Scoring system for prediction of metastatic spine tumor prognosis

Assessing the prognosis before treatment for metastatic spine tumor is extremely important in therapy selection.Therefore,we review some prognostic scoring systems and their outcomes.Articles with combinations of two keywords among"metastatic spine tumor"and"prognosis","score","scoring system","predicting",or"life expectancy"were searched for in Pub Med.As a result,236 articles were extracted.Those referring to representative scoring systems about predicting the survival of patients with metastatic spine tumors were used.The significance and limits of these scoring systems,and the future perspectives were described.Tokuhashi score,Tomita score,Baur score,Linden score,Rades score,and Katagiri score were introduced.They are all scoring systems prepared by combining factors that affect prognosis.The primary site of cancer and visceral metastasis were common factors in all of these scoring systems.Other factors selected to influence the prognosis varied.They were useful to roughly predict thesurvival period,such as,"more than one year or not"or"more than six months or not".In particular,they were utilized for decision-making about operative indications and avoidance of excessive medical treatment.Because the function depended on the survival period in the patients with metastatic spine tumor,it was also utilized in assessing functional prognosis.However,no scoring system had more than 90%consistency between the predicted and actual survival periods.Future perspectives should adopt more oncological viewpoints with adjustment of the process of treatment for metastatic spine tumor.

Surgical resection of intradural extramedullary tumors in the atlantoaxial spine via a posterior approach

BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.

An overview of the role of cancer stem cells in spine tumors with a special focus on chordoma

Primary malignant tumors of the spine are relatively rare, less than 5% of all spinal column tumors. However, these lesions are often among the most difficult to treat and encompass challenging pathologies such as chordoma and a variety of invasive sarcomas. The mechanisms of tumor recurrence after surgical intervention, as well as resistance to radiation and chemotherapy, remain a pervasive and costly problem. Recent evidence has emerged supporting the hypothesis that solid tumors contain a sub-population of cancer cells that possess characteristics normally associated with stem cells. Particularly, the potential for long-term proliferation appears to be restricted to subpopulations of cancer stem cells(CSCs) functionally defined by their capacity to self-renew and give rise to differentiated cells that phenotypically recapitulate the original tumor, thereby causing relapse and patient death. These cancer stem cells present a unique opportunity to better understand the biology of solid tumors in general, as well as targets for future therapeutics. The general objective of the current study is to discuss the fundamental concepts for understanding the role of CSCs with respect to chemoresistance, radioresistance, special cell surface markers, cancer recurrence and metastasis intumors of the osseous spine. This discussion is followed by a specific review of what is known about the role of CSCs in chordoma, the most common primary malignant osseous tumor of the spine.

APPLICATION VALUE OF MAGNETIC RESONANCE SEQUENCES IN DIAGNOSIS OF EARLY SPINAL METASTATIC TUMOR

Objective To investigate the clinical value of different magnetic resonance (MR) pulse sequences in diagnosis of spinal metastatic tumor. Methods Fifteen patients with clinically suspected spinal metastatic tumor were included in this study. These patients were with documented primary tumors. Four MR pulse sequences, T1-weighted spin echo (T1WI SE), T2-weighted fast spin echo (T2WI FSE), short time inversion recovery (STIR), and gradient echo 2-D multi echo data imaging combination (GE Me-2D) were used to detect spinal metastasis. Results Fifteen vertebral bodies were entire involvement, 38 vertebral bodies were section involvement, and totally 53 vertebral bodies were involved. There were 19 focal infections in pedicle of vertebral arch, 15 metastases in spinous process and transverse process. Fifty-three vertebral bodies were abnormal in T1WI SE and GE Me-2D, 35 vertebral bodies were found abnormal in T2WI FSE, and 50 vertebral bodies were found abnormal in STIR. The verges of focal signal of involved vertebral bodies were comparatively clear in T1WI SE, comparatively clear or vague in T2WI FSE, vague in STIR, and clear in GE Me-2D.Conclusions GE Me-2D may be the most sensitive technique to detect metastases. So three sequences (T1WI SE, T2WI FSE, GE Me-2D) can demonstrate the early changes of spinal metastasis roundly.

