The multidisciplinary treatment model led by surgery has become a comprehensive strategy and overall concept for the treatment of spinal metastatic tumors. But the surgical treatment of spinal metastatic tumors is different from primary malignant tumors of the spine. Surgery is only a part of the multidisciplinary comprehensive treatment. Therefore, the following aspects need to be evaluated comprehensively based on the survival assessment, evaluation of spinal stability damage, nerve dysfunction, and oncological characteristics of the metastatic tumors with a reasonable surgical intervention. The attention should be paid to the minimally invasive treatment of spinal metastases, progress of new radiotherapy technology, neoadjuvant chemotherapy, targeted drug therapy and other medical treatment to make a comprehensive and individualization decision which is benefit to relieve patients ' pain, reconstruct spinal stability and avoid paralysis. While improving patient survival, increasing local tumor control rate and possibly prolonging survival time, avoiding excessive surgery as much as possible.
Humans ; Spine/surgery* ; Spinal Neoplasms/surgery*

PURPOSETo investigate the usefulness of three-dimensional (3D) printing in complex spinal surgery.

METHODSThe study was conducted from October 2014 to March 2015 in Shenzhen Second Peoples' Hospital and 4 cases of complex severe spinal disorders were selected from our department. Among them one patient combined with congenital scoliosis, one with atlas neoplasm, one with atlantoaxial dislocation, and the rest one with atlantoaxial fracture-dislocation. The data of the diseased region was collected from computerized tomography scans for 3D digital reconstruction and rapid prototyping to prepare photosensitive resin models, which were applied in the treatment of these cases.

RESULTSThe use of 3D models reduced operating time and intraoperative blood loss as well as the risk of postoperative complications. Furthermore, no pedicle penetrations or screw misplacement occurred according to the postoperative planar radiographic images.

CONCLUSIONThe tactile models from 3D printing allow direct observation and measurement, helping the orthopedists to have accurate morphometric information to provide personalized surgical planning and better communication with the patient and coworkers. Moreover, the photosensitive resin models can also guide the actual surgery with the drilling of pedicle screws and safe resection of tumor.

Aged ; Child ; Humans ; Male ; Precision Medicine ; Printing, Three-Dimensional ; Scoliosis ; surgery ; Spinal Diseases ; surgery ; Spinal Fractures ; surgery ; Spinal Neoplasms ; surgery

Humans ; Osteoblastoma/surgery* ; Neck/surgery* ; Spinal Neoplasms ; Cervical Vertebrae

OBJECTIVE: To explore the feasibility and key technology of microscopic resection of lumbar intraspinal tumor through microchannel keyhole approach. METHODS: The clinical features, imaging characteristics and surgical methods of 54 cases of lumbar intraspinal tumor which were microscopically operated by microchannel from February 2017 to September 2019 were reviewed and analyzed. There were 8 cases of extradural tumor, 3 cases of extra-and intradural tumor and 43 cases of subdural extramedullary tumor (including 3 cases of ventral spinal tumor). The tumors were 0.5-3.0 cm in diameter. The clinical symptoms included 49 cases of pain in the corresponding innervation area, 5 cases of sensory disturbance (numbness) at or below the tumor segment, 7 cases of limb weakness and 2 cases of urination and defecation dysfunction. RESULTS: In the study, 37 tumors were resected through hemilaminectomy, 14 tumors were resected through interlaminar fenestration, 3 tumors were resected through hemilaminectomy or interlaminar fenestration combined with facetectomy of medial 1/4 facet. All of the 54 tumors were totally resected. The operation time was 75-135 min, with an average of 93.3 min. The postoperative hospital stay was 4-7 days, with an average of 5.7 days. Postoperative pathology included 34 cases of schwannoma, 4 cases of meningioma, 9 cases of ependymoma, 1 case of enterogenous cyst, 5 cases of teratoma/epidermoid/dermoid cyst, and 1 case of paraganglioma. No infection or cerebrospinal fluid leakage was found after operation. No neurological dysfunction occurred except 1 case of urination dysfunction and 4 cases of limb numbness. The follow-up period ranged from 3 to 33 months with an average of 14.4 months. Five patients with new onset symptoms returned to normal. The pain symptoms of 49 patients were completely relieved; 4 of 5 patients with hypoesthesia recovered completely, the other 1 patient had residual mild hypoesthesia; 7 patients with limb weakness, and 2 patients with urination and defecation dysfunction recovered to normal. No spinal instability or deformity was found, and no recurrence or residual tumors were found. According to McCormick classification, they were of all grade Ⅰ. CONCLUSION The lumbar intraspinal extramedullary tumors within two segments (including the ventral spinal tumors) can be totally resected at stage Ⅰ through microchannel keyhole approach with appropriate selection of the cases. Microchannel technique is beneficial to preserve the normal structure and muscle attachment of lumbar spine, and to maintain the integrity and stability of lumbar spine.
Humans ; Hypesthesia ; Lumbar Vertebrae/surgery* ; Meningeal Neoplasms ; Pain ; Retrospective Studies ; Spinal Cord Neoplasms/surgery* ; Spinal Neoplasms/surgery* ; Treatment Outcome

