Pub Date : 2024-12-01Epub Date: 2024-11-01DOI: 10.1016/j.semss.2024.101140
Chukwuemeka Mbagwu, Lancelot Benn, Addisu Mesfin
Osseous/extradural pediatric spine tumors are uncommon and divided into benign and malignant. The Enneking classification is used to divide the benign tumors into latent, benign aggressive and aggressive. The malignant spine tumors include osteosarcoma, Ewing's sarcoma and lymphoma. A tissue biopsy is crucial for diagnosis and is essential to manage these tumors in a multi-disciplinary manner.
{"title":"Update on the management of extradural primary pediatric spinal tumors","authors":"Chukwuemeka Mbagwu, Lancelot Benn, Addisu Mesfin","doi":"10.1016/j.semss.2024.101140","DOIUrl":"10.1016/j.semss.2024.101140","url":null,"abstract":"<div><div>Osseous/extradural pediatric spine tumors are uncommon and divided into benign and malignant. The Enneking classification is used to divide the benign tumors into latent, benign aggressive and aggressive. The malignant spine tumors include osteosarcoma, Ewing's sarcoma and lymphoma. A tissue biopsy is crucial for diagnosis and is essential to manage these tumors in a multi-disciplinary manner.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101140"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706077","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}
Intradural spine tumors are relatively uncommon and include tumors outside (extramedullary) or within the spinal cord (intramedullary). The proximity of these tumors to important neural structures can cause significant neurologic morbidity and prompt management is critical for maintaining function. Surgical intervention is generally the primary treatment depending on presenting symptoms, radiologic features, and the likelihood of a clear surgical planes vis-à-vis the spinal cord. Adjuvant radiation, chemotherapy, or other novel therapeutic strategies may play a role in postoperative management. Here we review management strategies for common intradural extramedullary (meningiomas, schwannomas, and neurofibromas) and intradural intramedullary tumors (astrocytomas, ependymomas, and hemangioblastomas).
{"title":"Management of intradural extramedullary and intramedullary spinal tumors","authors":"Amanda Roehrkasse, Jeffrey Breton, Jean-Marc Voyadzis","doi":"10.1016/j.semss.2024.101141","DOIUrl":"10.1016/j.semss.2024.101141","url":null,"abstract":"<div><div>Intradural spine tumors are relatively uncommon and include tumors outside (extramedullary) or within the spinal cord (intramedullary). The proximity of these tumors to important neural structures can cause significant neurologic morbidity and prompt management is critical for maintaining function. Surgical intervention is generally the primary treatment depending on presenting symptoms, radiologic features, and the likelihood of a clear surgical planes vis-à-vis the spinal cord. Adjuvant radiation, chemotherapy, or other novel therapeutic strategies may play a role in postoperative management. Here we review management strategies for common intradural extramedullary (meningiomas, schwannomas, and neurofibromas) and intradural intramedullary tumors (astrocytomas, ependymomas, and hemangioblastomas).</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101141"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706078","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}
Pub Date : 2024-12-01Epub Date: 2024-11-26DOI: 10.1053/S1040-7383(24)00070-4
{"title":"Contributors to authors","authors":"","doi":"10.1053/S1040-7383(24)00070-4","DOIUrl":"10.1053/S1040-7383(24)00070-4","url":null,"abstract":"","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101147"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706046","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}
Pub Date : 2024-12-01Epub Date: 2024-11-04DOI: 10.1016/j.semss.2024.101138
Chukwuka Obiofuma, Addisu Mesfin
Surgical site infections (SSI) and wound complications are common following primary and metastatic spine tumor surgery. Some risks factors include pre-operative radiation therapy, malnutrition, revision surgeries, length of surgery and co-morbidities. Some strategies to decrease wound complications include plastic surgery closure and use of betadine irrigation and vancomycin intrawound power. However, larger series prospective randomized studies are needed in order advance the field of spine oncology and to continue to decrease wound complications.
