Management of cervical spine deformity after intradural tumor resection

Management of intradural spinal tumors requires posterior decompressive techniques. Cervical spine deformity secondary to sagittal and/or coronal imbalance after a laminectomy may result in significant cervical pain and functional deterioration, as well as neurological deficits in the most severe cases. In this paper, the authors discuss the management of cervical spine deformity after intradural tumor resection, with emphasis on the surgical strategies required to reestablish acceptable cervical spine alignment and to correct postoperative deformity. In general, after an oncological evaluation, assessing the alignment, extent, and flexibility of the deformity is mandatory before surgical planning. Rigid deformities require an osteotomy and, most often, combined approaches to restore cervical alignment. Flexible deformities can often be treated with a single approach, although a circumferential approach has its advantages.

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Customized “Whole-Cervical-Vertebral-Body” Reconstruction After Modified Subtotal Spondylectomy of C2-C7 Spinal Tumor Via Piezoelectric Surgery

Operative Neurosurgery ◽

10.1093/ons/opz077 ◽

2019 ◽

Vol 17 (6) ◽

pp. 580-587 ◽

Cited By ~ 5

Author(s):

Shaohui He ◽

Xinghai Yang ◽

Jian Yang ◽

Chen Ye ◽

Weibo Liu ◽

...

Keyword(s):

Cervical Spine ◽

Tumor Resection ◽

Three Dimensional ◽

Radical Resection ◽

Spinal Tumor ◽

Uneventful Recovery ◽

Spinal Tumors ◽

Neurological Improvement ◽

Piezoelectric Surgery ◽

3D Printed

Abstract BACKGROUND Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine. OBJECTIVE To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery. METHODS A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability. RESULTS The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence. CONCLUSION The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.

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Diagnostic and therapeutic values of intraoperative electrophysiological neuromonitoring during resection of intradural extramedullary spinal tumors: a single-center retrospective cohort and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2018.11.spine181095 ◽

2019 ◽

Vol 30 (6) ◽

pp. 839-849 ◽

Cited By ~ 3

Author(s):

Wataru Ishida ◽

Joshua Casaos ◽

Arun Chandra ◽

Adam D’Sa ◽

Seba Ramhmdani ◽

...

Keyword(s):

Evoked Potentials ◽

Predictive Value ◽

Meta Analysis ◽

Tumor Resection ◽

Diagnostic Value ◽

Neurological Deficits ◽

Spinal Tumors ◽

Intradural Extramedullary ◽

Baseline Characteristics

OBJECTIVEWith the advent of intraoperative electrophysiological neuromonitoring (IONM), surgical outcomes of various neurosurgical pathologies, such as brain tumors and spinal deformities, have improved. However, its diagnostic and therapeutic value in resecting intradural extramedullary (ID-EM) spinal tumors has not been well documented in the literature. The objective of this study was to summarize the clinical results of IONM in patients with ID-EM spinal tumors.METHODSA retrospective patient database review identified 103 patients with ID-EM spinal tumors who underwent tumor resection with IONM (motor evoked potentials, somatosensory evoked potentials, and free-running electromyography) from January 2010 to December 2015. Patients were classified as those without any new neurological deficits at the 6-month follow-up (group A; n = 86) and those with new deficits (group B; n = 17). Baseline characteristics, clinical outcomes, and IONM findings were collected and statistically analyzed. In addition, a meta-analysis in compliance with the PRISMA guidelines was performed to estimate the overall pooled diagnostic accuracy of IONM in ID-EM spinal tumor resection.RESULTSNo intergroup differences were discovered between the groups regarding baseline characteristics and operative data. In multivariate analysis, significant IONM changes (p < 0.001) and tumor location (thoracic vs others, p = 0.018) were associated with new neurological deficits at the 6-month follow-up. In predicting these changes, IONM yielded a sensitivity of 82.4% (14/17), specificity of 90.7% (78/86), positive predictive value (PPV) of 63.6% (14/22), negative predictive value (NPV) of 96.3% (78/81), and area under the curve (AUC) of 0.893. The diagnostic value slightly decreased in patients with schwannomas (AUC = 0.875) and thoracic tumors (AUC = 0.842). Among 81 patients who did not demonstrate significant IONM changes at the end of surgery, 19 patients (23.5%) exhibited temporary intraoperative exacerbation of IONM signals, which were recovered by interruption of surgical maneuvers; none of these patients developed new neurological deficits postoperatively. Including the present study, 5 articles encompassing 323 patients were eligible for this meta-analysis, and the overall pooled diagnostic value of IONM was a sensitivity of 77.9%, a specificity of 91.1%, PPV of 56.7%, and NPV of 95.7%.CONCLUSIONSIONM for the resection of ID-EM spinal tumors is a reasonable modality to predict new postoperative neurological deficits at the 6-month follow-up. Future prospective studies are warranted to further elucidate its diagnostic and therapeutic utility.

