scholarly journals Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection

2003 ◽  
Vol 15 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Issada Thongtrangan ◽  
Raju S. V. Balabhadra ◽  
Hoang Le ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Vertebral Body ◽  
Tumor Resection ◽  
Anterior Column ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Wide Resection ◽  
Primary Tumors ◽  
Expandable Cage ◽  
Expandable Cages

Object The authors report their clinical experience with expandable cages used to stabilize the spine after verte-brectomy. The objectives of surgical treatment for spine tumors include a decrease in pain, decompression of the neural elements, mechanical stabilization of the spine, and wide resection to gain local control of certain primary tumors. Most of the lesions occur in the anterior column or vertebral body (VB). Anterior column defects following resection of VBs require surgical restoration of anterior column support. Recently, various expandable cages have been developed and used clinically for VB replacement (VBR). Methods Between January 2001 and June 2003, the authors treated 15 patients who presented with primary spinal tumors and metastatic lesions from remote sites. All patients underwent vertebrectomy, VBR with an expandable cage, and anterior instrumentation with or without posterior instrumentation, depending on the stability of the involved segment. The correction of kyphotic angle was achieved at an average of 20°. Pain scores according to the visual analog scale decreased from 8.4 to 5.2 at the last follow-up review. Patients whose Frankel neurological grade was below D attained at least a one-grade improvement after surgery. All patients achieved immediate stability postsurgery and there were no significant complications related to the expandable cage. Conclusions The advantage of the expandable cage is that it is easy to use because it permits optimal fit and correction of the deformity by in vivo expansion of the device. These results are promising, but long-term follow up is required.

scholarly journals Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

2020 ◽  
Vol 8 (B) ◽  
pp. 76-80
Author(s):  
Moneer K. Faraj ◽  
Bassam Mahmood Flamerz  Arkawazi ◽  
Hazim Moojid Abbas ◽  
Zaid Al-Attar
Keyword(s):  
Functional Outcome ◽  
Vertebral Body ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Spinal Tuberculosis ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Karnofsky Performance Status Scale ◽  
Significant Change

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors.

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

2019 ◽  
Vol 30 (6) ◽  
pp. 839-849 ◽  
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.

Thoracoscopic Vertebral Body Replacement with an Expandable Cage after Ventral Spinal Canal Decompression

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS317-ONS323 ◽  
Author(s):  
Brian T. Ragel ◽  
Amin Amini ◽  
Meic H. Schmidt
Keyword(s):  
Minimally Invasive ◽  
Vertebral Body ◽  
Visual Information ◽  
Length Of Hospital Stay ◽  
Vertebral Body Replacement ◽  
Minimal Access ◽  
Port Placement ◽  
Thoracoscopic Approach ◽  
Expandable Cage ◽  
Spine Pathology

Abstract Objective: Minimally invasive thoracic anterior surgery using a thoracoscopic approach has evolved to include spinal biopsy, debridement, discectomy, decompressive corpectomy, interbody fusions, and internal fixations. Minimal access techniques can potentially decrease surgical access morbidity and also reduce the time required for recovery and healing. The thoracoscopic approach for decompression, stabilization, and anterior vertebral reconstruction of thoracolumbar fractures is described. Methods: In this article and video, we discuss patient selection, surgical positioning, port placement, thoracic level localization, exposure and removal of fractured vertebral bodies, anterior vertebral column reconstruction using an expandable cage, instrumentation, and postoperative management. Results: The potential advantages of using a minimally invasive thoracoscopic approach include direct trajectory to anterior spine pathology, minimal tissue and rib retraction, and decreased postoperative pain and length of hospital stay. The associated disadvantages include the steep learning curve for the surgeon, the need to operate with two-dimensional visual information and long instruments, and the requirement that one have an experienced surgical assistant. Conclusion: Minimally invasive surgery using a thoracoscopic approach for vertebral body replacement with an expandable cage can be performed safely. Expandable cages facilitate the vertebral body reconstruction via minimal access surgery.

Sequentially Staged Resection and 2-Column Reconstruction for C2 Tumors Through a Combined Anterior Retropharyngeal–Posterior: Approach Surgical Technique and Results in 11 Patients

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons184-ons194 ◽  
Author(s):  
Xinghai Yang ◽  
Zhipeng Wu ◽  
Jianru Xiao ◽  
Honglin Teng ◽  
Dapeng Feng ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Posterior Approach ◽  
Tumor Resection ◽  
The Other ◽  
Neurological Improvement ◽  
Experienced Pain ◽  
Alive With Disease ◽  
Solid Fusion ◽  
Deep Location

Abstract BACKGROUND Surgical treatment of C2 tumors remains challenging. Because of the deep location and unique anatomical complexity, anterior exposure in this region is considered difficult and dangerous, and few reports concerning anterior tumor resection and reconstruction exist. OBJECTIVE To describe a technique of sequentially staged resection and 2-column reconstruction for C2 tumors through a combined anterior retropharyngeal–posterior approach. METHODS Eleven patients with C2 tumors underwent sequentially staged tumor resection and 2-column reconstruction in our institute. Eight primary lesions and 3 metastases were involved. Tumor resections and anterior reconstructions with conventional constructs were accomplished by an anterior retropharyngeal approach, and occipitocervical fusions through posterior access were performed in the same anesthesia. RESULTS No operative mortality occurred in this series. All patients experienced pain relief and neurological improvement after surgery. Except for 1 incidence of screw pullout, which was corrected by revision surgery, solid fusion was achieved in all patients. A follow-up period of 12 to 37 months was available for this study. Two patients with chordoma relapsed; 1 died of disease, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases. No evidence of local recurrence was found in the other patients. CONCLUSION The anterior retropharyngeal approach is a favorable route to treat tumor lesions of the C2 vertebral body that allows tumor resection and placement of anterior constructs between C1 and the subaxial vertebral body. Tumor resection and 2-column reconstruction could safely be accomplished simultaneously through the combined anterior retropharyngeal–posterior approach.