{"title":"Wound complications following spine tumor surgery: Risk factors and prevention","authors":"Chukwuka Obiofuma, Addisu Mesfin","doi":"10.1016/j.semss.2024.101138","DOIUrl":"10.1016/j.semss.2024.101138","url":null,"abstract":"<div><div>Surgical site infections (SSI) and wound complications are common following primary and metastatic spine tumor surgery. Some risks factors include pre-operative radiation therapy, malnutrition, revision surgeries, length of surgery and co-morbidities. Some strategies to decrease wound complications include plastic surgery closure and use of betadine irrigation and vancomycin intrawound power. However, larger series prospective randomized studies are needed in order advance the field of spine oncology and to continue to decrease wound complications.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101138"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706075","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}
Pub Date : 2024-12-01Epub Date: 2024-10-28DOI: 10.1016/j.semss.2024.101134
Atousa Nourmahnad , Matiar Jafari , Thomas E Olson , Andrew C. Vivas , Elizabeth L. Lord
Minimally invasive spine surgery is primed for innovation and development. As imaging and navigations modalities continue to develop, their impact on clinical outcomes and patient quality of life is expected to be substantial, marking a significant step forward in neurosurgical practice. By combining these advanced technologies with minimally invasive surgical approaches and adjuvant therapies, we are bound to significantly improve patient outcomes, minimize neurological deficits, and enhance the overall quality of life for patients with spinal tumors.
{"title":"Minimally invasive management of metastatic spine tumors","authors":"Atousa Nourmahnad , Matiar Jafari , Thomas E Olson , Andrew C. Vivas , Elizabeth L. Lord","doi":"10.1016/j.semss.2024.101134","DOIUrl":"10.1016/j.semss.2024.101134","url":null,"abstract":"<div><div>Minimally invasive spine surgery is primed for innovation and development. As imaging and navigations modalities continue to develop, their impact on clinical outcomes and patient quality of life is expected to be substantial, marking a significant step forward in neurosurgical practice. By combining these advanced technologies with minimally invasive surgical approaches and adjuvant therapies, we are bound to significantly improve patient outcomes, minimize neurological deficits, and enhance the overall quality of life for patients with spinal tumors.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101134"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-09-10DOI: 10.1016/j.semss.2024.101132
Omar Salim , Mohamed S Draz , Emily R Bligh , Calan Mathieson
Purpose
Protracted admissions following lumbar surgeries are rising, often stemming from inefficient identification of patients requiring nonhome discharge for rehabilitation. The SORG Orthopaedic Research Group at Harvard Medical School have developed a machine learning algorithm for predicting discharge following lumbar surgery. This study assessed its predictive performance on an independent tertiary centre patient cohort.
Methods
Medical records were retrospectively reviewed for all elective adult lumbar disc degeneration or herniation surgeries performed between July 2017–2021 at a tertiary neurosurgical centre in the United Kingdom. Preoperative variables were collated and discharge destinations noted. Algorithm predictions were analysed using the concordance (c) statistic, Brier score and calibration plot. Positive and negative predictive values (PPV, NPV) were calculated, and a decision curve analysis (DCA) plotted.
Results
251 subjects were included (48.2 % female, mean age 55.3 years). 2.8 % underwent nonhome discharge. Most had surgery at 1/2 spinal levels (98.4 %) and were functionally independent (84.5 %). Algorithm predictions yielded a 0.88 c-statistic and 0.029 Brier score. The algorithm was miscalibrated to the data (calibration plot slope 1.31 and intercept -1.12). At a 0.25 threshold for nonroutine discharge risk, the PPV was 0.19 and NPV 0.98. DCA revealed limited clinical utility.
Conclusions
Algorithm predictive performance was mixed for this cohort, displaying strong discrimination but poor calibration and overestimation of nonroutine discharges. Differences in patient management practices and the low nonhome discharge rate may explain this. Larger validation studies across different healthcare systems, alongside geographically specific algorithm development, will improve predictive accuracy prior to clinical application.