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Osteoid Osteoma and Osteoblastoma of the Cervical Spine: The Cause of Unusual Persistent Neck Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2010/13/549 ◽

2010 ◽

Vol 6;13 (6;12) ◽

pp. 549-554

Author(s):

Tuncay Kaner

Keyword(s):

Cervical Spine ◽

Retrospective Study ◽

Neck Pain ◽

Osteoid Osteoma ◽

Tumor Resection ◽

Spinal Instrumentation ◽

The Other ◽

Neurological Deficits ◽

Common Symptom

Background: The most important symptom in patients with osteoid osteoma and osteoblastoma is a resistant localized neck pain and stiffness in the spine. Objective: To evaluate and analyze 6 cases of osteoid osteoma and osteoblastoma of the cervical spine that were surgically treated over a 7-year period and to emphasize the unusual persistent neck pain associated with osteoid osteoma and osteoblastoma of the cervical spine. Study Design: Retrospective study. Methods: Six patients, 3 male and 3 female, with a mean age of 21 years (range 16-31) diagnosed with osteoid osteoma or osteoblastoma during 2003 to 2009 were analyzed retrospectively. The preoperative neurological and clinical symptoms, neck pain duration, preoperative deformity, location of lesion, radiological findings, surgical technique and clinical follow-up outcomes of each patient were evaluated. Results: The average follow-up duration was 40.5 months (range, 19 to 83 months). Three patients had osteoid osteoma (2 female and one male), and 3 patients had osteoblastoma (one female and 2 male). Two male patients had recurrent osteoblastoma. The locations of the lesions were as follows: C7 (2 patients), C3 (one patient), C2 (one patient), C3-C4 (one patient) and C5-C6 (one patient). The most common symptom was local neck pain in the region of the tumor. Among all patients, only one patient, who had osteoblastoma, had neurological deficits (right C5-C6 root symptoms). The other patients had no neurological deficits. All patients were treated with surgical resection using microsurgery. Two patients underwent only tumor resection, one patient underwent tumor resection and fusion, and the other 3 patients underwent tumor resection, fusion and spinal instrumentation. No perioperative complications developed in any of our patients. There was no tumor recurrence during the follow-up period. Limitations: A retrospective study with 6 analyses of cases. Conclusion: Surgical treatment of osteoid osteoma and osteoblastoma of the spine has been standardized. The most common symptom of osteoid osteoma and osteoblastoma of the cervical spine is local persistent neck pain in the region of the tumor. This symptom can be significant in the diagnosis of these tumors. Key words: neck pain, osteoid osteoma, osteoblastoma, bone tumors, cervical spine

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A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors

Journal of Neurosurgery Spine ◽

10.3171/2011.1.spine09860 ◽

2011 ◽

Vol 14 (6) ◽

pp. 758-764 ◽

Cited By ~ 36

Author(s):

Daniel C. Lu ◽

Dean Chou ◽

Praveen V. Mummaneni

Keyword(s):

