Primary Spinal Tumors Research Articles

Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan.

To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs. The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts. Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas. A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.

Role of MRI in the Diagnosis of Intra Medullary Spinal Tumor with Histopathological Correlation

Introduction: Intramedullary spinal cord tumor (IMSCT) constitutes 8% to 10% of all primary spinal tumors with the majority comprised of gliomas (80% to 90%), of which 60% to 70% are ependymomas and 30% to 40% are astrocytomas. Astrocytomas are common in the thoracic region whereas ependymomas are common in cervical region. Ependymomas are the most common glial tumor in adults, whereas astrocytomas are the most common intramedullary tumor in children. Overall, 15% of all primary intramedullary spinal cord tumors are ependymal in origin and include one of three histopathologic subtypes: ependymoma, subependymoma and myxopapillary ependymoma. Aim of the Study: The aim of this study was to evaluate the role of MRI in diagnosis of intra medullary spinal tumors compared to histopathological findings. Methods: This was a cross sectional study and was conducted in the Department of Radiology and Imaging, Sylhet M.A.G. Osmani Medical College, Sylhet in collaboration with Department of Neurosurgery & Pathology of the same hospital, Sylhet, Bangladesh during the period from September, 2018 to August 2020. Result: In total 35 patients completed the study. In our study we found the Mean ± SD of age was 41.71±13.9 in years. Majority (57%) of our patients presented with intramedullary spinal cord tumor were male compared to female (43%).We found that among of our 35 patients 20 (57.14%) were ependymoma, 15 (42.86%) patients were astrocytoma diagnosed by MRI. Majority (40%) patients of ependymoma belong to 41-50 years and majority patients of astrocytoma (40%) belong to 10-20 years old. Both ependymoma and astrocytoma showed male predominance with 55% and 60% respectively. It was observed that majority (70% & 55%) patients of ependymoma had back & radicular pain respectively. Majority (80% & 60%) patients of astrocytoma had back & radicular pain respectively. Ependymoma was determined by calculating sensitivity 95.0%, specificity 100%, accuracy 97.14%, PPV 100% and NPV 93.75% ....

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1).

Spinal meningiomas are the most common primary intradural spinal tumors. Although they are a separate entity, a large portion of the knowledge on spinal meningiomas is based on findings in intracranial meningiomas. Therefore, a comprehensive review of all the literature on spinal meningiomas was performed. Electronic databases were searched for all studies on spinal meningiomas dating from 2000 and onward. Findings of matching studies were pooled to strengthen the current body of evidence. A total of 104 studies were included. The majority of patients were female (72.83%), elderly (peak decade: seventh), and had a world health organization (WHO) grade 1 tumor (95.7%). Interestingly, the minority of pediatric patients had a male overrepresentation (62.0% vs. 27.17%) and higher-grade tumors (33.3% vs. 4.3%). Sensory and motor dysfunction and pain were the most common presenting symptoms. Despite a handful of studies reporting promising findings associated with the use of non-surgical treatment options, the literature still suffers from contradictory results and limitations of study designs. Elderly females with WHO grade 1 tumors constituted the stereotypical type of patient. Compared to surgical alternatives, the evidence for the use of non-surgical treatments is still relatively weak.

Minimally Invasive Resection of Benign Osseous Tumors of the Spinal Column: 10 Years' Experience and Long-Term Outcomes of a Specialized Center.

Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on minimally invasive resection of these lesions are rare. We report a series of patients managed by total resection of benign osseous spine tumors using MIS techniques. Surgical decisions and technical considerations are discussed. Materials and Methods: A retrospective evaluation of prospectively collected data of patients who underwent minimally invasive surgery for removal of benign osseous vertebral tumors. Demographic, clinical and radiographic features, operative details and final pathological reports were summarized. Primary outcomes were completeness of tumor resection and pain relief assessed by VAS for back and leg pain. Secondary outcome measures were recurrence of tumor on repeat post-operative MRI and postoperative unstable deformity on standing scoliosis X-rays. Results: This series included 32 cases of primary osseous spine tumors resected by minimally invasive techniques. There were 17 males and 15 females aged 5-68 years (mean 23.3). The follow-up period was 8-90 months (mean 32 months) and the preoperative symptoms duration was 9-96 months. Axial spinal pain was the presenting symptom in all the patients. Five patients also complained about radicular pain and four patients had antalgic scoliosis. The tumor involved the thoracic spine in 12 cases, the lumbar segment in 11, the cervical in 5 and the sacral area in 4 cases. Complete tumor removal was performed in all patients. No procedure-related complications were encountered. Histopathology showed osteoid osteoma in 24 patients, osteoblastoma in 5 patients, and fibrous dysplasia, fibroadenoma and eosinophilic granuloma in one case each. All patients experienced significant pain relief after surgery, and had stopped pain medications by 12 months postoperatively. No patient suffered from tumor recurrence or spinal deformity. Conclusions: Minimally invasive surgery is feasible for total removal of selected benign vertebral tumors and may have some advantages over conventional surgical techniques.

