Spinal Resection Research Articles

Intentional Dural Resection during en bloc Spinal Resection Could Provide a Secure Surgical Margin for Patients with Recurrent Spinal Tumors.

It is always difficult to obtain a comfortable surgical margin for patients with recurrent malignant or invasive benign spinal tumors. Tumor intraspinal invasion and dural adhesion are the essential reasons. There are always residual tumor cells maintained at the edge of dura. Dural resection is a key point to obtain a comfortable surgical margin for such cases. Whether such patients benefit from this risky surgical procedure is unknown. This study aims to understand better the oncological results, associated risks, and neurological function of this risky surgical procedure. We retrospectively reviewed clinical data from six consecutive patients who registered spinal tumors in our institute and underwent dural resection during en bloc spinal resection from June 2013 to May 2020. The demographic and perioperative data, oncological outcomes, complications, and neurological status were collected and analyzed. All six patients were followed up for 24 to 46 months (mean follow-up time: 32.8 months). Local recurrence was detected in one patient (1/6, 16.7%) at 36 months postoperatively and in five patients with no evidence of disease at the last follow up (survival rate 83.3%). Eleven complications occurred in four patients (66.7%), and the dural resection-related complications included only four cases of cerebrospinal fluid leakage (CSFL), which accounted for 36.4% (4/11) of all complications. Neurologic status evaluated by the Frankel grade showed improvement of one grade in one case and deterioration of one to two grades in five patients immediately after surgery. All deterioration cases recovered to the preoperative level 6 months after the operation. Dural resection is significant for patients with dura matter invaded by recurrent primary malignant or invasive benign spinal tumors with the purpose of clinical cure. This study demonstrated that in strictly selected cases, intentional dural resection could provide satisfying local control and long-term disease-free survival with acceptable complications and satisfying neurological function.

Factors Influencing Surgical Outcomes for Intradural Spinal Tumours: A Single-Centre Retrospective Cohort Study

IntroductionIntradural spinal tumours are relatively uncommon tumours of the central nervous system. In this study, we sought to assess our current practice and determine the factors which affect the surgical outcomes of intradural spinal tumour resection.MethodsAll consecutive patients who underwent surgical resection of intradural spinal tumours from December 2011 to November 2018 were retrospectively reviewed. The Modified McCormick Scale (MMS) was used to grade patients’ neurological status both pre-operatively and at the latest follow-up. The associations between changes in MMS and variables such as patient demographics, tumour location, number and experience of consultants involved in the procedure, use of intraoperative neuro-monitoring, bony spinal exposure and dural closure methods were assessed. A multivariable binary logistic regression model was performed to identify independent predictors of improvements in MMS. All analyses were performed using IBM SPSS 22 (IBM Corp. Armonk, NY), with p<0.05 deemed to be indicative of statistical significance throughout.ResultsA total of 145 patients met the inclusion criteria, with a median age of 56.5 years; of whom 119 had extramedullary tumours and 26 had intramedullary tumours. Methods of dural closure were variable, and there was an increasing trend over time towards using the laminoplasty approach for bony exposure. Neither the experience of consultants (p=0.991) nor the number of consultants involved (p=0.084) was found to be significantly associated with the change in MMS, with the strongest predictor being the baseline MMS (p<0.001). Patients who had adjuvant therapy were also significantly more likely to have a poorer neurological outcome (p=0.001).ConclusionA good neurological baseline is a significant positive predictor of an improved functional outcome. The number and seniority of consultant surgeons involved in intradural spinal tumour resections did not significantly alter the postoperative outcomes of patients in our single-unit retrospective study.

C4-T3 Replacement Laminoplasty and Microsurgical Resection of Ependymoma: 2-Dimensional Operative Video.

Spinal ependymomas are the most common intramedullary spinal cord tumors in adults.1-4 They are benign histologically, and maximum safe surgical resection should be pursued with the goal of maintaining neurological integrity.4 Spinal ependymoma resections have been described in the operative video literature, including those using techniques of laminoplasty to prevent postlaminectomy kyphosis.1-3,5 Defining the planes between tumor and normal spinal cord is critical to achieving safe maximum resection.3 This video will illustrate the microsurgical techniques used in the resection of a large spinal cord ependymoma in a patient who presented with progressive lower extremity paraparesis and incontinence and was found to have a large intradural, intramedullary C4-T3 lesion with a rostral glial tumor cyst. The patient consented to surgical intervention. The patient was placed prone in MAYFIELD 3-point pin fixation (Integra LifeSciences, Plainsboro Township, New Jersey). Intraoperative neurophysiological electrodes were placed for somatosensory evoked potentials, motor evoked potentials, and D-wave monitoring of corticospinal tracts.6,7 C3-T4 replacement laminoplasties were performed. A midline dural incision spanning C4-T4 was made. A midline myelotomy preserving the pial venous plexus was performed with a 69 Beaver blade.2 The attachments of the tumor to the normal white matter of the spinal cord were microsurgically defined, coagulated, and divided. Tumor debulking was performed with an ultrasonic aspirator. Once gross total resection was achieved, the pial edges of the spinal cord were reapproximated. The dura was closed in a watertight fashion. The patient recovered from surgery well with preservation of her motor function with a continued T7 sensory level.

