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Diagnostics
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Assessment and Management of Instability in Spinal Tumors
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Assessment and Management of Instability in Spinal Tumors

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 January 2023) | Viewed by 8768

Special Issue Editors

Dr. Fabio Cofano

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Guest Editor
1. Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy
2. Spine Surgery Unit, Humanitas Gradenigo, Turin, Italy
Interests: spinal metastases, spinal intramedullary tumors, spinal extramedullary tumors, primary tumors of the spine
Prof. Dr. Diego Garbossa

E-Mail Website
Co-Guest Editor
Neurosurgery Unit, Department of Neuroscience, University of Turin, Via Giuseppe Verdi, 8, 10124 Turin, Italy
Interests: neurobiology; neurobiology and brain physiology; neurodegeneration; synaptic plasticity; neuroanatomy; neurodegenerative diseases; neural plasticity
Special Issues, Collections and Topics in MDPI journals
Dr. Giuseppe Di Perna

E-Mail Website
Co-Guest Editor
2. Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10124 Turin, Italy
1. Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy
Interests: spinal metastases, spinal intramedullary tumors, spinal extramedullary tumors, primary tumors of the spine

Special Issue Information

Dear Colleagues,

The stability of the spine has always represented a crucial topic when treating oncological diseases.

In recent years, significant advancements in the development of technological tools for the diagnosis and management of spinal tumors have been made, often changing surgical treatment procedures.

The survival prognosis of patients with spinal metastases has significantly improved, making the assessment and management of spinal instability before and after treatment a crucial issue. The introduction of even more minimally invasive techniques and new materials to improve diagnostic/planning evaluation such as carbon fiber instrumentation, new concepts such as separation surgery, and the emerging crucial role of stereotactic radiosurgery have enhanced the necessity of more comprehensive strategies.

Primitive bone lesions often require the careful evaluation of the mechanical integrity of the spine before and after minor or extensive reconstructive surgical approaches. The rising importance of particle therapies as alternative or adjuvant strategies has contributed to enriching the debate but the evidence is still limited.

Spinal canal tumors rarely involve the osteo-ligamentous structures of the spine. Nevertheless, the real role of different minimally invasive approaches to reaching and treating tumors while avoiding impairing stability has been poorly investigated, along with the need for reconstructive strategies.

Therefore, we invite investigators to contribute to this Special Issue with original research articles, review articles, and meta-analyses focusing on the current knowledge of the assessment and management of stability in the treatment of spine tumors, with special regard to the clinical, radiological, and surgical implications for common practice.

Dr. Fabio Cofano
Guest Editor

Dr. Diego Garbossa
Dr. Giuseppe Di Perna
co-Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Spinal metastases
  • Primary tumors of the spine
  • Spinal extramedullary tumors
  • Spinal intramedullary tumors
  • Spinal stability diagnosis
  • Spinal stability assessment
  • Spinal stability follow-up
  • Imaging in spinal oncology

Published Papers (5 papers)

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Research

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14 pages, 876 KiB  
Article
Clear Cell Renal Cell Carcinoma Spinal Metastases: Which Factors Matter to the Overall Survival? A 10-Year Experience of a High-Volume Tumor Spine Center
by Silvia Terzi, Valerio Pipola, Cristiana Griffoni, Federica Trentin, Elisa Carretta, Annalisa Monetta, Fabio Vita, Stefano Bandiera, Giovanni Barbanti-Bròdano, Riccardo Ghermandi, Gisberto Evangelisti, Giuseppe Tedesco, Marco Girolami, Carlotta Cavallari and Alessandro Gasbarrini
Diagnostics 2022, 12(10), 2442; https://doi.org/10.3390/diagnostics12102442 - 09 Oct 2022
Cited by 2 | Viewed by 989
Abstract
Clear cell renal cell carcinoma (ccRCC) usually spreads in the spinal region causing instability or spinal cord compression leading to neurological deficits. Therefore, surgical treatment is required for improving the outcome of patients. The aim of this study is to identify which prognostic [...] Read more.
Clear cell renal cell carcinoma (ccRCC) usually spreads in the spinal region causing instability or spinal cord compression leading to neurological deficits. Therefore, surgical treatment is required for improving the outcome of patients. The aim of this study is to identify which prognostic factors could affect overall survival in patients affected by ccRCC. Methods: Retrospective cohort study of patients with ccRCC spinal metastases, surgically treated from November 2009 to April 2019. Demographic and clinical data were collected. The Kaplan–Meier method was used to estimate overall survival, and the log-rank test was used to evaluate differences in survival among potentially prognostic factors. Results: A total of 69 patients were surgically treated and followed up for a median period of 65 months. The average age at the time of surgery was 62.6 years old. The median overall survival (OS) was 34.7 months (95% CI 20.8–51.9) and 5-year OS was 31.2% (95% CI 19.2–44.1). A high Tokuhashi score (p = 0.0217), the presence of visceral metastases (p < 0.001), other bone metastases (p = 0.02012) and the kind of surgical treatment (p = 0.0395) are the main prognostic factors that influence the OS. Moreover, 3-year progression-free survival (PFS) was analyzed: the median PFS was 53.1 months and the % 3-year PFS was 62.9% (45.2–76.3). In the multivariate analysis, only pre-operative radiation therapy had a significant impact on 3-year PFS (95% CI 0.929–12.994, p = 0.0643). Conclusion: The results of this study suggest that the absence of visceral metastases and an aggressive surgery as en-bloc, when feasible, could prolong the survival rate and improve quality of life for patients. Full article
(This article belongs to the Special Issue Assessment and Management of Instability in Spinal Tumors)
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12 pages, 1980 KiB  
Article
Primary Bone Tumors of the Spine—Proposal for Treatment Based on a Single Centre Experience
by Nicole Lange, Ann-Kathrin Jörger, Yu-Mi Ryang, Friederike Liesche-Starnecker, Jens Gempt and Bernhard Meyer
Diagnostics 2022, 12(9), 2264; https://doi.org/10.3390/diagnostics12092264 - 19 Sep 2022
Cited by 1 | Viewed by 1380
Abstract
This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed [...] Read more.
This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed 92 patients receiving surgery for PBTs from 2007 to 2019 at our center. They were analyzed based on surgical management and the course of the disease. A total of 145 surgical procedures were performed (50 cervical, 46 thoracic, 28 lumbar, and 21 sacral). Complete tumor resection was achieved in 65%, of which 22% showed tumor recurrence during follow-up (mean time to recurrence 334 days). The five-year mortality rate was significantly lower after complete resection (3% versus 25% after subtotal resection). Most of the patients improved in their symptoms through surgery. Regarding the tumor entity, the most common PBTs were vertebral hemangiomas (20%), osteoid osteomas (15%), and chordomas (16%). The Enneking graduation system showed a good correlation with the risk of recurrence and mortality. Complete resection in PBTs increased survival rates and remains the method of choice. Thus, quality of life—especially with a higher extent of resection—should be considered. Full article
(This article belongs to the Special Issue Assessment and Management of Instability in Spinal Tumors)
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Review

