Spinal Tumors

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 7194

Special Issue Editors

Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, Münster, Germany
Interests: brain tumors; pediatroc brain tumors; TBI; stroke; spine tumors; degenerative spine
Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
Interests: glioma; spine surgery; brain stimulation; skull base; neurosurgery; transcranial magnetic stimulation; diffusion tensor imaging; intraoperative neurophysiology; TMS; neuroimaging

Special Issue Information

Dear Colleagues, 

Spinal tumors are categorized as being intramedullary tumors, intradural extramedullary tumors, and extradural tumors. Though anatomically positioned close to each other, these groups of tumors include different histological entities. They range from the very rare—mainly glial— intramedullary tumors to the more frequent juxtamedullary tumors such as meningiomas and schwannomas, which are usually benign, through to the most frequent entity of bony spinal metastasis in vertebral bodies. Also included are primary bone tumors such as Ewing sarcoma, osteoblastoma, and osteochondroma, among others.

In recent years, information has been accumulating about the diagnostics and treatment of spinal tumors—not only with regard to surgical treatment but also other treatment modalities such as chemotherapy, proton beam, and stereotactic irradiation. In the surgical field, novel methods have also evolved, offering more safe and maximal resections of tumors and allowing improved oncologic and functional outcomes. One example is complex en bloc spondylectomy including resection of neighboring anatomical structures, such as the ribs, lungs, and vessels, and advances in intra-operative monitoring and imaging techniques allowing improved resection of intramedullary tumors.

Furthermore, modified treatment protocols for the treatment of spinal sarcomas have facilitated tumor reduction prior to surgery, enabling complete resection and thus improving patient outcome. Further translational and clinical studies are needed to discover new treatment options.

In addition to oncological and functional outcomes, the quality of treatment is becoming a more important issue. Rising costs together with the shortage of skilled workers and resources are also challenging therapists and society alike. Implementing treatment protocols, adhering to clinical guidelines, and optimizing the processes of care may improve clinical outcomes, increase patient satisfaction, and lower treatment expenses. Indicators for assessing quality include the length of hospital stay and rates of mortality, unplanned readmissions, and nosocomial infections.

Dr. Michael Schwake
Prof. Dr. Ehab Shiban
Guest Editors

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Keywords

  • spine tumors
  • intradural tumors
  • intramedullary tumors
  • spinal metastasis
  • intraoperative monitoring
  • spinal meningioma
  • spinal schwannoma
  • ependymoma
  • sarcoma
  • Ewing sarcoma
  • spinal instability
  • hemangioblastoma

Published Papers (5 papers)