Bone tumor metastases is relatively common. Approximately 5%-20% of spinal metastatic tumors will finally invade the spinal cord and exacerbate symptoms. The adoption of combined approach in recent years has significantly increased the survival rate. After excision of the tumors, internal fixation instrumentations are needed to stabilize the vertebrae. These procedures must be performed under the condition that the patients can tolerate the operation. Fused vertebra with instrumentation may cause degenerative diseases at the adjacent segments, which has been a problem of concern recently. Results of biomechanical tests indicated that these degenerative changes are related to the increased motion range of the neighboring segments. An old view is "the more rigid the instrumentation is, the better the results are", which has been disproved by clinical evidences. Improper use of internal spine fixation instrument should be avoided. Artificial intervertebral disc replacement can produce favorable short-time effects, however, its long-term effects and complications still requires further observations.
Humans ; Internal Fixators ; Intervertebral Disc ; surgery ; Spinal Fusion ; adverse effects ; methods ; Spinal Neoplasms ; secondary ; surgery ; Spine ; surgery

Adult ; Diagnosis, Differential ; Endometriosis ; pathology ; surgery ; Female ; Humans ; Laminectomy ; Spinal Canal ; pathology ; surgery ; Spinal Diseases ; pathology ; surgery ; Spinal Neoplasms ; pathology ; surgery

Adult ; Cervical Vertebrae ; pathology ; surgery ; Humans ; Male ; Spinal Neoplasms ; pathology ; surgery ; Teratoma ; pathology ; surgery

OBJECTIVETo evaluate the clinical outcomes of total en-bloc spondylectomy (TES) in recurrence spinal tumor.

METHODSThe study was a retrospective study of recurrence spinal tumor from January 2010 to October 2013. A total of 6 patients with recurrent spinal tumor underwent TES procedures, with 5 cases located in thoracic spine and 1 case located in L1. There were 3 male and 3 female patients, with a mean age of 33.2 years. Pathological diagnosis included giant cell tumor of bone in 3 cases, breast cancer, lung cancer and nasopharyngeal carcinoma with 1 case in each. The operation time, bleeding loss, resected segments, cutting edge, spinal cord function and complications was evaluated.

RESULTSSingle segment resected in 1 case, 2 segments resected in 2 cases and 3 segments resected in 3 cases. The average operation time was 8.9 hours (7.5 to 12.0 hours). The average blood loss was 3 116 ml (2 500 to 4 500 ml). The average follow-up period was 23.2 months (12 to 47 months) without recurrence. There was no spinal cord injury during operation. The neurologic function was significantly improved in 2 cases (American Spinal Injury Association (ASIA) grade C to grade D), unchanged in 1 cases (ASIA grade B) and no deteriorated case in 3 cases (ASIA grade E). There was no perioperative deaths case. Complications included 2 cases pleural rupture, 1 case dural tear and 1 case massive haemothorax. No peri-operation death case.

CONCLUSIONSome of the recurrent spinal tumors are still suitable for en-bloc resection and TES procedure with the extent of its applicability under strict control.

Adult ; Female ; Humans ; Lung Neoplasms ; Male ; Neoplasm Recurrence, Local ; Retrospective Studies ; Spinal Cord Neoplasms ; Spinal Neoplasms ; surgery ; Spine

OBJECTIVETo study the clinical characteristics of the intradural extramedullary tumor in the spinal canal, as well as the application of internal fixation technique to restore the spinal stability in the surgical treatment of intradural extramedullary tumor in the spinal canal through posterior approach.

METHODSAmong 24 patients receiving the tumor resection through posterior approach, 14 patients were male and 10 patients were female, ranging in age from 12 to 68 years, with an average of 40 years. Fourteen patients were treated with internal fixation and autogenous bone graft after tumor resection, and other 10 patients without internal fixation and autogenous bone graft.

RESULTSAll the patients underwent one-stage resection of the tumor. During the follow-up period ranged from 6 months to 3 years (average 22 months), no recurrence of the tumor was found and the injury of spine cord did not aggravate, no vascular or nerve-root injury after the operation. The Frankle grades were improved by 1 to 3 degrees. Bone fusion formed at the corresponding bone grafted place. And there was no instrument broken or loosening.

CONCLUSIONAfter the intradural extramedullary tumor is resected, internal fixation and autogenous bone graft can restore the stability of spine.

Adolescent ; Adult ; Aged ; Bone Transplantation ; Child ; Female ; Humans ; Internal Fixators ; Male ; Middle Aged ; Spinal Canal ; surgery ; Spinal Neoplasms ; surgery

The spine is the most common site of bone metastases from malignant tumors, with metastatic epidural spinal cord compression occurring in about 10% of patients with spinal metastases. Palliative radiotherapy and simple laminectomy and decompression have been the main treatments for metastatic spinal cord compression. The former is ineffective and delayed for radiation-insensitive tumors, and the latter often impairs spinal stability. With the continuous improvement of surgical techniques and instrumentation in recent years, the treatment model of spinal metastases has changed a lot. Decompression surgery underwent open decompression, separation surgery, minimally invasive surgery and laser interintermal thermal ablation decompression. However, no matter what kind of surgical plan is adopted, it should be assessed precisely according to the specific situation of the patient to minimize the risk of surgery as far as possible to ensure the smooth follow-up radiotherapy. This paper reviews the research progress of decompression for spinal metastases.
Humans ; Spinal Cord Compression/surgery* ; Spinal Neoplasms/secondary* ; Decompression, Surgical/methods* ; Spine/surgery* ; Retrospective Studies ; Treatment Outcome