scholarly journals Interbody distraction and vertebral body reconstruction with polymethylmethacrylate for the treatment of pathological fractures

2017 ◽  
Vol 27 (6) ◽  
pp. 700-708 ◽  
Author(s):  
Scott L. Zuckerman ◽  
Ganesh Rao ◽  
Laurence D. Rhines ◽  
Ian E. McCutcheon ◽  
Richard G. Everson ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Single Stage ◽  
Anterior Column ◽  
Survival Duration ◽  
Pathological Fractures ◽  
Primary Tumors ◽  
Postoperative Changes ◽  
Radiographic Measurements ◽  
Anterior Column Reconstruction

OBJECTIVETreatment of epidural spinal cord compression (ESCC) caused by tumor includes surgical decompression and stabilization followed by postoperative radiation. In the case of severe axial loading impairment, anterior column reconstruction is indicated. The authors describe the use of interbody distraction to restore vertebral body height and correct kyphotic angulation prior to reconstruction with polymethylmethacrylate (PMMA), and report the long-term durability of such reconstruction.METHODSA single institution, prospective series of patients with ESCC undergoing single-stage decompression, anterior column reconstruction, and posterior instrumentation from 2013 to 2016 was retrospectively analyzed. Several demographic, perioperative, and radiographic measurements were collected. Descriptive statistics were compiled, in addition to postoperative changes in anterior height, posterior height, and kyphosis. Paired Student t-tests were performed for each variable. Overall survival was calculated using the techniques described by Kaplan and Meier.RESULTSTwenty-one patients underwent single-stage posterior decompression with interbody distraction and anterior column reconstruction using PMMA. The median age and Karnofsky Performance Scale score were 61 years and 70, respectively. Primary tumors included renal cell (n = 8), lung (n = 4), multiple myeloma (n = 2), prostate (n = 2), and other (n = 5). Eighteen patients underwent a single-level vertebral body reconstruction and 3 underwent multilevel transpedicular corpectomies. The median survival duration was 13.3 months. In the immediate postoperative setting, statistically significant improvement was noted in anterior body height (p = 0.0017, 95% confidence interval [CI] −4.15 to −1.11) and posterior body height (p = 0.0116, 95% CI −3.14 to −0.45) in all patients, and improved kyphosis was observed in those with oblique endplates (p = 0.0002, 95% CI 11.16–20.27). In the median follow-up duration of 13.9 months, the authors observed 3 cases of asymptomatic PMMA subsidence. One patient required reoperation in the form of extension of fusion.CONCLUSIONSIn situ interbody distraction allows safe and durable reconstruction with PMMA, restores vertebral height, and corrects kyphotic deformities associated with severe pathological fractures caused by tumor. This is accomplished with minimal manipulation of the thecal sac and avoiding an extensive 360° surgical approach in patients who cannot tolerate extensive surgery.

scholarly journals Sagittal deformity correction with expandable cages with large endplates for thoracolumbar vertebral body replacement

2021 ◽  
Vol 1 ◽  
pp. 100421
Author(s):  
S. Motov ◽  
B. Stemmer ◽  
B. Sommer ◽  
M.N. Bonk ◽  
C. Wolfert ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Deformity Correction ◽  
Vertebral Body Replacement ◽  
Sagittal Deformity ◽  
Expandable Cages

scholarly journals Dorsal instrumentation with and without vertebral body replacement in patients with thoracolumbar osteoporotic fractures shows comparable outcome measures

2021 ◽  
Author(s):  
Maximilian Schwendner ◽  
Stefan Motov ◽  
Yu-Mi Ryang ◽  
Bernhard Meyer ◽  
Sandro M. Krieg
Keyword(s):  
Vertebral Body ◽  
Thoracolumbar Spine ◽  
Osteoporotic Fractures ◽  
The Elderly ◽  
Vertebral Body Replacement ◽  
Inclusion Criteria ◽  
Dorsal Instrumentation ◽  
The Individual

Abstract Purpose In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1–31.6°) compared to 6.0 ± 5.6° (0.2–22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1–11.8 years) and was 0.56 ± 0.32 (− 0.21–1.00) for VBR compared to 0.56 ± 0.34 (− 0.08–1.00) without VBR after dorsal instrumentation (p = 0.994). Conclusion 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.

scholarly journals Sarcomas of the extremities and the pelvis: comparing local recurrence after incisional and after core-needle biopsy

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexander Klein ◽  
Christof Birkenmaier ◽  
Julian Fromm ◽  
Thomas Knösel ◽  
Dorit Di Gioia ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Tumor Resection ◽  
Soft Tissue Sarcomas ◽  
Wide Resection ◽  
Incisional Biopsy ◽  
Core Needle

Abstract Background The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas. Methods We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival. Results One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy. Conclusions In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result.

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