Blood Loss ◽

Scale Score ◽

Tumor Resection ◽

Open Group ◽

Spinal Tumors ◽

Open Approach ◽

Score Improvement ◽

Intradural Tumor ◽

Significant Difference ◽

Mini Open

Object Standard approaches to thoracic intradural tumors often involve a large incision and significant tissue destruction. Minimally invasive techniques have been applied successfully for a variety of surgical decompression procedures but have been rarely used for the removal of intradural thoracolumbar tumors. In this paper, the authors compare the clinical outcome of mini-open resection of intradural thoracolumbar tumors with a standard open technique. Methods The authors retrospectively reviewed their series of 18 consecutive mini-open thoracolumbar, intradural, tumor resection cases and compared the outcomes with a profile-matched cohort of 9 cases of open intradural tumor resection. Operative statistics, functional outcome, and complications were compared. Results Tumors were removed successfully using both approaches, except for 1 case in the mini-open cohort in which only biopsy was performed for a diffusely infiltrating tumor (glioblastoma). There was no statistically significant difference in operative duration, American Spinal Injury Association scale score improvement, or back pain visual analog scale score improvement between groups. However, the mini-open group demonstrated a significantly lower estimated blood loss (153 vs 372 ml, respectively) and a significantly shorter length of hospitalization (4.9 vs 8.2 days, respectively). There was 1 complication of pseudomeningocele formation in the mini-open cohort and 1 complication of cerebral infarction in the open cohort. Mean follow-up length was 16 months in the mini-open group compared with 20 months in the open group. Conclusions The mini-open approach allows for adequate treatment of intradural thoracolumbar tumors with comparable outcomes to standard, open approaches. The mini-open approach is associated with less blood loss and a shorter length of stay compared with standard open surgery.

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Spinal Nerves Schwannomas: Experience on 367 Cases—Historic Overview on How Clinical, Radiological, and Surgical Practices Have Changed over a Course of 60 Years

Neurology Research International ◽

10.1155/2017/3568359 ◽

2017 ◽

Vol 2017 ◽

pp. 1-12 ◽

Cited By ~ 6

Author(s):

Jacopo Lenzi ◽

Giulio Anichini ◽

Alessandro Landi ◽

Alfonso Piciocchi ◽

Emiliano Passacantilli ◽

...

Keyword(s):

Tumor Resection ◽

Neurological Impairment ◽

Neurological Deficits ◽

Spinal Tumors ◽

Diagnostic Tools ◽

Treatment Goals ◽

Neurophysiologic Monitoring ◽

Spinal Nerves ◽

Treatment Techniques ◽

Before And After

Background.Spinal schwannomas are common benign spinal tumors. Their treatment has significantly evolved over the years, and preserving neurological functions has become one of the main treatment goals together with tumor resection.Study Design and Aims.Retrospective review focused on clinical assessment, treatment techniques, and outcomes.Methods.A retrospective study on our surgical series was performed. Clinical and operative data were analyzed. In regard to neurophysiologic monitoring, patients were retrospectively divided into two groups comparing the outcomes before and after introduction of routine intraoperative neurophysiology tests.Results.From 1951 to 2010, 367 patients overall were treated. Diagnosis was obtained using angiography and/or myelography (pre-CT era), MRI, or CT scan. A posterior spinal approach was used for most patients; complex approaches were adopted for treatment of giant/dumbbell tumors. A trend of neurophysiology monitoring decreasing the rate of post-op neurological deficits was observed but was not statistically significant enough to draft evidence-based conclusions.Conclusions.Clinical and radiological assessment of spinal schwannomas has markedly changed over the course of 50 years. Diagnostic tools have improved, and detection of recurrence has become way more sensitive. Neurophysiologic monitoring has become a useful intraoperative tool to guide resection and prevent post-op neurological impairment.

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Short-term Progressive Spinal Deformity Following Laminoplasty Versus Laminectomy for Resection of Intradural Spinal Tumors

Neurosurgery ◽

10.1227/01.neu.0000367721.73220.c9 ◽

2010 ◽

Vol 66 (5) ◽

pp. 1005-1012 ◽

Cited By ~ 73

Author(s):

Matthew J. McGirt ◽

Giannina L. Garcés-Ambrossi ◽

Scott L. Parker ◽

Daniel M. Sciubba ◽

Ali Bydon ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Spinal Deformity ◽

