65 Spinal Tumor | ScienceGate

OBJECTIVEThe surgical treatment of an upper cervical spinal tumor (UCST) at C1–2/C1–3 is challenging due to anterior exposure and reconstruction. Limited information has been published concerning the effective approach and reconstruction for an anterior procedure after C1–2/C1–3 UCST resection. The authors attempted to introduce a novel, customized, anterior craniocervical reconstruction between the occipital condyles and inferior vertebrae through a modified high-cervical retropharyngeal approach (mHCRA) in addressing C1–2/C1–3 spinal tumors.METHODSSeven consecutive patients underwent 2-stage UCST resection with circumferential reconstruction. Posterior decompression and occiput-cervical instrumentation was conducted at the stage 1 operation, and anterior craniocervical reconstruction using a 3D-printed implant was performed between the occipital condyles and inferior vertebrae via an mHCRA. The clinical characteristics, perioperative complications, and radiological outcomes were reviewed, and the rationale for anterior craniocervical reconstruction was also clarified.RESULTSThe mean age of the 7 patients in the study was 47.6 ± 19.0 years (range 12–72 years) when referred to the authors’ center. Six patients (85.7%) had recurrent tumor status, and the interval from primary to recurrence status was 53.0 ± 33.7 months (range 24–105 months). Four patients (57.1%) were diagnosed with a spinal tumor involving C1–3, and 3 patients (42.9%) with a C1–2 tumor. For the anterior procedure, the mean surgical duration and average blood loss were 4.1 ± 0.9 hours (range 3.0–6.0 hours) and 558.3 ± 400.5 ml (range 100–1300 ml), respectively. No severe perioperative complications occurred, except 1 patient with transient dysphagia. The mean pre- and postoperative visual analog scale scores were 8.0 ± 0.8 (range 7–9) and 2.4 ± 0.5 (range 2.0–3.0; p < 0.001), respectively, and the mean improvement rate of cervical spinal cord function was 54.7% ± 13.8% (range 42.9%–83.3%) based on the modified Japanese Orthopaedic Association scale score (p < 0.001). Circumferential instrumentation was in good position and no evidence of disease was found at the mean follow-up of 14.8 months (range 7.3–24.2 months).CONCLUSIONSThe mHCRA provides optimal access to the surgical field at the C0–3 level. Customized anterior craniocervical fixation between the occipital condyles and inferior vertebrae can be feasible and effective in managing anterior reconstruction after UCST resection.

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Serous degeneration of bone marrow mimics spinal tumor

European Spine Journal ◽

10.1007/s00586-016-4778-8 ◽

2016 ◽

Vol 26 (S1) ◽

pp. 80-84 ◽

Cited By ~ 1

Author(s):

Chih-Wei Sung ◽

Kevin Li-Chun Hsieh ◽

Yun-Ho Lin ◽

Chun-Yi Lin ◽

Chian-Her Lee ◽

...

Keyword(s):

Bone Marrow ◽

Spinal Tumor

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An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases

Journal of Neurosurgery Spine ◽

10.3171/2016.4.spine1674 ◽

2016 ◽

Vol 25 (6) ◽

pp. 790-794 ◽

Cited By ~ 13

Author(s):

Bishan D. Radotra ◽

Ashish Aggarwal ◽

Ankur Kapoor ◽

Navneet Singla ◽

Debajyoti Chatterjee

Keyword(s):