Composite hemangioendothelioma in the cervical spine with kaposiform hemangioendothelioma features in an elderly patient: a case report.

Composite hemangioendothelioma (CHE) is an intermediate group of tumors with features between hemangioma and angiosarcoma both histologically and biologically. CHE is predominant in young and middle-aged adults, but very infrequently affects the spine. We describe the case of primary CHE in the cervical spine exhibiting kaposiform hemangioendothelioma (KHE)-like components that was associated with cervical myelopathy with vertebral body destruction in an elderly woman. We retrospectively reviewed the case of a primary cervical spinal tumor, diagnosed as CHE with KHE-like components in pathological findings, associated with cervical myelopathy and cervical vertebral body destruction. An 80-year-old woman presented with progressive cervical myelopathy caused by a cervical spine tumor. Preoperative cervical MRI revealed a neoplastic lesion invading the cervical spine that strongly compressed the spinal cord, causing right upper-limb paralysis. We performed partial tumor resection along with posterior decompression and fixation. Postoperatively, pathological findings showed that the tumor was CHE with KHE-like features. Following radiotherapy, no recurrences have been observed in 21 months. This is the first report of CHE with features of KHE in the spine of an elderly patient. Posterior decompression and fusion of the cervical spine and subsequent radiotherapy resulted in a good outcome.

En bloc resection of huge primary tumors with epidural involvement in the mobile spine using the "rotation-reversion" technique: Feasibility, safety, and clinical outcome of 11 cases.

En bloc resection of spinal tumors provides better local control and survival outcomes than intralesional resection. Safe margins during en bloc resection of primary spinal tumors with epidural involvement are required for improved outcomes. The present study describes a "rotation-reversion" technique that has been used for en bloc resection of huge primary tumors in the mobile spine with epidural involvement and reported the clinical outcomes in these patients. All patients with primary spinal tumors who were treated with the rotation-reversion technique at our institution between 2015 and 2021 were evaluated retrospectively. Of the patients identified, those with both huge extraosseous soft-tissue masses and epidural involvement were selected for a case review. Clinical and radiological characteristics, pathologic findings, operative procedures, complications, and oncological and functional outcomes of these patients were reviewed. Of the 86 patients identified with primary spinal tumors who underwent en bloc resection using the rotation-reversion technique between 2015 and 2021, 11 had huge extraosseous soft-tissue masses with epidural involvement in the mobile spine. The average maximum size of these 11 tumors was 8.1 × 7.5 × 9.7 cm. Median follow-up time was 28.1 months, mean operation time was 849.1 min (range 465-1,340 min), and mean blood loss was 6,972.7 ml (range 2,500-17,700 ml), with 10 (91%) of the 11 patients experiencing perioperative complications. The negative margin rate was 91%, with only one patient (9%) experiencing local recurrence. Ten patients were able to walk normally or with a crutch at the last follow-up, whereas one was completely paralyzed preoperatively. The rotation-reversion technique is an effective procedure for the en bloc resection of huge primary spinal tumors, with the extension of invasion in selected patients including not only the vertebral body but also the pedicle and part of the posterior arch.