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17 pages, 3195 KiB  
Review
Diagnostic Approach and Differences between Spinal Infections and Tumors
by Domenico Compagnone, Riccardo Cecchinato, Andrea Pezzi, Francesco Langella, Marco Damilano, Andrea Redaelli, Daniele Vanni, Claudio Lamartina, Pedro Berjano and Stefano Boriani
Diagnostics 2023, 13(17), 2737; https://doi.org/10.3390/diagnostics13172737 - 23 Aug 2023
Cited by 2 | Viewed by 2375
Abstract
Study design: A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. Background and Purpose: The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one [...] Read more.
Study design: A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. Background and Purpose: The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. Methods: A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. Results: A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. Conclusion: Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory. Full article
(This article belongs to the Special Issue Assessment and Management of Instability in Spinal Tumors)
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24 pages, 22945 KiB  
Review
Craniovertebral Junction Instability after Oncological Resection: A Narrative Review
by Malte Ottenhausen, Elena Greco, Giacomo Bertolini, Andrea Gerosa, Salvatore Ippolito, Erik H. Middlebrooks, Graziano Serrao, Maria Grazia Bruzzone, Francesco Costa, Paolo Ferroli and Emanuele La Corte
Diagnostics 2023, 13(8), 1502; https://doi.org/10.3390/diagnostics13081502 - 21 Apr 2023
Cited by 3 | Viewed by 1894
Abstract
The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological [...] Read more.
The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the anatomy, biomechanics and pathology of the craniovertebral junction and to describe the available surgical approaches to and considerations of joint instability after craniovertebral tumor resections. Although a one-size-fits-all approach cannot encompass the extremely challenging pathologies encountered in the CVJ area, including the possible mechanical instability that is a consequence of oncological resections, the optimal surgical strategy (anterior vs posterior vs posterolateral) tailored to the patient’s needs can be assessed preoperatively in many instances. Preserving the intrinsic and extrinsic ligaments, principally the transverse ligament, and the bony structures, namely the C1 anterior arch and occipital condyle, ensures spinal stability in most of the cases. Conversely, in situations that require the removal of those structures, or in cases where they are disrupted by the tumor, a thorough clinical and radiological assessment is needed to timely detect any instability and to plan a surgical stabilization procedure. We hope that this review will help shed light on the current evidence and pave the way for future studies on this topic. Full article
(This article belongs to the Special Issue Assessment and Management of Instability in Spinal Tumors)
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Other

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15 pages, 632 KiB  
Systematic Review
Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation
by Stefano Colonna, Andrea Bianconi, Fabio Cofano, Alessandro Prior, Giuseppe Di Perna, Giuseppe Palmieri, Gianluigi Zona, Diego Garbossa and Pietro Fiaschi
Diagnostics 2023, 13(6), 1164; https://doi.org/10.3390/diagnostics13061164 - 18 Mar 2023
Cited by 3 | Viewed by 1244
Abstract
Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in [...] Read more.
Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in which an alternating current is delivered to the tumor lesion producing local heating and consequent necrosis. However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability, and indeed the aim of the present study is to investigate the effects of RFA on spine stability. A systematic review according to PRISMA-P guidelines was performed, and 17 papers were selected for the systematic review. The results show how RFA is an effective, safe, and feasible alternative to conventional radiotherapy for the treatment of VBM without indication for surgery, but spine stability is a major issue in this context. Although exerting undeniable benefits on pain control and local tumor recurrence, RFA alone increases the risk of spine instability and consequent vertebral body fractures and collapses. Concomitant safe and feasible therapeutic strategies such as percutaneous vertebroplasty and kyphoplasty have shown synergic positive effects on back pain and improvement in spine stability. Full article
(This article belongs to the Special Issue Assessment and Management of Instability in Spinal Tumors)
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