{"title":"Evaluating the performance of the SORG machine learning algorithm for predicting discharge disposition in lumbar surgery patients","authors":"Omar Salim , Mohamed S Draz , Emily R Bligh , Calan Mathieson","doi":"10.1016/j.semss.2024.101132","DOIUrl":"10.1016/j.semss.2024.101132","url":null,"abstract":"<div><h3>Purpose</h3><div>Protracted admissions following lumbar surgeries are rising, often stemming from inefficient identification of patients requiring nonhome discharge for rehabilitation. The SORG Orthopaedic Research Group at Harvard Medical School have developed a machine learning algorithm for predicting discharge following lumbar surgery. This study assessed its predictive performance on an independent tertiary centre patient cohort.</div></div><div><h3>Methods</h3><div>Medical records were retrospectively reviewed for all elective adult lumbar disc degeneration or herniation surgeries performed between July 2017–2021 at a tertiary neurosurgical centre in the United Kingdom. Preoperative variables were collated and discharge destinations noted. Algorithm predictions were analysed using the concordance (c) statistic, Brier score and calibration plot. Positive and negative predictive values (PPV, NPV) were calculated, and a decision curve analysis (DCA) plotted.</div></div><div><h3>Results</h3><div>251 subjects were included (48.2 % female, mean age 55.3 years). 2.8 % underwent nonhome discharge. Most had surgery at 1/2 spinal levels (98.4 %) and were functionally independent (84.5 %). Algorithm predictions yielded a 0.88 c-statistic and 0.029 Brier score. The algorithm was miscalibrated to the data (calibration plot slope 1.31 and intercept -1.12). At a 0.25 threshold for nonroutine discharge risk, the PPV was 0.19 and NPV 0.98. DCA revealed limited clinical utility.</div></div><div><h3>Conclusions</h3><div>Algorithm predictive performance was mixed for this cohort, displaying strong discrimination but poor calibration and overestimation of nonroutine discharges. Differences in patient management practices and the low nonhome discharge rate may explain this. Larger validation studies across different healthcare systems, alongside geographically specific algorithm development, will improve predictive accuracy prior to clinical application.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101132"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-31DOI: 10.1016/j.semss.2024.101135
Lauren Park , Nora Tabori , John Smirniotopoulos
Objective
Interventional radiology procedures can offer locoregional tumor control and palliative options for patients with metastatic disease to spine to relieve pain, to delay neurologic deficits, and to improve quality of life and daily function.
Findings
Multiple thermal energies for percutaneous ablation of metastases to the spine exist and are chosen according to tumor characteristics, volume, and location. Vertebral augmentation is most often combined with ablation for structural stability. Intravascular embolization of metastases provides tumor palliative or presurgical devascularization.
Conclusion
Ablation, vertebral augmentation, and intravascular embolization are efficacious minimally invasive options for the management of spinal tumors.
{"title":"Interventional radiology procedures for metastatic spine tumors","authors":"Lauren Park , Nora Tabori , John Smirniotopoulos","doi":"10.1016/j.semss.2024.101135","DOIUrl":"10.1016/j.semss.2024.101135","url":null,"abstract":"<div><h3>Objective</h3><div>Interventional radiology procedures can offer locoregional tumor control and palliative options for patients with metastatic disease to spine to relieve pain, to delay neurologic deficits, and to improve quality of life and daily function.</div></div><div><h3>Findings</h3><div>Multiple thermal energies for percutaneous ablation of metastases to the spine exist and are chosen according to tumor characteristics, volume, and location. Vertebral augmentation is most often combined with ablation for structural stability. Intravascular embolization of metastases provides tumor palliative or presurgical devascularization.</div></div><div><h3>Conclusion</h3><div>Ablation, vertebral augmentation, and intravascular embolization are efficacious minimally invasive options for the management of spinal tumors.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101135"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706072","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}
Primary spine tumors present significant clinical challenges due to their potential for local invasiveness and metastasis. Total en bloc spondylectomy (TES) has emerged as a feasible surgical technique for the complete resection of thoracic and lumbar spinal tumors, providing superior local control and long-term survival benefits. This review synthesized the current evidence and clinical experiences and demonstrated that TES achieved lower recurrence rates and higher disease-free survival than those of piecemeal resection. Despite the high perioperative complication rates, TES is essential for treating primary spine tumors. The importance of skilled surgical teams to optimize patient outcomes has been emphasized.