RTID-01. ONC108: A RANDOMIZED PHASE 3 STUDY OF ONC201 IN PATIENTS WITH NEWLY DIAGNOSED H3 K27M-MUTANT DIFFUSE GLIOMA

Abstract BACKGROUND H3 K27M-mutant diffuse midline glioma is a universally fatal malignancy primarily affecting children and young adults; while radiotherapy (RT) provides transient benefit, no effective systemic therapy is currently available. ONC201, a first-in-class imipridone, is an oral, blood-brain barrier penetrating, selective small molecule antagonist of dopamine receptor D2/3 (DRD2) and agonist of the mitochondrial protease ClpP. An integrated pooled analysis of objective response in ONC201-treated patients enrolled in one of five open-label trials has previously demonstrated efficacy in patients with recurrent disease. This phase 3 trial will be the first randomized, controlled study evaluating ONC201 in patients with H3 K27M-mutant disease. METHODS ONC108 is a randomized, double-blind, placebo-controlled, parallel-group, international Phase 3 study of ONC201 in patients with newly diagnosed H3 K27M-mutant diffuse glioma. Patients will be randomized to receive once-weekly ONC201 or placebo following standard frontline radiotherapy. Primary efficacy endpoints are overall survival (OS) and progression-free survival (PFS) in all participants; PFS will be assessed with the response assessment in neuro-oncology-high grade glioma by blind independent central review. Other objectives include assessments of safety, additional efficacy endpoints, clinical benefit, quality of life, pharmacokinetics, biomarkers, and healthcare resource utilization. Eligible patients will have histologically confirmed H3 K27M-mutant diffuse glioma, a Karnofsky/Lanksy performance status ≥ 70, and completed first-line radiotherapy. Eligibility will not be restricted based on age; however, patients must be ≥ 10 kg at time of randomization. Patients with a primary spinal tumor, diffuse intrinsic pontine glioma, leptomeningeal disease, or cerebrospinal fluid dissemination are not eligible.

Clinical characteristics, prognostic factors, and predictive model for elderly primary spinal tumor patients who are difficult to tolerate surgery or refuse surgery.

As a rare tumor, surgery is the best treatment for primary spinal tumors. However, for elderly patients who cannot undergo surgery, the prognosis is often difficult to evaluate. The purpose of this study was to identify the risk factors that may lead to death and predict the prognosis of elderly patients with primary spinal tumors who have not undergone surgical treatment. In this study, 426 patients aged 60 years or older diagnosed with a primary spinal tumor between 1975 and 2015 were selected and included from the Surveillance, Epidemiology, and End Results database. A retrospective analysis was performed by using the Cox regression algorithm to identify independent prognostic factors. A nomogram model was developed based on the results. Multiple evaluation methods (calibration curve, receiver operating characteristic curve, and decision curve analyses) were used to evaluate and validate the performance of the nomogram. A nomogram was developed, with age, histological type, and stage as independent prognostic factors. The results indicated that the prognostic risk tended to increase significantly with age and tumor spread. Osteosarcoma was found to have the most prominent risk prognosis in this patient group, followed by chondrosarcoma and chordoma. The area under the curve and the C-index of the model were both close to or greater than 0.7, which proved the high-differentiation ability of the model. The calibration curve and decision curve analyses showed that the model had high predictive accuracy and application value. We successfully established a practical nomogram to assess the prognosis of elderly patients with primary spinal tumors who have not undergone surgical treatment, providing a scientific basis for clinical management.

The Impact of the COVID-19 Pandemic on the Presentation of Patients With Spinal Metastases.

Retrospective review. The aim was to determine if preoperative spinal instability neoplastic scores (SINSs) and Tokuhashi prognostication scores differed in patients receiving surgical care before and during the coronavirus disease-2019 (COVID-19) pandemic. The COVID-19 pandemic has caused delays in scheduling nonemergent surgeries. Delay in presentation and/or surgical treatment for oncology patients with metastatic spinal disease could result in progression of the disease, which can complicate surgical care and worsen patient outcomes. Retrospective review of electronic medical records between March 1, 2019 and March 1, 2021 at a tertiary medical center was performed to identify patients who underwent surgery for metastatic spine disease. Primary spinal tumors were excluded. Patients were separated into two groups base on their surgery date: before the COVID-19 pandemic (March 1, 2019-February 29, 2020) and during the COVID-19 pandemic (March 1, 2020-March 1, 2021). Primary outcomes included SINS and Tokuhashi scores. A variety of statistical tests were performed to compare the groups. Fifty-two patients who underwent surgery before the COVID-19 pandemic were compared to 41 patients who underwent surgery during the COVID-19 pandemic. There was a significant difference between the before and during groups with respect to SINS (9.31±2.39 vs . 11.00±2.74, P =0.002) and Tokuhashi scores (9.27±2.35 vs . 7.88±2.85, P =0.012). Linear regression demonstrated time of surgery (before or during COVID-19 restrictions) was a significant predictor of SINS (β=1.55, 95% CI: 0.42-2.62, P =0.005) and Tokuhashi scores (β=-1.41, 95% CI: -2.49 to -0.34, P =0.010). Patients with metastatic spinal disease who underwent surgery during the COVID-19 pandemic had higher SINS, lower Tokuhashi scores and similar Skeletal Oncology Research Group scores compared to patients who underwent surgery before the pandemic. This suggests the pandemic has impacted the instability of disease at presentation in patients with spinal metastases, but has not impacted surgical prognosis, as there were no differences in Skeletal Oncology Research Group scores and the difference in Tokuhashi scores is most likely not clinically significant.

