Oncologic Spine Research Articles

Use of Biological Tissue Matrix in Postneurosurgical Posterior Trunk Reconstruction Is Associated with Higher Wound Complication Rates.

Patients undergoing neurosurgical spine surgery for spinal tumors are increasingly undergoing soft-tissue reconstruction involving the use of biological tissue matrices. There are limited data available on the safety of these devices in posterior trunk reconstruction. A cohort study of patients undergoing oncologic spine surgery with subsequent plastic surgery soft-tissue reconstruction from 2002 to 2014 was conducted. Demographic, medical, and surgical variables were recorded. The primary outcome variable was development of a postoperative wound complication. Secondary outcome variables were specific complications, including infection, seroma, hematoma, dehiscence, and cerebrospinal fluid leak. The predictor variable was the presence or absence of biological matrix at the reconstruction site. A total of 293 cases in 260 patients were included in this study. The cohorts were similar with regard to demographic, medical, and surgical variables. The incidence of all-cause wound complications in patients receiving biological matrix for reconstruction was 49.2 percent, whereas the all-cause complication rate for patients not receiving the matrix was 31.7 percent (p = 0.010). The rates of infection (34.9 percent versus 20.9 percent) and seroma (19.0 percent versus 10.0 percent) were also increased in patients receiving biological matrix. In multivariate analysis, biological matrix use remained a predictor of wound complications (p = 0.045), infection (p = 0.011), and seroma (p = 0.047). The authors identified an increased risk of infection and seroma with the use of biological tissue matrix in posterior trunk reconstruction. Careful consideration of the risks and benefits of using these devices in this patient population is warranted. Therapeutic, III.

Mesenchymal Stem Cells Derived from Vertebrae Show Best Biological Properties

Introduction Due to their properties and characteristics, human mesenchymal stem cells (MSCs) appear to have great therapeutic potential, because they can contribute to the tissue regeneration. Many different populations of MSCs that differ for the embryonic origin and the anatomical localization have been described and to understand whether they have equivalent biological properties is a critical issue for their therapeutic application. Spine fusion is frequently used to treat traumatic, degenerative, and oncological spine diseases. Autologous bone graft has been considered the gold standard for spine fusion procedures because of its osteogenic, osteoinductive, and osteoconductive ability. However, its use is associated with significant disadvantages, including donor site pain, increased operative time, insufficient availability, and nonunion postlumbar fusion. Various bone substitutes have been developed to promote spinal fusion. Also, MSCs have been successfully tested for spinal fusion in several small and large animal models. Material and Methods To define the properties of MSCs for the use in clinical applications, we proposed to analyze the cellular and molecular characteristics of human adult MSCs derived from different body locations, such as bone marrow from the iliac crest (Ic-MSCs), sternum (St-MSCs), and vertebrae (vMSCs), as well as colon (Co-MSCs) and dental pulp (DPSCs), to identify the cell population showing better biological properties for spine fusion clinical application. Results MSCs from different sources presented very different growth kinetics. While iliac crest and sternum-derived MSCs could be maintained in culture for about 3 months, undergoing a limited expansion, mesenchymal cultures derived from dental pulp and colon grew much more rapidly, but could not be maintained longer. Strikingly, vMSCs continued to propagate at high rate even after 3.5 months ex vivo. MSCs from different sources were also induced to osteogenic, adipogenic, and chondrogenic differentiation following exposure to specific inducing agents. We observed that vMSCs generate mature cells of all mesenchymal lineages with greater efficiency, resulting into the best population both in terms of expansion and differentiation. Conclusion This finding could be very interesting and open new perspectives for the improvement of spine fusion, which is a mandatory step for the success of spinal surgical procedures. In the course of a surgical procedure for spinal fusion, vertebral bone marrow can be harvested simultaneously with the preparation of the site for pedicle screw insertion. Then multipotent MSCs can be isolated from vertebral bone marrow during the progress of the surgical procedure and reintroduced in the fusion site (using homologous or autologous bone tissue or biomaterials as scaffold), without any additional surgical time or any other donor site involvement.

Adverse events in emergency oncological spine surgery: a prospective analysis.

Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery. The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff. A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventy-six patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases. When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population.

Evidence-based medicine in metastatic spine disease

Treatment modalities for metastatic spine disease have significantly expanded over the last two decades. This expansion occurred in many different fields. Improvement in surgical techniques and instrumentation now allow the oncologic spine surgeons to effectively circumferentially decompress the neural elements without compromising stability. Percutaneous techniques, both vertebral augmentation and pre-operative endovascular embolization procedures, also greatly benefit patients suffering from spinal column metastasis. Imaging technology advances has contributed to better pre-operative planning and the development of highly conformational radiation techniques, thus permitting the delivery of high-dose radiation to tumors, while avoiding radiotoxicity to the spinal cord and other vital structures. These new developments, combined with evidence-based stability and disease-specific quality of life scores now allow not only better treatment, but also a solid foundation for high-quality research. Spine oncology literature currently suffers from a lack of high-quality evidence due to low prevalence of the disease and complex methodological issues. However, when following evidence-based medicine principles, which incorporate best available evidence, clinical expertise and patient preference, sound, evidence-based recommendations can be made regarding the abovementioned treatment modalities.

Navigation-assisted surgery for tumors of the spine

Computer-assisted navigation systems are largely used for pedicle screws positioning in degenerative and traumatic spine surgery. In oncologic spine surgery its use is still developing and could be extended for tumor identification and excision. Aim of this paper is to present our experience. Seven selected patients (5 females, 2 males), mean age 44 years (min 17-max 62) affected by primary benign or malignant tumors of the spine or spine metastases were surgically treated with the use of computer-assisted navigation system from March to October 2011. At 18 months mean F.U. (min 15-max 23), no LR were observed. Revision surgery was necessary only in one case for C1 pedicle screw malpositioning. Navigation system can improve surgical accuracy in screws placement and tumor localization and excision. Learning curve and technical aspects must be considered to avoid potential serious mistakes.

Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an

# 1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity {#article-title-2} Radiculopathy resulting from intervertebral disc herniation involves mechanical compression and biochemical inflammation of