Tenosynovial giant cell tumor involving the cervical spine: A case report

BACKGROUND Tenosynovial giant cell tumors(TGCTs)are a frequent benign proliferative disease originating from the synovial membrane.However,TGCTs rarely occur in the spine.The purpose of this paper is to report a case of TGCT occurring in the cervical spine.Although the disease is rare,it is essential to consider the possibility of TGCT in axial skeletal lesions.Awareness of spinal TGCTs is important because their characteristics are similar to common spinal tumor lesions.CASE SUMMARY A 49-year-old man with a 2-year history of neck pain and weakness in both lower extremities was referred to our ward.Imaging revealed a mass extending from the left epidural space to the C4-5 paravertebral muscles with uneven enhancement.The tumor originated in the synovium of the C4-5 lesser joint and eroded mainly the C4-5 vertebral arch and spine.Puncture biopsy was suggestive of a giant cellrich lesion.The patient had pulmonary tuberculosis,and we first administered anti-tuberculosis treatment.After the preoperative requirements of the antituberculosis treatment were met,we used a posterior cervical approach to completely remove the mass after fixation with eight pedicle screws.The mass was identified as a TGCT by postoperative immunohistochemical analysis.Recurrence was not detected after 1 year of follow-up.CONCLUSION Spinal TGCTs are often misdiagnosed.The radiological changes are not specific.The ideal treatment comprises complete excision with proper internal fixation,which can significantly reduce postoperative recurrence.

Observation of the therapeutic efficacy of stereotactic radiotherapy in 44 cases of retroperitoneal metastatic tumor

Objective: To investigate the therapeutic effects of stereotactic radiotherapy for retroperitoneal metastatic tumor. Methods: From August 1997 to October 2004, 44 patients with retroperitoneal metastatic tumors were treated with stereotactic radiotherapy. The planning target volume was encompassed by 90%–95% isodose line. Fractional dose was from 6 Gy to 8 Gy, and they were treated 2–3 times per-week and 4–8 times in all. The total radiation doses of PTV were from 32 Gy to 48 Gy. Re- sults: After the radiotherapy, the pain was obviously relieved in 81.8% patients. Three months after completion of radiotherapy passed and then, abdominal CT was performed to evaluate the results. The whole effective rate was 81.8% [CR 27.7% (12/44) and PR 54.5% (24/44)], and six months after radiotherapy, CR was 27.7% (12/44) and PR was 59.1% (26/44). The middle survival time was 12 months. Conclusion: It is suggested that stereotactic radiotherapy for retroperitoneal metastatic tumor is a safe and effective method.

Exploration and Discussion on the Clinical Therapeutic Effects of the Application of Cross-Injury Vertebral Fixation and Via-Injury Vertebrae Fixation in the Treatment of Bone Tumor with Thoracolumbar Spine Fracture

Objective:To explore and discuss the clinical therapeutic effects of the application of cross-injury vertebral fixation and via-injury vertebrae fixation in the treatment of bone tumor with thoracolumbar spine fracture.Methods:A total of 58 patients with bone tumors and thoracolumbar spine fractures admitted to our hospital from February to February 2019 were selected as the study subjects.They were randomly divided into control group and observation group,with 29 cases in each group.The patients in the control group received cross-injury vertebral fixation treatment,while the patients in the observation group were treated with via-injury vertebral fixation.The therapeutic effects of the two groups were compared.Results:The operation time and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05),and the postoperative drainage volume of the intraoperative blood loss was significantly less than that of the control group(P<0.05).There was no significant difference in postoperative pain and spinal JOA scores between the two groups(P>0.05);there was no significant difference in the compression ratio of the injured vertebrae and the kyphosis Cobb angle between the two groups(P>0.05),after the operation,the two groups of patients were significantly reduced,and the compression ratio of the injured vertebrae and kyphosis Cobb angle of the observation group were more obvious(P<0.05);the vertebral height loss and Cobb angle loss in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:In the treatment of bone tumor with thoracolumbar spine fracture,compared with cross-injury vertebral fixation,via-injury vertebral fixation has a more significant clinical effect and is more suitable for clinical application and promotion.