Independent predictors of vertebral compression fracture following radiation for metastatic spine disease.

The goal of this study was to determine independent risk factors for vertebral compression fracture (VCF) following radiation for metastatic spine disease, including low bone mineral density as estimated by Hounsfield units (HU). A retrospective chart review identified patients with a single vertebral column metastasis treated with radiation therapy, a pretreatment CT scan, and a follow-up CT scan at least 6 weeks after treatment. Patients with primary spine tumors, preradiation vertebroplasty, preradiation spine surgery, prior radiation to the treatment field, and proton beam treatment modality were excluded. The HU were measured in the vertebral bodies at the level superior to the metastasis, within the tumor and medullary bone of the metastatic level, and at the level inferior to the metastasis. Variables collected included basic demographics, Spine Instability Neoplastic Score (SINS), presenting symptoms, bone density treatment, primary tumor pathology, Weinstein-Boriani-Biagini (WBB) classification, Enneking stage, radiation treatment details, chemotherapy regimen, and prophylactic vertebroplasty. One hundred patients with an average age of 63 years and average follow-up of 18 months with radiation treatment dates ranging from 2017 to 2020 were included. Fifty-nine patients were treated with external-beam radiation therapy, with a median total dose of 20 Gy (range 8-40 Gy). Forty-one patients were treated with stereotactic body radiation therapy, with a median total dose of 24 Gy (range 18-39 Gy). The most common primary pathologies included lung (n = 22), prostate (n = 21), and breast (n = 14). Multivariable logistic regression analysis (area under the curve 0.89) demonstrated pretreatment HU (p < 0.01), SINS (p = 0.02), involvement of ≥ 3 WBB sectors (p < 0.01), primary pathology other than prostate (p = 0.04), and ongoing chemotherapy treatment (p = 0.04) to be independent predictors of postradiation VCF. Patients with pretreatment HU < 145 (n = 32), 145-220 (n = 31), and > 220 (n = 37) had a fracture rate of 59%, 39%, and 11%, respectively. An HU cutoff of 157 was found to maximize sensitivity (71%) and specificity (75%) in predicting postradiation VCF. Low preradiation HU, higher SINS, involvement of ≥ 3 WBB sectors, ongoing chemotherapy, and nonprostate primary pathology were independent predictors of postradiation VCF in patients with metastatic spine disease. Low bone mineral density, as estimated by HU, is a novel and potentially modifiable risk factor for VCF.

Endoscopic surgical treatment for primary spinal lesions.

Primary spinal cord tumours are infrequently encountered CNS neoplasms and can be broadly classified into intradural intramedullary and intradural extramedullary lesions. Resection of these lesions was traditionally done via open surgical access almost always with microscope assistance. With the advent of minimally invasive surgical techniques, endoscopic excision of these lesions has been attempted for selected tumours. Available literature mainly deals with retrospective reviews on small number of patients; therefore, extensive research is required to establish safety and efficacy of endoscopic approach for excision of primary spinal tumours.

Pathological Classification of the Intramedullary Spinal Cord Tumors According to 2021 World Health Organization Classification of Central Nervous System Tumors, a Single-Institute Experience.