Tumor Resection ◽

Cerebrospinal Fluid Leak ◽

Neurological Function ◽

Spinal Tumors ◽

Short Term ◽

Intradural Tumor ◽

Fluid Leak

Abstract OBJECTIVE Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution. METHODS We retrospectively reviewed the records of 238 consecutive patients undergoing resection of intradural tumor at a single institution. The incidence of subsequent progressive kyphosis or scoliosis, perioperative morbidity, and neurological outcome were compared between the LP and LM cohorts. RESULTS One hundred eighty patients underwent LM and 58 underwent LP. Patients were 46 ± 19 years old with median modified McCormick score of 2. Tumors were intramedullary in 102 (43%) and extramedullary in 102 (43%). All baseline clinical, radiographic, and operative variables were similar between the LP and LM cohorts. LP was associated with a decreased mean length of hospitalization (5 vs 7 days; P = .002) and trend of decreased incisional cerebrospinal fluid leak (3% vs 9%; P = .14). Following LP vs LM, 5 (9%) vs 21 (12%) patients developed progressive deformity (P = .728) a mean of 14 months after surgery. The incidence of progressive deformity was also similar between LP vs LM in pediatric patients < 18 years of age (43% vs 36%), with preoperative scoliosis or loss of cervical/lumbar lordosis (28% vs 22%), or with intramedullary tumors (11% vs 11%). CONCLUSION LP for the resection of intradural spinal tumors was not associated with a decreased incidence of short-term progressive spinal deformity or improved neurological function. However, LP may be associated with a reduction in incisional cerebrospinal fluid leak. Longer-term follow-up is warranted to definitively assess the long-term effect of LP and the risk of deformity over time.

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Spinal dural resection for oncological purposes: a systematic analysis of risks and outcomes in patients with malignant spinal tumors

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19477 ◽

2020 ◽

Vol 32 (1) ◽

pp. 69-78

Author(s):

Sean M. Barber ◽

Sanjay Konakondla ◽

Jonathan Nakhla ◽

Jared S. Fridley ◽

Jimmy Xia ◽

...

Keyword(s):

Statistical Significance ◽

Epithelioid Sarcoma ◽

Tumor Resection ◽

Spinal Metastases ◽

Neurological Deficits ◽

Spinal Tumors ◽

Spinal Neoplasms ◽

Oncological Outcomes ◽

Small Series

OBJECTIVEOncological outcomes for many malignant primary spinal tumors and isolated spinal metastases have been shown to correlate with extent of resection. For tumors with dural involvement, some authors have described spinal dural resection at the time of tumor resection in the interest of improving oncological outcomes. The complication profile associated with resection of the spinal dura for oncological purposes, however, and the relative influence of resecting tumor-involved dura on progression-free survival are not well defined. The authors performed a systematic review of the literature and identified cases in which the spinal dura was resected for oncological purposes in the interest of better understanding the associated risks and outcomes of this technique.METHODSElectronic databases (PubMed/MEDLINE, Scopus) were systematically searched to identify studies that reported clinical and/or oncological outcomes of patients with malignant spinal neoplasms undergoing resection of tumor-involved dura at the time of surgical intervention.RESULTSTen articles describing 15 patients were included in the analysis. The most common tumor histologies were chordoma (3/15, 20%), giant cell tumor (3/15, 20%), epithelioid sarcoma (2/15, 13.3%), osteosarcoma (2/15, 13.3%), and metastasis (2/15, 13.3%). Procedure-related complications were reported in 40% of patients. A trend was seen toward an increased complication rate in redo (66.7%) versus index (16.7%) operations, but this trend did not reach statistical significance (p = 0.24). New, unexpected postoperative neurological deficits were seen in 3 patients (of 14 reporting, 21.4%). A single patient experienced a profound, unexpected neurological deterioration (paraparesis/paraplegia) after surgery, which reportedly improved considerably at latest follow-up. Tumor recurrence was seen in 3 cases (of 12 reporting, 25%) at a mean of 28.34 ± 21.1 months postoperatively. The overall mean radiographic follow-up period was 49.6 ± 36.5 months.CONCLUSIONSResection of the spinal dura for oncological purposes is rarely performed, although a limited number of reports and small series have demonstrated that it is feasible. Spinal dural resection is primarily performed in patients with isolated, primary spinal neoplasms with an intent to cure. The risk associated with spinal dura resection is nontrivial and the complication profile is significant. The influence of dural resection on oncological outcomes is not well defined, and further study is needed before definitive conclusions may be drawn regarding the oncological benefit of dural resection for any particular patient or pathology.