Posterior approach to radical resection for thoracic tumor and spine stabilization and reconstruction in one stage

Objective To discuss total vertebrectomy and spine stability and reconstruction by posterior approach for thoracic vertebra tumor and pedicle secrew system fixation and intervertebral fusion. Methods Eighteen patients of 3 males and 15 females of thoracic total vertebral tumor were operated in this group. The age of the group were from 14 to 58 years old, with the average of 23 years. There were 4 aneurysmal bone cysts, 2 hemangiomas,2 osteoblastomas, 1 neurilemomas, 5 giant cell tumro, 1 solitary myeloma and 3 metastatic thoracic vertebra tumors. The locations of the tumors was T4 in 1 case,T5 in 1 case.T6 in 2 cases,T8 in 4 cases, T9 in 3 cases,T10 in 4 cases, T11 in 2 cases and T12 in 1 case respectively. Pre-operative Frankel classification was grade A in 6 cases, B in 7 cases, C in 3 cases and E in 2 cases. Circumferential decompression was performed with total spondylectomy through one-stage posterior approach. Anterior vertebral reconstruction was provided by autograft (ribs or ilium) bone or

Strategies of surgical treatment of the spinal metastatic tumors

Objective To study the clinical features, surgical treatments and the prognosis of the 103 patients with the metastatic tumors in the spine. Methods From Jan. 1996 to Dec. 2001,103 cases were treated by operation in our department, there were 62 males and 41 females, aging from 33 to 79 years old (average,59 years). The lesions were located at cervical spines in 34 cases, thoracic spines in 39,lumbar spines in 25 and sacrum in 5. The patients underwnet anterior, prosterior,combined or staged antero-posterior operations based on the location of lesions in the spine. Most of the patients were adopted vertebral reconstruction and internal fixation depending on the conditions. Preoperative clinical evaluation included of general conditions,X-ray films,CT scan.MRI and ECT in odrer to decide the endurance of the patient to the surgical treatment. The operation was only considered when the patient could have the expected survival time more than 6 months. Operative indications, surgical methods and prognosis

Macrophage inflammatory protein-2 contributes to liver resection-induced acceleration of hepatic metastatic tumor growth

AIM： To study the role of macrophage inflammatory protein （HIP）-2 in liver resection-induced acceleration of tumor growth in a mouse model of hepatic metastasis. METHODS： After a 50% hepatectomy, 1×10^5 CT26.WT cells were implanted into the left liver lobe of syngeneic balb/c mice （PHx）. Additional animals were treated with a monoclonal antibody （HAB452） neutralizing HIP-2 （PHx＋mAB）. Non-resected and non-mAB-treated mice （Con） served as controls. After 7 d, tumor angiogenesis and microcirculation as well as cell proliferation, tumor growth, and CXCR-2 expression were analyzed using in- travital fluorescence microscopy, histology, immunohisto- chemistry, and flow cytometry. RESULTS： Partial hepatectomy increased （P〈0.05）the expression of the HIP-2 receptor CXCR-2 on tumor cells when compared with non-resected controls, and markedly accelerated （P〈 0.05） angiogenesis and metastatic tumor growth. Neutralization of HIP-2 by HAB452 treatment significantly （P〈 0.05） depressed CXCR-2 expression. Further, the blockade of MIP-2 reduced the angiogenic response （P〈 0.05） and inhibited tumor growth （P〈 0.05）. Of interest, liver resection-induced hepatocyte proliferation was not effected by anti-HIP-2 treatment. CONCLUSION： HIP-2 significantly contributes to liver resection-induced acceleration of colorectal CT26.WT hepatic metastasis growth.