According to the new 2021 World Health Organization (WHO) classification of tumors of the central nervous system (CNS) the classification of the primary intramedullary spinal cord tumors (IM-SCT) follows that of CNS tumors. However, since the genetics and methylation profile of ependymal tumors depend on the location of the tumor, the ‘spinal (SP)’ should be added for the ependymoma (EPN) and subependymoma (SubEPN). For an evidence-based review, the authors reviewed SCTs in the archives of the Seoul National University Hospital over the past decade. The frequent pathologies of primary IM-SCT were SP-EPN (45.1%), hemangioblastoma (20.0%), astrocytic tumors (17.4%, including pilocytic astrocytoma [4.6%] and diffuse midline glioma, H3 K27-altered [4.0%]), myxopapillary EPN (11.0%), and SP-subEPN (3.0%) in decreasing order. IDH-mutant astrocytomas, oligodendrogliomas, glioneuronal tumors, embryonal tumors, and germ cell tumors can occur but are extremely rare in the spinal cord. Genetic studies should support for the primary IM-SCT classification. In the 2021 WHO classifications, extramedullary SCT did not change significantly but contained several new genetically defined types of mesenchymal tumors. This article focused on primary IM-SCT for tumor frequency, age, sex difference, pathological features, and genetic abnormalities, based on a single-institute experience.

Lumbar Solitary Osteochondroma with Lower Extremity Weakness: A Case Report

Background: Osteochondroma is the most common benign bone tumor. However, osteochondroma of the spine is relatively rare, accounting for only 4% to 7% of primary benign spinal tumors and less than 3% of all osteochondromas. Furthermore, symptomatic osteochondroma in the lumbar spine is much rarer. We herein describe a patient who was diagnosed with a lumbar solitary osteochondroma causing neurological symptoms of the lower extremities. The patient successfully underwent surgical removal of the lesion. Case Presentation: A 79-year-old man presented with a 3-year history of difficulty walking and gradual development of numbness in his left upper extremity, which further exacerbated his difficulty walking. Magnetic resonance imaging and computed tomography revealed spinal stenosis at C3/4, L4/5, and L5/S1 and an osseous solitary lesion. We performed a single-stage operation of both the cervical and lumbar spine. The osseous solitary lesion at L5/S1 was removed, and the pathological diagnosis was osteochondroma. After the operation, the patient’s upper extremity numbness and walking ability were improved. Conclusions: We experienced a rare case of a neurologically symptomatic solitary osteochondroma in the lumbar spinal canal. Moreover, this lesion was found at the same time as cervical spondylosis causing numbness. Therefore, we must perform careful examinations and thoroughly evaluate imaging and postoperative pathological findings.

Blood loss in total en bloc spondylectomy for primary spinal bone tumours: a comparison of estimated blood loss versus actual blood loss in a single centre over 10 years.

BackgroundTotal en bloc spondylectomy (TES) is a widely accepted surgical technique for primary spinal bone tumours but is frequently accompanied by substantial peri-operative blood loss. Prior studies have reported estimated blood loss (EBL) can reach up to 3,200 mL. The aim of this study is to estimate the blood loss during TES procedures performed in the last ten years at our tertiary referral centre and compare EBL with actual blood loss (ABL).MethodsWe performed a retrospective review of all cases managed surgically with TES referred to our centre between 2005 and 2015. We recorded the oncological characteristics of each tumour and surgical management in terms of resection margins, operative duration and instrumentation. Data relating to peri-operative blood loss was also recorded including an estimation of total blood loss, the use of cell salvage where applicable and transfusion rates.ResultsA total of 21 patients were found to meet our inclusion criteria. There were 11 men and 10 women, with a median age of 40 years. The mean total ABL was 3,310 mL. Total operation time ranged from 6.53 to 19.7 h. Compared to ABL, in 59% of cases EBL had been underestimated by an average of 78% by volume. The EBL of the remaining 41% cases had been overestimated by 43%. This was not statistically significant (P=0.373). Cell salvage was used in 62% patients with a mean blood loss of 2,845 mL (884–4,939 mL) and transfusion of 3.8 units (0–12 units) versus 4,069 mL (297–8,335 mL) and 9.3 units (0–18 units) in those not managed with cell salvage. There was no significant difference in ABL between the cell salvage and non-cell salvage groups.ConclusionsWe report one of the largest case series in TES for primary bone tumours. EBL is not a reliable predictor for ABL. A large blood loss should be anticipated and use of cell salvage is recommended.