Plasma Cells ◽

Treatment Guidelines ◽

Spinal Tumor ◽

Spinal Tumors ◽

Igg4 Related Disease ◽

Inflammatory Conditions ◽

Lumbar Level ◽

Multisystem Involvement ◽

Spinal Compression ◽

Storiform Fibrosis

IgG4-related disease is relatively new disease entity and a rare one, and our knowledge of this entity continues to evolve. It was first described in the pancreas and since then has been described in virtually every organ. Spinal involvement resulting in pachymeningitis is rare, and there are only 8 reported cases of the same to date, with the cervicothoracic spine being the most commonly affected region. The authors describe 2 cases in which the patients presented with spinal compression resulting in myeloradiculopathy (Case 1) and radiculopathy (Case 2). Imaging of spine in both cases revealed an ill-defined contrast-enhancing lesion at the lumbar level. Preoperatively, a diagnosis of spinal tumor was made, but intraoperatively no spinal tumor was found. The diagnosis was established histopathologically. The disease has no particular defining features clinically or radiologically and can mimic common spinal tumors. It is important to accurately diagnose this rare entity because of its multisystem involvement and progressive course. Strict treatment guidelines have yet to be formulated. Although histologically this disease can mimic other inflammatory conditions, the presence of storiform fibrosis and an increased number of IgG4-positive plasma cells can help in clarifying the diagnosis.

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Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools?

Neurosurgical FOCUS ◽

10.3171/2016.5.focus16141 ◽

2016 ◽

Vol 41 (2) ◽

pp. E18 ◽

Cited By ~ 31

Author(s):

Antonino Scibilia ◽

Carmen Terranova ◽

Vincenzo Rizzo ◽

Giovanni Raffa ◽

Adolfo Morelli ◽

...

Keyword(s):

Complex Function ◽

Spinal Tumor ◽

Neurological Deficits ◽

Neurological Injury ◽

Neurophysiological Monitoring ◽

Predictive Values ◽

Effective Role ◽

Mapping Techniques ◽

Sensitivity Specificity

Spinal tumor (ST) surgery carries the risk of new neurological deficits in the postoperative period. Intraoperative neurophysiological monitoring and mapping (IONM) represents an effective method of identifying and monitoring in real time the functional integrity of both the spinal cord (SC) and the nerve roots (NRs). Despite consensus favoring the use of IONM in ST surgery, in this era of evidence-based medicine, there is still a need to demonstrate the effective role of IONM in ST surgery in achieving an oncological cure, optimizing patient safety, and considering medicolegal aspects. Thus, neurosurgeons are asked to establish which techniques are considered indispensable. In the present study, the authors focused on the rationale for and the accuracy (sensitivity, specificity, and positive and negative predictive values) of IONM in ST surgery in light of more recent evidence in the literature, with specific emphasis on the role of IONM in reducing the incidence of postoperative neurological deficits. This review confirms the role of IONM as a useful tool in the workup for ST surgery. Individual monitoring and mapping techniques are clearly not sufficient to account for the complex function of the SC and NRs. Conversely, multimodal IONM is highly sensitive and specific for anticipating neurological injury during ST surgery and represents an important tool for preserving neuronal structures and achieving an optimal postoperative functional outcome.

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POS0294 PROFILE OF SPINAL TUMORS IN RHEUMATOLOGY DEPARTMENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3905 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 372.2-372

Author(s):

