Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: A scoping review

The field of spinal oncology has substantially evolved over the past decades. This review synthesizes and appraises what was learned and what will potentially be discovered from the recently completed and ongoing clinical studies related to the treatment of primary and secondary spinal neoplasms. This scoping review included all clinical studies on the treatment of spinal neoplasms registered in the ClinicalTrials.gov website from February/2000 to December/2020. The terms “spinal cord tumor”, “spinal metastasis”, and “metastatic spinal cord compression” were used. Of the 174 registered clinical studies on primary spinal tumors and spinal metastasis, most of the clinical studies registered in this American registry were interventional studies led by single institutions in North America (n=101), Europe (n=43), Asia (n=24) or other continents (n=6). The registered clinical studies mainly focused on treatment strategies for spinal neoplasms (90.2%) that included investigating stereotactic radiosurgery (n=33), radiotherapy (n=21), chemotherapy (n=20), and surgical technique (n=11). Of the 69 completed studies, the results from 44 studies were published in the literature. In conclusion, this review highlights the key features of the 174 clinical studies on spinal neoplasms that were registered from 2000 to 2020. Clinical trials were heavily skewed towards the metastatic population as opposed to the primary tumours which likely reflects the rarity of the latter condition and associated challenges in undertaking prospective clinical studies in this population. This review serves to emphasize the need for a focused approach to enhancing translational research in spinal neoplasms with a particular emphasis on primary tumors.

Exacerbating of chronic disease as risk factor for surgical delay in patients with spinal metastases

Object. Determining the degree of influence of exacerbation of somatic pathology on the shift of the terms of surgical treatment in patients with spinal metastases. Methods. A retrospective analysis of the data of 210 patients with spinal neoplasms undergoing treatment in the period from 2013 to 2017 was performed. In this cohort, the average terms from the moment of determining the indications for surgical treatment to surgery, as well as the frequency of somatic pathology, which was a contraindication to surgical treatment, were analyzed Results. The average time from the moment of determining the indications for surgical treatment to surgery in the main cohort of patients was 46.4 days (12 - 86). An aggravation of the gastrointestinal tract pathology with the formation of ulcers or erosion of the stomach and duodenum was the most common cause of delayed surgical treatment (41%). At the same time, 86% of cases of this complication led to a shift in the timing of surgery to 1 month. The presence of foci of chronic infection statistically significantly determined the greatest duration of the preoperative period (> 1 month) in 52.6% of cases. Conclusion. An aggravation of the gastrointestinal tract pathology and the presence of foci of chronic infection in patients with metastatic spinal lesions are the most frequent contraindications to surgical treatment and the reasons for the increase in the duration of the preoperative period.

DIFFERENTIAL SIGNS IN THE DIAGNOSIS OF CONSTRICTIVE MYELOPATHY AND SPINAL NEOPLASMS IN THE THORACOLUMBAR REGION

Neoplasms of the spinal column and spinal cord, depending on their localization relative to the spinal cord and its membranes, are classified into extradural, intradural extramedullary and intramedullary. Extradural tumors are located outside the dura mater. This category includes tumors of the vertebral bodies and tumors lying in the extradural space of the spinal canal. Intradural extramedullary tumors are found within the dura but outside the spinal parenchyma. Intramedullary tumors originate within the spinal cord and are the rarest group of spinal tumors. The aim of the study is to determine the criteria for the differential diagnosis of studied pathology.

Spinal Space Occupying Lesions: A Comprehensive Study of Clinico-pathological Spectrum and Measure of Degree of Agreement Between the Diagnostic Modalities