Spinal Giant Cell Tumor in Neurospine Surgery: A Narrative Study

Background and Aim: Spinal Giant Cell Tumor (GCT) is a primary low-grade malignant aggressive tumor of the spine and is more prevalent in the third and fourth decades of life. Spinal GCT frequently occurs in the sacrum. The most common presentation of spinal GCT is pain. Spinal GCT is seldom observed as an asymptomatic, incidental radiological occurrence. Based on the clinic-radiological findings, differential diagnoses of spinal GCT are Aneurismal Bone Cyst (ABC), plasmacytoma, symptomatic hemangioma, and Tuberculosis (TB). A biopsy is crucial for a definitive diagnosis. Because of the rich vascular supply about 24 hours prior to operation, Digital Subtraction Angiography (DSA) with tumor embolization is recommended. The treatment of choice for these tumors is complete, extralesional surgical resection which is not usually possible. General treatment is resorted as incomplete partial resection following local radiotherapy. The method of choice for reconstruction is cement or metallic cages and because of the high recurrence rate, bone graft is avoided. The local recurrence rate in the spinal column is lower than in other areas. Methods and Materials/Patients: The spinal GCT incidence, manifestations, diagnosis, and management were concisely reviewed. Using the keywords of GCT, GCT manifestations, GCT complications, GCT management, and GCT incidence, all the relevant articles were retrieved from Google Scholar, Medline, and PubMed, reviewed critically, and analyzed. Results: Spinal GCT rarely presents as an incidental finding in radiologic studies. Because of the high vascular supply of GCTs, preoperative embolization must be performed. The ideal treatment of spinal GCT is complete surgical tumor excision and when not possible, intralesional resection is an alternative treatment. The prognosis of spinal GCT is not good as other primary spinal tumors because of incomplete excision of the tumor and following high recurrence rate. Conclusion: Spinal GCTs are complex clinical entities. Operation is obligatory, and postoperative close follow-up is mandatory to stop recurrences early

P90. Racial disparities in surgical access and outcomes for oncologic spinal pathology: a multicenter study

BACKGROUND CONTEXT Racial disparities in access to spine surgery and differences in perioperative outcomes have become increasingly evident over the past several years within the United States. However, there is a paucity of evidence concerning racial disparities in surgical access and perioperative outcomes for oncologic spinal pathologies. PURPOSE To determine the association between patient race and access to inpatient spine surgery and perioperative outcomes among patients with oncologic spinal pathologies. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected data. PATIENT SAMPLE The 2010 to 2019 National Surgical Quality Improvement (NSQIP) database was used to identify all black and white patients undergoing surgery for primary or metastatic spine tumors. OUTCOME MEASURES Preoperative health care utilization data including method of hospital admission and rate of emergency surgery were investigated. Postoperative outcomes measures including postoperative length of stay (LOS), 30-day reoperation, 30-day readmission, discharge disposition and major perioperative complications were also investigated. METHODS Patients were stratified by race (black vs white). Two-tailed student t-test was used to analyze continuous data and the Chi Square Test was used to analyze categorical data. A p-value < 0.05 was considered statistically significant. RESULTS A total of 7,320 patients (879 blacks, 6,441 whites) were included in this study. Blacks were more likely to be transferred from an outside emergency room or hospital for definitive care compared to whites (17.3% vs 13.3%; p < 0.01) and a higher rate of emergency surgery was performed among blacks versus whites (14.6% vs 8.2%; p < 0.01). Blacks had a longer post-operative LOS (10.2± 9.2 days vs 7.7 ± 7.4 days; p < 0.01) and higher rates of one or more major perioperative complications (36.8% vs 29.6%; p < 0.01). Blacks also had higher rates of 30-day readmission (14.2% vs 10.4%; p < 0.01) and 30-day re-operation (6.9% vs 4.8%; p < 0.01) as well as higher rates of discharge to a facility (48.2% vs 33.5%). There were no differences in in-hospital mortality rates between blacks and whites (0.8% vs 1.0%; p=0.45). CONCLUSIONS There are significant racial disparities in both access to spine surgery and perioperative outcomes between blacks and whites undergoing surgery for oncologic spinal pathologies. Blacks are more likely to undergo emergency surgery, have longer postoperative LOS, and have higher rates of perioperative complications, 30-day readmission and 30-day reoperation. Renewed efforts to eliminate these disparities are needed on a national level. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Racial disparities in access to spine surgery and differences in perioperative outcomes have become increasingly evident over the past several years within the United States. However, there is a paucity of evidence concerning racial disparities in surgical access and perioperative outcomes for oncologic spinal pathologies. To determine the association between patient race and access to inpatient spine surgery and perioperative outcomes among patients with oncologic spinal pathologies. Retrospective analysis of prospectively collected data. The 2010 to 2019 National Surgical Quality Improvement (NSQIP) database was used to identify all black and white patients undergoing surgery for primary or metastatic spine tumors. Preoperative health care utilization data including method of hospital admission and rate of emergency surgery were investigated. Postoperative outcomes measures including postoperative length of stay (LOS), 30-day reoperation, 30-day readmission, discharge disposition and major perioperative complications were also investigated. Patients were stratified by race (black vs white). Two-tailed student t-test was used to analyze continuous data and the Chi Square Test was used to analyze categorical data. A p-value < 0.05 was considered statistically significant. A total of 7,320 patients (879 blacks, 6,441 whites) were included in this study. Blacks were more likely to be transferred from an outside emergency room or hospital for definitive care compared to whites (17.3% vs 13.3%; p < 0.01) and a higher rate of emergency surgery was performed among blacks versus whites (14.6% vs 8.2%; p < 0.01). Blacks had a longer post-operative LOS (10.2± 9.2 days vs 7.7 ± 7.4 days; p < 0.01) and higher rates of one or more major perioperative complications (36.8% vs 29.6%; p < 0.01). Blacks also had higher rates of 30-day readmission (14.2% vs 10.4%; p < 0.01) and 30-day re-operation (6.9% vs 4.8%; p < 0.01) as well as higher rates of discharge to a facility (48.2% vs 33.5%). There were no differences in in-hospital mortality rates between blacks and whites (0.8% vs 1.0%; p=0.45). There are significant racial disparities in both access to spine surgery and perioperative outcomes between blacks and whites undergoing surgery for oncologic spinal pathologies. Blacks are more likely to undergo emergency surgery, have longer postoperative LOS, and have higher rates of perioperative complications, 30-day readmission and 30-day reoperation. Renewed efforts to eliminate these disparities are needed on a national level.