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10 pages, 271 KiB  
Article
Does Early Mobilization Following Resection of Spinal Intra-Dural Pathology Increase the Risk of Cerebrospinal Fluid Leaks?—A Dual-Center Comparative Effectiveness Research
by Michael Schwake, Sophia Krahwinkel, Marco Gallus, Stephanie Schipmann, Emanuele Maragno, Volker Neuschmelting, Moritz Perrech, Michael Müther and Moritz Lenschow
Medicina 2024, 60(1), 171; https://doi.org/10.3390/medicina60010171 - 17 Jan 2024
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Abstract
Background and Objectives: Prolonged bed rest after the resection of spinal intradural tumors is postulated to mitigate the development of cerebrospinal fluid leaks (CSFLs), which is one of the feared postoperative complications. Nonetheless, the empirical evidence supporting this conjecture remains limited and [...] Read more.
Background and Objectives: Prolonged bed rest after the resection of spinal intradural tumors is postulated to mitigate the development of cerebrospinal fluid leaks (CSFLs), which is one of the feared postoperative complications. Nonetheless, the empirical evidence supporting this conjecture remains limited and requires further investigation. The goal of the study was to investigate whether prolonged bed rest lowers the risk of CSFL after the resection of spinal intradural tumors. The primary outcome was the rate of CSFL in each cohort. Materials and Methods: To validate this hypothesis, we conducted a comparative effectiveness research (CER) study at two distinct academic neurosurgical centers, wherein diverse postoperative treatment protocols were employed. Specifically, one center adopted a prolonged bed rest regimen lasting for three days, while the other implemented early postoperative mobilization. For statistical analysis, case–control matching was performed. Results: Out of an overall 451 cases, we matched 101 patients from each center. We analyzed clinical records and images from each case. In the bed rest center, two patients developed a CSFL (n = 2, 1.98%) compared to four patients (n = 4, 3.96%) in the early mobilization center (p = 0.683). Accordingly, CSFL development was not associated with early mobilization (OR 2.041, 95% CI 0.365–11.403; p = 0.416). Univariate and multivariate analysis identified expansion duraplasty as an independent risk factor for CSFL (OR 60.33, 95% CI: 0.015–0.447; p < 0.001). Conclusions: In this CER, we demonstrate that early mobilization following the resection of spinal intradural tumors does not confer an increased risk of the development of CSFL. Full article
(This article belongs to the Special Issue Spinal Tumors)
11 pages, 955 KiB  
Article
Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine
by Kateryna Goloshchapova, Maria Goldberg, Bernhard Meyer, Maria Wostrack and Vicki M. Butenschoen
Medicina 2023, 59(10), 1754; https://doi.org/10.3390/medicina59101754 - 30 Sep 2023
Viewed by 1085
Abstract
Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This [...] Read more.
Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors’ early and late postoperative clinical course. Materials and Methods: This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients’ preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. Conclusions: More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors. Full article
(This article belongs to the Special Issue Spinal Tumors)
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9 pages, 1875 KiB  
Article
Minimally Invasive Facetectomy and Fusion for Resection of Extensive Dumbbell Tumors in the Lumbar Spine
by Michael Schwake, Emanuele Maragno, Marco Gallus, Stephanie Schipmann, Dorothee Spille, Bilal Al Barim, Walter Stummer and Michael Müther
Medicina 2022, 58(11), 1613; https://doi.org/10.3390/medicina58111613 - 08 Nov 2022
Cited by 2 | Viewed by 1520
Abstract
Background and Objectives: Resection of dumbbell tumors can be challenging, and facet joint sparing approaches carry the risk of incomplete resection. In contrast, additional facetectomy may allow better surgical exposure at the cost of spinal stability. The aim of this study is [...] Read more.
Background and Objectives: Resection of dumbbell tumors can be challenging, and facet joint sparing approaches carry the risk of incomplete resection. In contrast, additional facetectomy may allow better surgical exposure at the cost of spinal stability. The aim of this study is to compare facet-sparing and facetectomy approaches for the treatment of lumbar spine dumbbell tumors. Materials and Methods: In a cohort study setting, we analyzed Eden type 2 and 3 tumors operated in our department. Conventional facet-sparing microsurgical or facetectomy approaches with minimally invasive fusions were performed according to individual surgeons’ preference. Primary outcomes were extent of resection and tumor progression over time. Secondary outcomes were perioperative adverse events. Results: Nineteen patients were included. Nine patients were operated on using a facet-sparing technique. Ten patients underwent facetectomy and fusion. While only one patient (11%) in the facet-sparing group experienced gross total resection (GTR), this was achieved for all patients in the facetectomy group (100%). The relative risk (RR) for incomplete resection in the facet-sparing cohort was 18.7 (95% CI 1.23–284.047; p = 0.035). In addition, time to progression was shorter in the facet-sparing cohort (p = 0.022) and all patients with a residual tumor underwent a second resection after a median follow-up time of 42 months (IQR 25–66). Conclusions: Minimally invasive resection of lumbar Eden type 2 and 3 dumbbell tumors including facetectomy in combination with instrumentation appears to be safe and superior to the facet-sparing approach in terms of local tumor control. Full article
