Simulated models for testing performance of a radiofrequency ablation device for spine tumors

Effectiveness of simulation models to assess performance a radiofrequency tumor ablation device.

Influence of tranexamic acid use on venous thromboembolism risk in patients undergoing surgery for spine tumors

OBJECTIVE Patients with spine tumors are at increased risk for both hemorrhage and venous thromboembolism (VTE). Tranexamic acid (TXA) has been advanced as a potential intervention to reduce intraoperative blood loss in this surgical population, but many fear it is associated with increased VTE risk due to the hypercoagulability noted in malignancy. In this study, the authors aimed to 1) develop a clinical calculator for postoperative VTE risk in the population with spine tumors, and 2) investigate the association of intraoperative TXA use and postoperative VTE. METHODS A retrospective data set from a comprehensive cancer center was reviewed for adult patients treated for vertebral column tumors. Data were collected on surgery performed, patient demographics and medical comorbidities, VTE prophylaxis measures, and TXA use. TXA use was classified as high-dose (≥ 20 mg/kg) or low-dose (< 20 mg/kg). The primary study outcome was VTE occurrence prior to discharge. Secondary outcomes were deep venous thrombosis (DVT) or pulmonary embolism (PE). Multivariable logistic regression was used to identify independent risk factors for VTE and the resultant model was deployed as a web-based calculator. RESULTS Three hundred fifty patients were included. The mean patient age was 57 years, 53% of patients were male, and 67% of surgeries were performed for spinal metastases. TXA use was not associated with increased VTE (14.3% vs 10.1%, p = 0.37). After multivariable analysis, VTE was independently predicted by lower serum albumin (odds ratio [OR] 0.42 per g/dl, 95% confidence interval [CI] 0.23–0.79, p = 0.007), larger mean corpuscular volume (OR 0.91 per fl, 95% CI 0.84–0.99, p = 0.035), and history of prior VTE (OR 2.60, 95% CI 1.53–4.40, p < 0.001). Longer surgery duration approached significance and was included in the final model. Although TXA was not independently associated with the primary outcome of VTE, high-dose TXA use was associated with increased odds of both DVT and PE. The VTE model showed a fair fit of the data with an area under the curve of 0.77. CONCLUSIONS In the present cohort of patients treated for vertebral column tumors, TXA was not associated with increased VTE risk, although high-dose TXA (≥ 20 mg/kg) was associated with increased odds of DVT or PE. Additionally, the web-based clinical calculator of VTE risk presented here may prove useful in counseling patients preoperatively about their individualized VTE risk.

Primary Osseous Spine Tumors in Adults: A Review and Update on Diagnosis and Treatment

Objective: This article aims to provide a convenient and comprehensive review describing unique features of the most common primary osseous spine tumors, as well as current diagnostic and therapeutic modalities for each tumor. Background: Primary osseous spine tumors are a rare and diverse group of neoplasms with varying biologic behavior. Clinical, radiographic, and pathologic correlation is critical in making a correct diagnosis. Prompt treatment is necessary to optimize clinical outcomes, and is based on tumor type, location, and disease stage. Most patients with spinal tumors present with a history of pain often similar in quality and intensity as non-tumoral etiologies of back pain. Spinal neoplasms, especially malignant tumors, require a multidisciplinary approach and are best treated in dedicated cancer centers to mitigate incorrect diagnoses and inappropriate treatment. Methods: A literature review was conducted using PubMed and EBSCO. Multiple search queries for relevant articles between 2014 to present were included. Preference was given to recent articles with clinical evidence, current treatment, diagnostic modalities and/or future potential therapies and diagnostic strategies. Results: Numerous modalities including surgery, chemotherapy, evolving immunologic and targeted therapies as well as stereotactic external beam radiation therapy are utilized to optimize care. Still, current therapeutic strategies result in significant morbidity and mortality and local disease recurrence and systemic relapse are common despite chemotherapy and advanced surgical techniques. Conclusion: Because primary spinal tumors are uncommon, level I and II data are scarce though novel treatment strategies are emerging. Medical and orthopaedic oncologists and spine surgeons therefore should have a fundamental knowledge of the current state of literature pertaining to this topic.