B. A. Hiba ◽

H. Sahli ◽

S. Boussaid ◽

S. Nouicer ◽

S. Jemmali ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Signal Intensity ◽

Spinal Tumor ◽

Sensory Function ◽

Spinal Tumors ◽

Vertebral Compression Fractures ◽

Myxopapillary Ependymoma ◽

Resonance Imaging ◽

Weighted Sequences

Background:Spine tumors remain a hot topic because of their associated morbidity by affecting motor and sensory function. Contrary to metastatic spine disease (MSD), extremely prevalent, rise within or surrounding the spinal cord and/or vertebral column, primary spinal tumors are rare, 5% of all primary skeletal tumors and frequently benign (20%). The diagnostic delay of these tumors, even when benign, is associated with a poor prognosis. Establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation.Objectives:to provide an overview of the epidemiology, radiological and histopathological of spinal tumors diagnosed in a rheumatology department.Methods:A retrospective study consisting of clinical characteristics analysis, laboratory and x-ray examinations, was performed on 40 patients who were hospitalised for a spinal tumor, in a rheumatology department, over 5-year period from 2015 to 2020.Results:A total of 40 patients with a mean age of 66 ± 13.5 years [18-93] and a sex-ratio of 1.1, were included. The most common initial complaints were inflammatory back pain (67.5%) and fatigue (52.5%), with a median duration of 5 months. Physical examination abnormalities included lumbar stiffness (32.5%), radicular signs (18.7%), hepatomegaly (12.5%), and lymphadenopathy (17.5%). Neurological deficit was found in only 3 patients (7.5%). Hypercalcemia (corrected serum calcium > 105 mg/l), and anemia (hemoglobin (Hb) < 100 g/l in female, Hb <110g/l in male) were present initially in respectively 47.5% and 46.3% patients, while biological inflammatory syndrome was present in 89.7% patients (median C-reactive protein of 44.7). Tumor markers were performed in 12 patients and they were positive in 9 of them.Plain radiographs findings were vertebral compression fractures (43.6%), osteolytic lesions (30.8%) and osteoblastic lesions (12.5%). Lumbar spine was the most affected (57.5%), followed by the dorsal spine (45%). Magnetic resonance imaging (MRI) was performed in 55%, and the most common lesion was low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences (68.1%).In our study, only one patient was diagnosed for a myxopapillary ependymoma, a benign primary spinal tumor characterised by a metastatic dissemination risk. For the rest (39 patients), the diagnosis of bone metastasis, multiple myeloma (57.7%), and of solid tumor cancers (40%), were established. Primary cancers were mainly prostate cancer (37.5%), lung cancer (18.7%) and kidney cancer (18.7%). By a median follow-up time of 25 months, overall survival rate was 30%.Conclusion:Extradural lesions are the most common, and are typically metastatic. Special attention should be pain to the patient’s medical history and laboratory abnormalities. In fact, an early diagnosis requires a high index of clinical suspicion.Disclosure of Interests:None declared

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Does preoperative transarterial embolization decrease blood loss during spine tumor surgery?

Interventional Neuroradiology ◽

10.15274/inr-2014-10091 ◽

2015 ◽

Vol 21 (1) ◽

pp. 129-135 ◽

Cited By ~ 9

Author(s):

Zhihong Qiao ◽

Ningyang Jia ◽

Qian He

Keyword(s):

Blood Loss ◽

Transarterial Embolization ◽

Surgical Excision ◽

Spinal Tumor ◽

Gelatin Sponge ◽

Spinal Tumors ◽

Control Group ◽

Time Interval ◽

Estimated Blood Loss ◽

Spine Tumor Surgery

This paper aimed to evaluate the effect of preoperative transarterial embolization (TAE) on estimated blood loss (EBL) during surgical excision of the vertebral tumors. Three hundred and forty-eight patients with spinal tumors were retrospectively analyzed. The preoperative TAE group consisted of 190 patients and the control group consisted of 158 patients. Gelatin sponge particles mixed withy contrast agent were used in the TAE group to embolize the tumor-feeding artery. The factors evaluated included: the time interval between embolism and surgery; the number of vertebrae involved by the tumor; pathological type of tumor; surgical approach; extent of excision and instrumental fixation. The time interval (P = 0.4669)between embolism and surgery had no significant correlation with EBL during surgery. The pathological diagnosis of vertebral tumor such as plasma cell myeloma, giant cell tumor, chondrosarcoma, hemangioma and metastasis had no significant correlation with EBL between the TAE group and control group during surgery, while the EBL of chordoma in the TAE group was significantly higher than that in the control group (p = 0.0254). The number of vertebrae involved (p = 0.4669, 0.6804, 0.6677), posterior approach (p = 0.3015), anterior approach (p = 0.2446), partial excision (p = 0.1911) and instrumental fixation (p = 0.1789) had no significant correlation with EBL during surgery between the TAE group and the control group. This study showed that preoperative TAE of the spinal tumor had no significant effect on intra-operative blood loss during surgical excision of the spinal tumor. In view of the risk of embolism, this method should be carefully considered.

