and the assessment of its clinical outcomes. Methods and Materials: From 2014 to 2019, five patients with neglected bi-facetal cervical dislocation were surgically treated in two stages by the posterior-anterior approach and were followed up for one year. The average age was 47.4 years, with a mean delay of 9.8 weeks. A posterior approach was preferred first, where a reduction was achieved with the help of lateral mass reduction screws after soft tissue release and facetectomy. This was followed by anterior discectomy and stabilization. Neck pain was assessed by the neck disability index (NDI) and the Visual analogue score (VAS). Neurology was assessed by using the modified Japanese Orthopaedic Association (mJOA) score. Sagittal alignment and fusion were also recorded. Results: Anatomical reduction was achieved in all patients without neurological worsening. NDI, VAS and mJOA score were significantly improved after the surgery. In all patients, complete fusion occurred at the final follow-up and no complications were encountered. Conclusion: It is difficult to reduce a neglected bi-facetal dislocation. Liberal facetectomy and the use of reduction lateral mass screws provides for a safe and controlled reduction. The reported two-stage technique successfully achieves an anatomical reduction and a stable circumferential fusion.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"215 - 221"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41846576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Gonzales-Portillo, M. Avila, Omar Rizvi, T. Dumont
Background: Transitional anatomy and pars defects are two common incidental findings seen on imaging of the lumbosacral spine. The purpose of this study was to investigate whether there is a correlation between these two lumbar spine phenomena. Materials and Methods: A retrospective review of spinal imaging was conducted of patients presenting with thoracolumbar fractures at our Level I Trauma Center between 2017 and 2018. Computed tomography scans from 260 patients were obtained and assessed for the presence of lumbosacral transitional anatomy and pars defect. Results: From the 260 patients reviewed, 16 patients had transitional anatomy (6%) and 20 patients had lumbar non-traumatic pars defect (8%). Only one patient presented with both transitional anatomy and pars defect. Overall, there was no difference in incidence of pars defect whether transitional lumbosacral anatomy was present (5%) or not (6.25%), P = 1.00, Fisher’s exact test. Conclusion: The findings suggest that patients with transitional anatomy do not have an increased association with lumbar pars defects.
{"title":"The correlation between lumbosacral transitional anatomy and pars defect","authors":"G. Gonzales-Portillo, M. Avila, Omar Rizvi, T. Dumont","doi":"10.4103/isj.isj_59_21","DOIUrl":"https://doi.org/10.4103/isj.isj_59_21","url":null,"abstract":"Background: Transitional anatomy and pars defects are two common incidental findings seen on imaging of the lumbosacral spine. The purpose of this study was to investigate whether there is a correlation between these two lumbar spine phenomena. Materials and Methods: A retrospective review of spinal imaging was conducted of patients presenting with thoracolumbar fractures at our Level I Trauma Center between 2017 and 2018. Computed tomography scans from 260 patients were obtained and assessed for the presence of lumbosacral transitional anatomy and pars defect. Results: From the 260 patients reviewed, 16 patients had transitional anatomy (6%) and 20 patients had lumbar non-traumatic pars defect (8%). Only one patient presented with both transitional anatomy and pars defect. Overall, there was no difference in incidence of pars defect whether transitional lumbosacral anatomy was present (5%) or not (6.25%), P = 1.00, Fisher’s exact test. Conclusion: The findings suggest that patients with transitional anatomy do not have an increased association with lumbar pars defects.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"209 - 214"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46779301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naresh Kumar, Sean Lee, Sridharan Alathur Ramakrishnan, A. Thomas, Sarah Tang, B. Vellayappan
Advancements in medical therapy have led to the increased incidence of metastatic spine tumor surgery (MSTS) owing to the increased survivability of cancer patients. Over the years, surgical techniques have evolved from simple laminectomy to advanced radical surgery with reconstruction. Surgery with radiotherapy (RT) and chemotherapy have been established as key paradigms for the management of metastatic spine disease (MSD). In general, surgical treatment is split into two categories, open and minimally invasive. Decompression and stabilization form the basis of the common surgical techniques for managing MSD. Pedicle screw-rod instrumentation forms the basis of fixation, whereas decompression can be achieved through techniques such as laminectomy, separation surgery, partial corpectomy, near piecemeal corpectomy, or en bloc corpectomy. However, complications such as infection, wound dehiscence, and instrument failure remain the challenges of MSTS. This gives the need for auxiliary techniques and advancements to improve the efficacy of MSTS and reduce complications. Recent advancements such as intraoperative cell salvage in MSTS have reduced the need for allogenic blood transfusion, thus reducing the risk of infection and other complications. Additionally, implant materials such as carbon-fiber-reinforced polyether–ether-ketone (PEEK) and titanium-coated PEEK with better biocompatibility, imaging, and RT compatibility have been explored for use in MSTS. Current trends in MSTS are shifting toward minimally invasive surgery (MIS); however, open surgery remains the “gold standard.” Open surgery is preferred in cases with compromised visibility, i.e., hypervascular tumor secondaries and in regions of spinal column with limited access where the MIS approach is likely to be dangerous. We recommend that all spine surgeons be familiar with the concepts and techniques of open surgery for MSD.