Therapeutic effect of irregular dividing radiotherapy on pain due to metastatic tumors of mammary cancer

Objective To investigate therapeutic effect of rapidly divided radiotherapy in the management of pain due to bone metastases in mammary cancer. Method 20 patients among 33 received rapidly divided radiotherapy in 25 lesions, DTU 5CTY a time, 2～3 times a week, total dose was 15～30 Gy. 13 patients (22 lesions ) received routine dividing radiotherapy, DT 4～5 Gy each time, 5 times a week, total dose was 40～60 Gy. Result In rapidly divided group, total analgesic rate was 95.0% (19/20). In routine dividing group, total analgesic rate was 69.3%. There was no significant difference between the 2 groups (P >0.05). Pain was controlled in 84% of lesions in rapidly divided group 2 week after radiotherapy. Analgesic rate of DT 20～30 Gy went up to 45.5%. Differences between 2 groups were significant statistically (P< 0.01).Conclusion Rapidly divided radiotherapy is rapid and reliable in managing pain. Patients can endure its toxicological and adverse reactions . It’s therapeutic effect is comparable with that of routine divided radiotherapy.

Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery:A case report

BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.

Exploring the Need and Strategy for Intraoperative Freezing to Identify Metastatic Adenocarcinoma of the Lungs

Objective: To explore the necessity and strategy of intraoperative freezing to identify primary and metastatic adenocarcinoma of the lung. Methods: This study retrospectively analyzes the impact of failing to make a definitive diagnosis of metastatic adenocarcinoma of the lung on the clinical surgical approach in four cases of intraoperative freezing. It also examines the reasons for this failure and reviews the relevant literature. Results: All 4 cases of intraoperative freezing were diagnosed as invasive adenocarcinoma, and none of them made a definitive diagnosis of metastatic adenocarcinoma. Conclusion: It is difficult to confirm the diagnosis of metastatic adenocarcinoma of the lung by intraoperative frozen section, and the combination of patient history, rapid immunohistochemistry, and histological morphology of intraoperative frozen section for its identification can guide the surgeon to adjust the surgical approach in time and provide evidence for the establishment of surgical protocols for reference.

Primitive neuroectodermal tumor of lumbar spine:case report

Primitive neuroectodermal tumors （PNETs）, derived from the primitive neural crest, are highly malignant and mainly exist in the central nervous system （CNS）, chest wall, lower extremities, trunk, kidney, and orbit but rarely in the spine. Though multidisciplinary treatments have been well established as the standard therapy for intracranial PNETs, little is known about the optimal treatment strategy and therapeutic results for intraspinal PNETs. The following report illustrates the operative and non-operative management of an extradural PNET at the level of L5 in a young girl.

Recurrence Factors in Giant Cell Tumors of the Spine

Background： Giant cell tumors （GCTs） are benign, locally aggressive tumors. We exalnined the rate of local rectirrence of spinal GCTs and sought to identify recurrence factors in patients who underwent surgery. Methods： Between 1995 and 2014, 94 mobile spine GCT patients were treated at our hospital, comprising 43 male and 51 female patients with an average age of 33.4 years. Piecemeal intralesional spondylectomy and total en bloc spondylectomy （TES） were performed. Radiotherapy was suggested for recurrent or residual GCT cases. Since denosumab was not available before 2014 in our country, only interferon and/or zoledronic acid was suggested. Results： Of the 94 patients, four underwent conservative treatment and 90 underwent operations. Seventy-five patients （79.8%） were followed tip for a minimum of 24 months or until death. The median follow-up duration was 75.3 months. The overall recurrence rate was 37.3%. Ten patients （13.3%） died before the last follow-up （rnedian： 18.5 months）. Two patients （2.6%） developed osteogenic sarcoma. The local recurrence rate was 80.0% （24/30） in patients who underwent intralesional curettage, 8.8% （3/34） in patients who underwent extracapsular piecemeal spondylectomy,and 0 （0/9） in patients who underwent TES. The risk factors for local recurrence were lesions located in the cervical spine （P = 0.049）, intralesional curettage （P 〈 0.001 ）, repeated surgeries （P 0.014）, and malignancy （P 〈 0.001 ）. Malignant transformation was a significant risk factor for death （P 〈 0.001 ）. Conclusions： Cervical spinal tumors, curettage, and nonintact tumors were risk l;actors for local recurrence. Intralesional curettage and malignancy were the most important significant factors for local rectirrence and death, respectively.