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Cervical spine deformity associated with resection of spinal cord tumors

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.2.3 ◽

2006 ◽

Vol 20 (2) ◽

pp. 1-7 ◽

Cited By ~ 47

Author(s):

Daniel R. Fassett ◽

Randy Clark ◽

Douglas L. Brockmeyer ◽

Meic H. Schmidt

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Sagittal Plane ◽

Cervical Spinal Cord ◽

Tumor Resection ◽

Spine Deformity ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Spine Deformities ◽

Anterior Posterior

✓ Postoperative sagittal-plane cervical spine deformities are a concern when laminectomy is performed for tumor resection in the spinal cord. These deformities appear to occur more commonly after resection of intramedullary spinal cord lesions, compared with laminectomy for stenosis caused by degenerative spinal conditions. Postlaminectomy deformities are most common in pediatric patients with an immature skeletal system, but are also more common in young adults (< 25 years of age) in comparison with older adults. The extent of laminectomy and facetectomy, number of laminae removed, location of laminectomy, preoperative loss of lordosis, and postoperative radiation therapy in the spine have all been reported to influence the risk of postlaminectomy spinal deformities. When these occur, patients should be monitored closely with serial imaging studies, because a significant percentage will have progressive deformities. These can range from focal kyphosis to more complicated swan-neck deformities. General indications for surgical intervention include progressive deformity, axial pain in the area, and neurological symptoms attributable to the deformity. Surgical options include anterior, posterior, and combined anterior–posterior procedures. The authors have reviewed the literature on postlaminectomy kyphosis as it relates to resection of cervical spinal cord tumors, and they summarize some general factors to consider when treating these patients.

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Benign Giant Cell Lesion of C1 Lateral Mass: A Case Report and Literature Review

Brain Sciences ◽

10.3390/brainsci9050105 ◽

2019 ◽

Vol 9 (5) ◽

pp. 105 ◽

Cited By ~ 2

Author(s):

Christopher Heinrich ◽

Vadim Gospodarev ◽

Albert Kheradpour ◽

Craig Zuppan ◽

Clifford C. Douglas ◽

...

Keyword(s):

Cervical Spine ◽

Giant Cell ◽

Patient Population ◽

Pediatric Population ◽

Tumor Resection ◽

Surgical Techniques ◽

Spinal Column ◽

Spinal Tumors ◽

Giant Cell Lesion ◽

Posterior Instrumented Fusion

Primary osseous tumors of the spinal column account for approximately 1% of the total number of spinal tumors found in the pediatric patient population. The authors present a case of a C1 benign giant cell lesion that was incidentally found in a 15-year-old patient. A transoral biopsy was performed followed by treatment with denosumab, with definitive management in the form of transoral tumor resection with subsequent occiput-cervical three posterior instrumented fusion. The patient tolerated all of the procedures well, as there were no post-operative complications, discharged home neurologically intact and was eager to return to school when assessed during a follow-up visit in clinic. Osteolytic lesions affecting the cervical spine are rare in the pediatric population. It is of utmost importance to have sufficient background knowledge in order to formulate a differential diagnosis, as well as an understanding of principles underlying surgical techniques required to prevent occipital-cervical instability in this patient population. The information presented will guide surgical decision-making by identifying the patient population that would benefit from neurosurgical interventions to stabilize the atlantoaxial junction, in the context of rare osteolytic conditions affecting the cervical spine.

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Instrumentation following intradural tumor resection: A case analyses and literature review

Surgical Neurology International ◽

10.25259/sni_96_2020 ◽

2020 ◽

Vol 11 ◽

pp. 131 ◽

Cited By ~ 1

Author(s):

Brandon Michael Wilkinson ◽

Michael Galgano

Keyword(s):

Pediatric Patients ◽

Sagittal Alignment ◽

Tumor Resection ◽

Spinal Tumors ◽

Spine Biomechanics ◽

Tumor Removal ◽

Increased Risk ◽

Intradural Tumor ◽

Postoperative Spine ◽

Sagittal Deformity

Background: Resection of intradural spinal tumors typically utilizes a posterior approach and often contributes to significant biomechanical instability and sagittal deformity. Methods: We searched PubMed for studies regarding pre- and postoperative spine biomechanics/alignment in patients with intradural tumors undergoing posterior decompressions. Results: Three patients underwent posterior decompressions with instrumented fusions to preserve good sagittal alignment postoperatively. Variables analyzed in this study included the extent of preoperative and postoperative deformity, the number of surgical levels decompressed and fused, the different frequencies of instability following the resection of cervical versus thoracic versus lumbar lesions, and whether pediatric patients were most likely to develop instability. Conclusion: Simultaneously performing instrumented fusions following posterior spinal decompressions for tumor removal proved optimal in preventing postoperative spinal deformity. Further, “open” surgical procedures offered more optimal/definitive tumor removal versus minimally invasive approaches, and the greater operative exposure and resultant increased risk for instability were remediated by performing simultaneous fusion.

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