{"title":"Concepts, rationale, and techniques of the open approach in the surgical management of metastatic spine disease","authors":"Naresh Kumar, Sean Lee, Sridharan Alathur Ramakrishnan, A. Thomas, Sarah Tang, B. Vellayappan","doi":"10.4103/isj.isj_73_21","DOIUrl":"https://doi.org/10.4103/isj.isj_73_21","url":null,"abstract":"Advancements in medical therapy have led to the increased incidence of metastatic spine tumor surgery (MSTS) owing to the increased survivability of cancer patients. Over the years, surgical techniques have evolved from simple laminectomy to advanced radical surgery with reconstruction. Surgery with radiotherapy (RT) and chemotherapy have been established as key paradigms for the management of metastatic spine disease (MSD). In general, surgical treatment is split into two categories, open and minimally invasive. Decompression and stabilization form the basis of the common surgical techniques for managing MSD. Pedicle screw-rod instrumentation forms the basis of fixation, whereas decompression can be achieved through techniques such as laminectomy, separation surgery, partial corpectomy, near piecemeal corpectomy, or en bloc corpectomy. However, complications such as infection, wound dehiscence, and instrument failure remain the challenges of MSTS. This gives the need for auxiliary techniques and advancements to improve the efficacy of MSTS and reduce complications. Recent advancements such as intraoperative cell salvage in MSTS have reduced the need for allogenic blood transfusion, thus reducing the risk of infection and other complications. Additionally, implant materials such as carbon-fiber-reinforced polyether–ether-ketone (PEEK) and titanium-coated PEEK with better biocompatibility, imaging, and RT compatibility have been explored for use in MSTS. Current trends in MSTS are shifting toward minimally invasive surgery (MIS); however, open surgery remains the “gold standard.” Open surgery is preferred in cases with compromised visibility, i.e., hypervascular tumor secondaries and in regions of spinal column with limited access where the MIS approach is likely to be dangerous. We recommend that all spine surgeons be familiar with the concepts and techniques of open surgery for MSD.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"158 - 167"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47974635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brucellosis is the most common zoonosis globally, and it is endemic to the Indian subcontinent. It can mimic a number of febrile illnesses and inflammatory disease conditions. An 18-year-old boy presented with low back pain and a fever of three-month duration. Magnetic resonance imaging revealed a unilateral sacroiliitis, which was being treated as an inflammatory spondyloarthropathy. Because of non-resolving symptoms, a biopsy was performed, which showed a granulomatous inflammation that was consistent with tuberculosis or brucellosis infection. A history of exposure to livestock and consumption of unpasteurized milk led to a clinical suspicion of brucellosis, which was confirmed on a positive serology. He was treated with antibiotics with improvement in symptoms and complete resolution of the sacroiliitis. A high index of suspicion must be maintained for brucellosis, especially in patients with a rural residence, exposure to livestock, and febrile illness with a clinically suspected unilateral sacroiliitis.
{"title":"Brucellosis sacroiliitis masquerading as inflammatory spondyloarthropathy","authors":"Alok Gupta, A. Shyam, P. Sancheti, S. Aiyer","doi":"10.4103/isj.isj_38_21","DOIUrl":"https://doi.org/10.4103/isj.isj_38_21","url":null,"abstract":"Brucellosis is the most common zoonosis globally, and it is endemic to the Indian subcontinent. It can mimic a number of febrile illnesses and inflammatory disease conditions. An 18-year-old boy presented with low back pain and a fever of three-month duration. Magnetic resonance imaging revealed a unilateral sacroiliitis, which was being treated as an inflammatory spondyloarthropathy. Because of non-resolving symptoms, a biopsy was performed, which showed a granulomatous inflammation that was consistent with tuberculosis or brucellosis infection. A history of exposure to livestock and consumption of unpasteurized milk led to a clinical suspicion of brucellosis, which was confirmed on a positive serology. He was treated with antibiotics with improvement in symptoms and complete resolution of the sacroiliitis. A high index of suspicion must be maintained for brucellosis, especially in patients with a rural residence, exposure to livestock, and febrile illness with a clinically suspected unilateral sacroiliitis.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"241 - 245"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47983456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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