(This article belongs to the Special Issue Spinal Tumors)
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11 pages, 664 KiB  
Article
Spinal Meningioma Surgery in Octogenarians: Functional Outcomes and Complications over a 2-Year Follow-Up Period
by Pavlina Lenga, Gelo Gülec, Awais Akbar Bajwa, Mohammed Issa, Karl Kiening, Basem Ishak and Andreas W. Unterberg
Medicina 2022, 58(10), 1481; https://doi.org/10.3390/medicina58101481 - 18 Oct 2022
Cited by 1 | Viewed by 1651
Abstract
Background and Objectives: Population aging in industrial nations has led to an increased prevalence of benign spinal tumors, such as spinal meningiomas (SMs), in the elderly. The leading symptom of SM is local pain, and the diagnosis is confirmed after acute neurological [...] Read more.
Background and Objectives: Population aging in industrial nations has led to an increased prevalence of benign spinal tumors, such as spinal meningiomas (SMs), in the elderly. The leading symptom of SM is local pain, and the diagnosis is confirmed after acute neurological decline. However, little is known about the optimal treatment for this frail patient group. Therefore, this study sought to assess the clinical outcome, morbidity, and mortality of octogenarians with SMs and progressive neurological decline undergoing surgery and to determine potential risk factors for complications. Materials and Methods: Electronic medical records dated between September 2005 and December 2020 from a single institution were retrieved. Data on patient demographics, neurological conditions, functional status, degree of disability, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Results: Thirty patients aged ≥80 years who were diagnosed with SMs underwent posterior decompression via laminectomy and microsurgical tumor resection. The patients presented with a poor baseline history (mean CCI 8.9 ± 1.6 points). Almost all SMs were located in the thoracic spine (n = 25; 83.3%). Progressive preoperative neurological decline was observed in 21/30 (n = 21; 70%) patients with McCormick Scores (mMCS) ≥3, and their mean motor score (MS) was 85.9 ± 12.3. in the in-hospital and 90-day mortality rates were 6.7% and 10.0%, respectively. The MS (93.6 ± 8.3) and mMCS (1.8 ± 0.9) improved significantly postoperatively (p < 0.05). The unique risk factor for complications was the severity of comorbidities. Conclusions: Decompressive laminectomy and tumor removal in octogenarians with progressive neurological decline improved patient functional outcomes at discharge. Surgery seems to be the “state of the art” treatment for symptomatic SMs in elderly patients, even those with poor preoperative clinical and neurologic conditions, whenever there is an acceptable risk from an anesthesiological point of view. Full article
(This article belongs to the Special Issue Spinal Tumors)
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7 pages, 5119 KiB  
Case Report
Myositis Ossificans with Aneurysmal Bone Cystic Changes at the Thoracic Paraspinal Region: A Case Report
by In Ho Han, You Seon Song, In Sook Lee, Dong Hwan Kim and Kyung Un Choi
Medicina 2022, 58(10), 1452; https://doi.org/10.3390/medicina58101452 - 14 Oct 2022
Viewed by 1544
Abstract
Myositis ossificans (MO) is a benign heterotopic bone formation in muscle or soft tissue. It is a self-limiting disease that is usually initiated by trauma and often occurs in the extremities of the body. Here we report a rare case of traumatic myositis [...] Read more.
Myositis ossificans (MO) is a benign heterotopic bone formation in muscle or soft tissue. It is a self-limiting disease that is usually initiated by trauma and often occurs in the extremities of the body. Here we report a rare case of traumatic myositis ossificans caused by unusual trauma (extracorporeal shock wave therapy) at thoracic paraspinal muscles. After a needle biopsy, the lesion increased in size, and the patient’s symptoms worsened. Malignant soft tissue tumors such as osteosarcoma should be differentiated, so excision of the mass was performed. The final diagnosis was MO with aneurysmal bone cystic change. This case is a very rare form of MO that showed an unusual cause, location, clinical course, and pathologic result on follow-up. This can be an instructive case for radiologists as it is a common disease entity with unusual manifestations. Full article
(This article belongs to the Special Issue Spinal Tumors)
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