Primary vascular bone tumors in the spine: a challenge for pathologists and spine oncology surgeons

n/

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

Abstract Purpose To investigate whether the World Health Organization Safety Surgical Checklist (SSC) is an effective tool to reduce complications in spinal surgery. Methods We retrospectively evaluated the clinical and radiological charts prospectively collected from patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist's effectiveness. Results The sample size was 917 patients with an average of 30-month follow-up. The mean age was 52.88 years. The majority of procedures were performed for oncological diseases (54.4%) and degenerative diseases (39.8%). In total, 159 complications were detected (17.3%). The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. No correlation was observed between the type of pathology and the complication incidence. We observed a reduction in the overall incidence of complications following the introduction of the SSC: In 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%). Conclusions The SSC seems to be an effective tool to reduce complications in spinal surgery. We propose to extend the use of checklist system also to the preoperative and postoperative phases in order to further reduce the incidence of complications. Graphic abstract These slides can be retrieved under Electronic Supplementary Material

Carbon Fiber-Reinforced PolyEtherEtherKetone (CFR-PEEK) Instrumentation in Degenerative Disease of Lumbar Spine: A Pilot Study

: CFR-PEEK is gaining popularity in spinal oncological applications due to its reduction of imaging artifacts and radiation scattering compared with titanium, which allows for better oncological follow-up and efficacy of radiotherapy. We evaluated the use of these materials for the treatment of lumbar degenerative diseases (DDs) and considered the biomechanical potential of the carbon fiber in relation to its modulus of elasticity being similar to that of bone. Twenty-eight patients with DDs were treated using CRF-PEEK instrumentation. The clinical and radiographic outcomes were collected at a 12-month FU. Spinal fusion was evaluated in the CT scans using Brantigan scores, while the clinical outcomes were evaluated using VAS, SF-12, and EQ-5D scores. Out of the patients evaluated at the 12-month FU, 89% showed complete or almost certain fusion (Brantigan score D and E) and presented a significant improvement in all clinical parameters; the patients also presented VAS scores ranging from 6.81 ± 2.01 to 0.85 ± 1.32, EQ-5D scores ranging from 53.4 ± 19.3 to 85.0 ± 13.7, SF-12 physical component scores (PCSs) ranging from 29.35 ± 7.04 to 51.36 ± 9.75, and SF-12 mental component scores (MCSs) ranging from 39.89 ± 11.70 to 53.24 ± 9.24. No mechanical complications related to the implant were detected, and the patients reported a better tolerance of the instrumentation compared with titanium. No other series of patients affected by DD that was stabilized using carbon fiber implants have been reported in the literature. The results of this pilot study indicate the efficacy and safety of these implants and support their use also for spinal degenerative diseases

Clinical study to evaluate the safety and efficacy of the use of carbon implants for thoraco-lumbar vertebral arthrodesis and for the fixation of the spine affected by tumors in the thoracic and lumbar area which is expected to undergo radiation therapy protocols.