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Hernia intraesponjosa de Schmörl sintomática. [Symptomatic intraosseous Schmörl herniation]

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2019.84.3.847 ◽

2019 ◽

Vol 84 (3) ◽

pp. 273-285

Author(s):

Joint Halley Guimbard Pérez ◽

Andrés Barriga-Martín ◽

Luis María Romero-Munóz

Keyword(s):

Pancreatic Cancer ◽

Literature Review ◽

Intervertebral Disc ◽

Nucleus Pulposus ◽

Vertebral Body ◽

Rheumatic Diseases ◽

Unusual Case ◽

Spinal Tumor ◽

Adjacent Vertebral Body ◽

Lumbar Spinal

Las hernias discales intraesponjosas vertebrales o nódulos de Schmörl consisten en una herniación o una extrusión del núcleo pulposo del disco intervertebral a través del platillo vertebral hacia el cuerpo adyacente. Suelen asociarse a deformidades vertebrales, como la enfermedad de Scheuermann, o a enfermedades reumáticas, como la espondilitis anquilopoyética. En general, son hallazgos casuales y cuadros asintomáticos; son pocos los casos publicados de nódulos sintomáticos. Su aparición estaría relacionada con un platillo vertebral debilitado por traumatismo o estrés repetido. Cuando el nódulo es agudo o reciente, puede ser difícil diferenciar la degeneración benigna de una infiltración maligna o una infección. Presentamos un caso inusual de un nódulo de Schmörl doloroso en un hombre sin antecedentes de relevancia, que enmascaró una lesión metastásica de carcinoma pancreático a nivel lumbar. Se realiza una revisión bibliográfica. ABSTRACTIntraosseous disc herniation –or Schmörl nodes (SN)– are a herniation or prolapse of the nucleus pulposus of the intervertebral disc through the vertebral plate and into the adjacent vertebral body. They are usually associated with vertebral deformities, suchas Scheuermann’s disease, or rheumatic diseases, such as ankylopoietic spondylitis. In general, they are spontaneous and asymptomatic findings, and there are only a few reported cases of symptomatic nodes. The etiology is supposedly related to a weakened spinal plate due to trauma or repeated stress. When the node is acute or recent, it can be difficult to differentiate a benign degeneration from a malignant infiltration or infection. In this paper, we discuss the unusual case of a painful Schmörl node in a man with no relevant history and a masked metastatic lumbar spinal tumor originated from pancreatic cancer. We performed a literature review.

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Thoracic spine schwannoma presenting with traumatic spinal cord injury: A case report

Surgical Neurology International ◽

10.25259/sni_856_2020 ◽

2021 ◽

Vol 12 ◽

pp. 251

Author(s):

Daniela Matos ◽

Ricardo Pereira

Keyword(s):

Case Report ◽

Thoracic Spine ◽

Spinal Tumor ◽

High Impact ◽

Good Recovery ◽

Motor Rehabilitation ◽

Thoracic Spinal ◽

Cord Injury ◽

Early Diagnose ◽

Dural Opening

Background: The presentation of a thoracic spinal tumor due to high-impact trauma is quite rare and we found no other case reported. Case Description: This is a case report and literature review. A patient presented with severe paraparesis on day 4 after trauma. Thoracic MRI showed an oval image centered to T4-T5 suggestive of hemorrhage. The patient underwent a bilateral T4 and T5 laminectomy and microsurgically assisted intradural exploration. After laminectomy, we found no extradural lesions, so we proceeded to dural opening, after which we found a large extramedullary lesion which was completely removed. Pathology revealed a schwannoma. The patient had a very good recovery after surgery and motor rehabilitation. At 6 months after surgery, inferior limbs muscle strength was completely normal. We found no other case reported. Conclusion: Thoracic spine schwannomas are difficult to early diagnose unless there is a clinical suspicion. Initial presentation as bleeding after trauma was not described before. This presentation should be kept in the differential diagnosis of any patient with an acute neurological deficit without trauma signs on admission imaging.

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