106. Usage trends and safety profile of recombinant human bone morphogenetic protein-2 for spinal column tumor surgery: a national matched analysis

<h3>BACKGROUND CONTEXT</h3> Achieving arthrodesis after spinal tumor surgery remains a significant challenge. Patients in this vulnerable cohort commonly experience poor bone quality, malnutrition and concurrent use of chemotherapy or radiotherapy—all of which interfere with proper bone formation and healing. To augment fusion efforts, recombinant human bone morphogenetic protein-2 (rhBMP-2) emerged as a powerful osteogenic factor after its FDA approval in 2002 but its use has remained a persistent concern. Although most recent evidence does not seem to suggest significantly increased rates of complications or carcinogenicity due to rhBMP-2 use, these findings remain poorly defined in the spinal oncology subcohort. <h3>PURPOSE</h3> To investigate national rates of rhBMP-2 utilization in spinal tumor surgery and examine its association with postoperative complications, revisions, and carcinogenicity. <h3>STUDY DESIGN/SETTING</h3> Retrospective national database analysis. <h3>PATIENT SAMPLE</h3> All patients diagnosed with primary or metastatic spinal tumors who underwent subsequent surgical intervention involving a spinal fusion recorded in Medicare, Medicaid, and commercial administrate claims databases in PearlDiver from 2005-2020. <h3>OUTCOME MEASURES</h3> Utilization rates; postoperative rates of complications, revisions, and failures; survivorship. <h3>METHODS</h3> Patients were organized into two cohorts according to rhBMP-2 usage and 1:1 matched based on age, gender, and Charlson Comorbidity Index. rhBMP-2 utilization trends were compared via a Pearson correlation across calendar years. Postoperative complications and revisions were examined at 1 month, 3 months, 6 months, and 1 year after spinal fusion. New cancer incidence following spinal tumor surgery was assessed until 5 years postoperatively. Post hoc comparisons were characterized using chi-squared analysis, and threshold for significance was established at P < 0.05. <h3>RESULTS</h3> A total of 11,198 patients underwent fusion surgery after resection of spinal tumors between 2005 and 2020, with 909 cases reporting the use of rhBMP-2 (8.1%). An annualized analysis revealed that the proportion of spine tumor fusion procedures utilizing rhBMP-2 has been significantly decreasing (R2 = 0.859, P < 0.001), with the most recent annual utilization rate at 1.1%. The final matched cohorts each comprised 894 patients. At least 6 months after surgery, significantly increased incidences of surgical site (7.3% vs 1.6%, P = 0.05) and systemic infections (13.8% vs 4.1%, P = 0.01) were observed in patients who underwent fusion with rhBMP-2. Across all time points, no significant differences were observed between the groups in survival, implant removal, or revision rates. In addition, incidence of new cancer diagnoses after fusion surgery was comparable between the two groups. <h3>CONCLUSIONS</h3> rhBMP-2 has been widely used off-label to promote arthrodesis; however. its role in spinal fusion procedures involving spinal tumors remains controversial. This analysis demonstrated significantly declining national utilization rates, and while rhBMP-2 usage was not associated with new cancer incidence postoperatively, its impact on local and metastatic progression remains unknown and requires further investigation. Compared with nonusers, spinal tumor cases utilizing rhBMP-2 sustained greater rates of surgical site and systemic infections. Furthermore, rhBMP-2 usage did not significantly reduce the risk of mortality, implant failure, or reoperation–suggesting it may not be essential to fulfilling the needs of this specific patient population. <h3>FDA DEVICE/DRUG STATUS</h3> BMP-2: not approved for this indication.