Diagnosis and treatment of primary diffuse-type tenosynovial giant cell tumors of the cervical spine

Diffuse-type tenosynovial giant cell tumor （D-TGCT） belongs to a group of lesions believed to arise from tendon sheaths,bursae,or the synovium of diarthrodial joints.The etiology of D-TGCT is unknown.Because it shares histological characteristics with pigmented villonodular synovitis,however,D-TGCT is also termed extra-articular pigmented villonodular synovitis.D-TGCT,which occurs mainly in middle-aged women （20-50 years of age1）,usually involves large load-bearing joints （e.g.,knee,ankle,and hip）.Clinical case reports of D-TGCT involving the spine are rare.2 We retrospectively analyzed a series of three patients diagnosed with cervical D-TGCT in our department over a 10-year period.

Clnical Study of the Treatment of Patients with a Metastatic Spinal Tumor by Percutaneous Vertebroplasty under the Guidance of DSA

OBJECTIVE To explore the clinical effect in patients with metastatic spinal tumors treated by percutaneous vertebroplasty （PVP） under the guidance of digital subtraction angiography （DSA）. METHODS A total of 110 cases with a metastatic spinal tumor were di- vided into 55 cases in the treatment group （group A ） and 55 cases in the control group （group B ）. The general clinical data were statistically analyzed before treatment with the parameters showing no differences. Group A was treated by PVP and chemotherapy as well. Group B was treated by the regular chemotherapy and regular radiation therapy. The same chemotherapy program was used for the same type of disease. All cases were provided with a follow-up survey for 12 months. During the follow-up survey, changes in the quality of life, in evaluation of bone pain and in vertebral column stability as well as adverse reactions were observed. RESULTS The statistics showed a significant difference between the 2 groups, specifically changes in the quality of life and evaluation of bone pain （P〈0.05, t1=2.74, t2=9.02）. During the follow-up survey, 5 cases in group A died of other organ complilcations, the death rate being 9.1% （5 out of 55）, but all survived more than 3 months following PVP. The vertebral columns of the survivors were kept stable, with no pathological fractures occurring in the vertebral bodies filled with bone cement, there were no obvious adverse reactions, and no paraplegia occurred. Thirteen cases died in group B with a death rate of 23.6% （13 out of 55）. Pathological compression fractures in the vertebral bodies occurred in 30 cases, and 12 cases of complicated paraplegia were noted. The incident rate of paraplegia was 21.8% （12 out of 55）. CONCLUSION PVP is a simple operation causing only small wounds and few complications. It can effectively alleviate pain of metastatic spinal tumors in patients, improve quality of life and reduce the incidence rate of paraplegia.

Surgical treatment of metastatic spinal tumors

Objective The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis. In order to treat or prevent spinal cord paralysis, decompression and stabilization should be performed on the patients with spinal pain and/or severe spinal cord compression. Methods From July 1998 through July 2001,62 patients (27 women and 35 men) with metastatic spinal tumors had been treated at our department. Of 62 patients, the thoracic vertedbrae were involved in 37 cases, lumbar vertebrae in and cervical vertebrae in 6. Among 43 of 62 patients who presented with neurological dysfunction, 24 patients were incompletely paraplegic and the others were completely paraplegic. The follow-up ranged form 8 to 36 months. Results Pain relief was obtained in 58 of 62 patients (94%), and good neurological recovery was obtained in 33 of the 43 patients. Improved bowel and bladder function was obtained in 12 of 25 patients who