{"title":"Total en bloc spondylectomy for primary tumors of the thoracic and lumbar spine: A review article","authors":"Takaki Shimizu , Satoshi Kato , Noriaki Yokogawa , Takaaki Uto , Yuji Ishino , Kazuhiro Nanpo , Megumu Kawai , Hideki Murakami , Satoru Demura","doi":"10.1016/j.semss.2024.101137","DOIUrl":"10.1016/j.semss.2024.101137","url":null,"abstract":"<div><div>Primary spine tumors present significant clinical challenges due to their potential for local invasiveness and metastasis. Total en bloc spondylectomy (TES) has emerged as a feasible surgical technique for the complete resection of thoracic and lumbar spinal tumors, providing superior local control and long-term survival benefits. This review synthesized the current evidence and clinical experiences and demonstrated that TES achieved lower recurrence rates and higher disease-free survival than those of piecemeal resection. Despite the high perioperative complication rates, TES is essential for treating primary spine tumors. The importance of skilled surgical teams to optimize patient outcomes has been emphasized.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101137"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706074","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}
Pub Date : 2024-12-01Epub Date: 2024-11-06DOI: 10.1016/j.semss.2024.101139
Ikechukwu C. Amakiri , Daniel G. Tobert
Benign primary spinal tumors (BPST) are rare entities with significant diagnostic and therapeutic challenges. These tumors can originate from the various mesenchymal tissues that compose the spinal column. They are typically classified using the Enneking or Weinstein-Boriani-Biagini (WBB) classifications, which guide surgical planning and intervention. The most frequent benign spinal tumors include osteoblastoma, osteoid osteoma, osteochondroma, giant cell tumors, aneurysmal bone cysts, hemangiomas, and Langerhans cell histiocytosis. Treatment options vary from nonoperative therapies such as analgesics, radiotherapy, and tumor ablation, to surgical interventions ranging from intralesional curettage to en bloc resection. The choice of treatment depends on factors such as tumor type, location, and potential for recurrence. A multidisciplinary approach, involving orthopedic surgeons, oncologists, and radiologists, is crucial for optimizing patient care. This review aims to provide concise information for the operative and nonoperative treatments of the most common extramedullary primary benign spinal tumors.
{"title":"Operative and non-operative options for benign primary spine tumors","authors":"Ikechukwu C. Amakiri , Daniel G. Tobert","doi":"10.1016/j.semss.2024.101139","DOIUrl":"10.1016/j.semss.2024.101139","url":null,"abstract":"<div><div>Benign primary spinal tumors (BPST) are rare entities with significant diagnostic and therapeutic challenges. These tumors can originate from the various mesenchymal tissues that compose the spinal column. They are typically classified using the Enneking or Weinstein-Boriani-Biagini (WBB) classifications, which guide surgical planning and intervention. The most frequent benign spinal tumors include osteoblastoma, osteoid osteoma, osteochondroma, giant cell tumors, aneurysmal bone cysts, hemangiomas, and Langerhans cell histiocytosis. Treatment options vary from nonoperative therapies such as analgesics, radiotherapy, and tumor ablation, to surgical interventions ranging from intralesional curettage to <em>en bloc</em> resection. The choice of treatment depends on factors such as tumor type, location, and potential for recurrence. A multidisciplinary approach, involving orthopedic surgeons, oncologists, and radiologists, is crucial for optimizing patient care. This review aims to provide concise information for the operative and nonoperative treatments of the most common extramedullary primary benign spinal tumors.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101139"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706076","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}
Pub Date : 2024-12-01Epub Date: 2024-10-28DOI: 10.1016/j.semss.2024.101142
Douglass C. Johnson , S. Mohammed Karim , Addisu Mesfin
Sacral tumors can range from benign to malignant. The sacrum is a common site of metastases however surgical intervention is not common for sacral metastases unless there is neurological compromise. Benign aggressive tumors such giant cell tumors, osteoblastomas and aneurysmal bone cysts (ABC) can be found in the sacrum. Malignant primary tumors including chordoma, chondrosarcomas and osteosarcomas can affect the sacrum. Management depends on the tumor histology including debulking and stabilization for metastatic spine lesions. For benign tumors such as ABCs, intralesional resection is an option. For primary spine tumors partial or total sacrectomies are an option and morbidity is dependent on the level of sacral resection.
{"title":"Overview and management of sacral tumors","authors":"Douglass C. Johnson , S. Mohammed Karim , Addisu Mesfin","doi":"10.1016/j.semss.2024.101142","DOIUrl":"10.1016/j.semss.2024.101142","url":null,"abstract":"<div><div>Sacral tumors can range from benign to malignant. The sacrum is a common site of metastases however surgical intervention is not common for sacral metastases unless there is neurological compromise. Benign aggressive tumors such giant cell tumors, osteoblastomas and aneurysmal bone cysts (ABC) can be found in the sacrum. Malignant primary tumors including chordoma, chondrosarcomas and osteosarcomas can affect the sacrum. Management depends on the tumor histology including debulking and stabilization for metastatic spine lesions. For benign tumors such as ABCs, intralesional resection is an option. For primary spine tumors partial or total sacrectomies are an option and morbidity is dependent on the level of sacral resection.</div></div>","PeriodicalId":39884,"journal":{"name":"Seminars in Spine Surgery","volume":"36 4","pages":"Article 101142"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142706079","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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