Potential molecular mechanism in self-renewal is associated with miRNA dysregulation in sacral chordoma – A next-generation RNA sequencing study

BackgroundChordoma, the most frequent malignant primary spinal neoplasm, characterized by a high rate of recurrence, is an orphan disease where the clarification of the molecular oncogenesis would be crucial to developing new, effective therapies. Dysregulated expression of non-coding RNAs, especially microRNAs (miRNA) has a significant role in cancer development. MethodsNext-generation RNA sequencing (NGS) was used for the combinatorial analysis of mRNA-miRNA gene expression profiles in sacral chordoma and nucleus pulposus samples. Advanced bioinformatics workflow was applied to the data to predict miRNA-mRNA regulatory networks with altered activity in chordoma. ResultsA large set of significantly dysregulated miRNAs in chordoma and their differentially expressed target genes have been identified. Several molecular pathways related to tumorigenesis and the modulation of the immune system are predicted to be dysregulated due to aberrant miRNA expression in chordoma. We identified a gene set including key regulators of the Hippo pathway, which is targeted by differently expressed miRNAs, and validated their altered expression by RT-qPCR. These newly identified miRNA/RNA interactions are predicted to have a role in the self-renewal process of chordoma stem cells, which might sustain the high rate of recurrence for this tumor. ConclusionsOur results can significantly contribute to the designation of possible targets for the development of anti-chordoma therapies.

Customized Multilevel 3D Printing Implant for Reconstructing Spine Tumor: A Retrospective Case Series Study in a Single Center.

ObjectiveTo investigate the clinical efficacy and safety of 3D printed artificial vertebral body for patients who underwent multilevel total en bloc spondylectomy (TES) and analyze whether it could reduce the incidence of implant subsidence.MethodsThis is a retrospective study. From January 2017 to May 2018, eight consecutive cases with spine tumor undergoing multilevel TES were analyzed. All patients underwent X‐ray and CT examinations to evaluate the stability of internal fixation during the postoperative follow‐up. Demographic, surgical details, clinical data, and perioperative complications was collected. Visual analog scale, Frankel score, and spinal instability neoplastic score (SINS) classification were also recorded.ResultsThere were six cases of primary spinal tumor and two cases of metastatic spinal tumor. All patients achieved remarkable pain relief and improvement in neurological function. Five patients underwent operation through the posterior approach, one patient underwent operation through the anterior approach and the remaining two patients through a combined anterior and posterior approach. At the last follow‐up period, X‐rays showed that the 3D printed artificial vertebral body of all cases matched well, and the fixation was reliable. Hardware failure such as loosening, sinking, breaking, and displacement wasn't observed during the follow‐up period.Conclusion3D printed customized artificial vertebral body can provide satisfying good clinical and radiological outcomes for patients who have undergone multilevel TES.

Classification, Presentation, Diagnosis, and Treatment of Primary and Metastatic Spine Tumors

Contemporary Spine Surgery: July 2022 - Volume 23 - Issue 7 - p 6 doi: 10.1097/01.CSS.0000835136.41048.70