Back ground: Spinal SOLs are quite fascinating group of lesions, comprising a minority of central nervous system lesions often resulting in significant morbidity. There is paucity of comprehensive population-based data of these SOLs in Indian subcontinent. Material and methods: The present study was a retrospective descriptive study conducted at the department of pathology, Kamineni Institute of Medical Sciences for 3 years starting from January 2017 to December 2019. Results: We analyzed eighty-nine spinal SOLs during the study period. Spinal neoplasms encompassed the largest number accounting for 70.7% of total spinal SOLs. Majority were reported in the 20-40 years’ age group with predominant male preponderance except for universal phenomenon of female predominance in meningioma. Back pain was the most common clinical presentation. Among spinal neoplasms, NSTs comprising of schwannoma and neurofibroma, was the most common finding and spinal tuberculosis was the most common non-neoplastic SOL. Majority of benign spinal tumors were distributed in the intradural extra medullary location and involved thoracic vertebrae. Malignant tumors predominantly involved extradural location and were clustered along thoracic and lumbar vertebrae. Measure of agreement between radiological and histopathological diagnosis using kappa statistics revealed almost perfect agreement for extradural spinal SOLs and moderate agreement for intradural intramedullary and intradural extra medullary SOLs. Conclusion: Comprehensive evaluation of spinal SOLs warrants multidisciplinary approach. Rapid advancements in radiology optimised diagnostic evaluation of non-neoplastic SOLs, however we conclude that histopathological evaluation is still the gold standard for diagnosis of primary spinal cord tumours and for planning the treatment and predicting prognosis.

Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients

OBJECTIVEWound breakdown and infection are common postoperative complications following resection of spinal neoplasms. Accordingly, it has become common practice at some centers for plastic surgeons to assist with closure of large posterior defects after spine tumor resection. In this study, the authors tested the hypothesis that plastic surgery closure of complex spinal defects improves wound outcomes following resection of spinal neoplastic disease.METHODSElectronic medical records of consecutive patients who underwent resection of a spinal neoplasm between June 2015 and January 2019 were retrospectively reviewed. Patients were separated into two subpopulations based on whether the surgical wound was closed by plastic surgery or neurosurgery. Patient demographics, preoperative risk factors, surgical details, and postoperative outcomes were collected in a central database and summarized using descriptive statistics. Outcomes of interest included rates of wound complication, reoperation, and mortality. Known preoperative risk factors for wound complication in spinal oncology were identified based on literature review and grouped categorically. The presence of each category of risk factors was then compared between groups. Univariate and multivariate linear regressions were applied to define associations between individual risk factors and wound complications.RESULTSOne hundred six patients met inclusion criteria, including 60 wounds primarily closed by plastic surgery and 46 by neurosurgery. The plastic surgery population included more patients with systemic metastases (58% vs 37%, p = 0.029), prior radiation (53% vs 17%, p < 0.001), prior chemotherapy (37% vs 15%, p = 0.014), and sacral region tumors (25% vs 7%, p = 0.012), and more patients who underwent procedures requiring larger incisions (7.2 ± 3.6 vs 4.5 ± 2.6 levels, p < 0.001), prolonged operative time (413 ± 161 vs 301 ± 181 minutes, p = 0.001), and greater blood loss (906 ± 1106 vs 283 ± 373 ml, p < 0.001). The average number of risk factor categories present was significantly greater in the plastic surgery group (2.57 vs 1.74, p < 0.001). Despite the higher relative risk, the plastic surgery group did not experience a significantly higher rate of wound complication (28% vs 17%, p = 0.145), reoperation (17% vs 9%, p = 0.234), or all-cause mortality (30% vs 13%, p = 0.076). One patient died from wound-related complications in each group (p = 0.851). Regression analyses identified diabetes, multilevel instrumentation, and BMI as the factors associated with the greatest wound complications.CONCLUSIONSInvolving plastic surgery in the closure of spinal wounds after resection of neoplasms may ameliorate expected increases in wound complications among higher-risk patients.

Common neoplastic causes of paediatric and adolescent back pain

Neoplasm of the spinal column in children is rare, but can involve either benign or malignant tumours. Early detection of malignant tumours is key to successful clinical outcome and long-term prognosis. In such cases, back pain is a common presenting symptom, but often has a non-neoplastic cause. Therefore, it is important for GPs and trainees who encounter paediatric patients to be aware of the clinical entity to be able to thoroughly assess them in clinical practice. This article discusses the types of paediatric spinal neoplasms, anatomical-based classification, clinical red flags, imaging modalities and outlines brief management options.