Background: Barre e viti peduncolari sono usati per operazioni chirurgiche spinali toraco-lombari. I comuni impianti metallici interferiscono con i protocolli di radioterapia (RT), spesso necessari a completamento del trattamento chirurgico di tumori della colonna vertebrale riducendone l’efficacia e provocando effetti collaterali su tessuti adiacenti. I sistemi di fissazione in carbonio comprendono barre e viti peduncolari I benefici del dispositivo proposto sono: - stabilità meccanica paragonabile agli impianti in titanio - riduzione o assenza dispersione durante radioterapia e riduzione o nessuna interferenza con protocolli di radioterapia. - nessun o minore artefatto in RM/TAC con miglior visualizzazione Obiettivo del presente lavoro è valutare sicurezze ed efficacia degli impianti in PEEK e fibra di carbonio Materiali e Metodi 110 pazienti trattati per patologie oncologiche primitive del rachide toraco- lombare (51), metastasi del rachide toraco-lombare (36), plasmocitocitomi del rachide toraco-lombare (4) e patologie degenerative del rachide toraco-lombare (19). Sono stati raccolti dati relativi alle procedure chirurgiche eseguite, all’eventuale trattamento radiante successivo e alle complicanze registrate Risultati Le complicanze meccaniche si sono tutte verificate in pazienti oncologici (rottura intra-operatoria di 3 viti, 1 caso di rottura di barre, 3 casi di mobilizzazione delle viti). La presenza di impianti in carbonio non ha creato limitazioni alla pianificazione e al trattamento radioterapico laddove necessario limtando il numero di recidive locali sia di tumori primitivi che di metastasi Conclusione I risultati dimostrano che gli impianti di PEEK e fibra di carbonio sono equivalenti o comunque non inferiori ai corrispettivi in titanio in termini di tenuta dell’impianto. Dimostrano di ottimizzare la pianificazione e l’efficacia del trattamento radiante rispetto ai mezzi di sintesi in titanio e di permettere una migliore definizione delle immagini TC ed RMN con migliore e precoce identificazione di recidive di malattia, valutazione della fusione e presenza o meno di discopatie del segmento adiacente.Background: Rods and pedicle screws are used for thoracolumbar spinal surgery. Metal implants are known to interfere with radiotherapy protocols (RT), often necessary to complete the surgical treatment of spinal tumors, reducing their effectiveness and causing side effects on adjacent tissues. Carbon fixation systems include rods and pedicle screws. Potential benefits of the proposed device are: - mechanical stability comparable to titanium implants - reduction or absence of dispersion during radiation therapy and radiotherapy protocols. - no or less artifact in MRI / CT scan with better visualization Aim of this paper is to evaluate the safety and effectiveness of PEEK and carbon fiber systems Materials and methods 110 patients treated for primitive oncological pathologies of the thoracolumbar spine (51), metastasis of the thoracolumbar spine (36), plasmacytomas of the thoraco-lumbar spine (4) and degenerative pathologies of the thoraco-lumbar spine (19). Data relating to the surgical procedures performed, any subsequent radiation treatment and the complications recorded were collected Results The mechanical complications have all occurred in cancer patients (intraoperative breakage of 3 screws, 1 case of brakage of bars, 3 cases of mobilization of the screws). The presence of carbon implants did not create limitations to planning and radiotherapy treatment where necessary, limiting the number of local recurrences of both primary tumors and metastases Conclusion The results show that the PEEK and carbon fiber implants are equivalent or in any case not less than titanium in terms of mechanical stability. They also demonstrate optimizing the planning and efficacy of the radiation treatment with respect to the titanium hardware and to allow a better definition of the CT and MRI follow up images with the possibility of a better and early identification of local recurrence, evaluation of the fusion and presence or absence of discopathies in the adjacent segment

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer

Objective: Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. Materials and methods: Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38–84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded. Results: The mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000). Conclusions: Elastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures. Level of evidence: Level IV, therapeutic study. Keywords: Elastoplasty, Vertebroplasty, Silicone, PMMA, Vertebral compression fractur

Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report

Protocols including combination of surgery and radiotherapy are more and more frequent in the treatment of bone tumors of the spine. In metastatic disease, combination of surgery and radiotherapy is since long time accepted, as based on clinical evidence. In primary tumors, combination of surgery and radiotherapy can be considered in all the cases in which a satisfactory oncological margin cannot be achieved: high-grade malignancies, recurrent tumors, huge tumors expanding in an extracompartimental area, and when tumor-free margin requires unacceptable functional sacrifices. However, metal implants are an obstacle in the collaboration between surgeons and radiation oncologists. Carbon-fiber-reinforced polyethil-ether-ether-ketone (CFR-PEEK) composite implants could make easier and more effective the treatment as radiolucent and not interfering with ionizing radiation and accelerated particles. The purpose of this article is to report the preliminary results from a cohort of patients treated with CFR-PEEK and to evaluate the safety and the non-inferiority of the device respect the commonly used titanium implants

Function Preservation or Oncological Appropriateness in Spinal Bone Tumors? A Case Series of Segmental Resection of the Spinal Canal Content (Spinal Amputation)

Retrospective review of prospectively collected data

Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review

(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management

Extensive cytoreductive surgery in a Jehovah's Witness patient. A case report

Jehovah's Witnesses are a well-known patient demographic in medicine because of their religious-based refusal of blood transfusion. This case report outlines the treatment of a Jehovah's Witness patient in need of an extensive cytoreductive surgery due to a peritoneal carcinomatosis of ovarian origin. The surgeons carried out all the recommended surgical and anaesthetic measures concluding that extensive cytoreductive surgery on a Jehovah's Witness is possible and that a complete cytoreduction can be safely performed