Combined video-assisted thoracoscopy surgery and posterior midline incision for en bloc resection of non-small-cell lung cancer invading the spine.

This article aims to evaluate the feasibility and safety of a hybrid video-assisted thoracic surgery (VATS) approach to achieve en bloc lobectomy and spinal resection for non-small-cell lung cancer (NSCLC). Between October 2015 and November 2020, 10 patients underwent VATS anatomical lobectomy and en bloc chest wall and spinal resection through a limited posterior midline incision as a single operation for T4 (vertebral involvement) lung cancer. Nine patients had Pancoast syndrome without vascular involvement and 1 patient had NSCLC of the right lower lobe with invasion of T9 and T10. There were 5 men and 5 women. The mean age was 61 years (range: 47-74 years). Induction treatment was administered to 9 patients (90%). The average operative time was 315.5 min (range: 250-375 min). The average blood loss was 665 ml (range: 100-2500 ml). Spinal resection was hemivertebrectomy in 6 patients and wedge corpectomy in 4 patients. Complete resection (R0) was achieved in all patients. The average hospitalization stay was 14 days (range: 6-50 days). There was no in-hospital mortality. The mean follow-up was 32.3 months (range: 6-66 months). Six patients (60%) are alive without recurrence. VATS is feasible and safe to achieve en bloc resection of NSCLC inviding the spine without compromising oncological efficacy. Further experience and longer follow-up are needed to determine if this approach provides any advantages over thoracotomy.

Application of 3D printed porous artificial vertebra in reconstruction of thoracolumbar tumor

Objective To evaluate the clinical effectiveness of the reconstruction of the thoracic and lumbar spine using the 3D-printed vertebral body after total en bloc spondylectomy. Methods From December 2016 to September 2019, 33 patients with spinal tumors were treated with total en bloc spondylectomy, including 25 males and 8 females with an average age of 58.0 years(range, 15 to 76). The locations of the lesions contained: 29 in the thoracic and 4 in the lumbar. The surgical segments includeda single vertebra in 30 cases, 2 vertebrae in 2 cases, and 3 vertebrae in 1 case. The tumor type: the primary malignant tumor in 6 cases, the metastatic tumor in 27 cases. The preoperative Tomita score was 2-5 points (mean 3.9 points), while Tokuhashi score was 9-15 points (average 11.1 points). Divided into two groups according to different reconstruction methods during total spinal resection, 33 patients with thoracolumbar vertebral body malignant tumors were divided into 3D printed artificial vertebral body reconstruction group (21 patients, 3D printed artificial vertebral body was used for anterior column reconstruction) and titanium Mesh reconstruction group (12 cases, titanium mesh implanted with allograft bone was used for reconstruction). The main observation indicators included the degree of spinal nerve damage and pain recovery, the local tumor control rate, and the incidence of prosthesis sinking. The visual analogue scale (VAS) at 24 hours and 3 months after operation was compared with that before operation using paired design t test. Results All cases were followed up for 3 to 31 months. There was no statistically significant difference in intraoperative blood loss (t=2.042, P>0.05), surgical time (t=0.591, P>0.05), and postoperative drainage (t=0.118, P>0.05) between the two groups. The visual analogue scale (VAS) between the two groups at preoperative, 24 hours and 3 months after operation was not statistically different (P<0.05). The Frankel grading of 31 patients (97.0%) had at least one grade improvement 3 months after operation. During the follow-up period, 12 patients (41.7%) who underwent reconstruction with titanium mesh showed different degrees of subsidence in imaging, and 21 patients who used 3D printed artificial vertebral reconstruction did not exhibit prosthetic deposition. Chi-square test results of postoperative sink rate of the two methods was statistically different (χ2=10.313, P=0.013). Conclusion This preliminary report suggests the 3D-printed vertebral body has good biocompatibility and mechanical stability, which can be used for reconstruction after total en bloc spondylectomy. Key words: Spinal neoplasms; Spinal fusion; Prostheses and implants

Intradural Spinal Tumour Resections at The Royal Orthopaedic Hospital NHS Foundation Trust: Service Evaluation

Intradural Spinal Tumour Resections at The Royal Orthopaedic Hospital NHS Foundation Trust: Service Evaluation

En Bloc Resection of Thoracic Tumors Invading the Spine: A Single-Center Experience

Vertebral involvement by a thoracic tumor has long been considered as a limit to surgical treatment, and despite advances, such an invasive operation remains controversial. The aim of this study was to characterize a single-center cohort and to evaluate the outcome, focusing on survival and complications. We retrospectively reviewed the data of all patients operated on for tumors involving the thoracic spine in an 8-year period. En bloc resection was generally performed by a double team involving thoracic and orthopedic surgeons. Distant follow-up was recorded for oncologic and functional analysis. There were 31 patients operated on. An induction therapy was administered in 20 patients. Spinal resection (mostly including ≥2 vertebral levels) was combined with lobectomy in 48.3% of the patients, and osteosynthesis was required in 22 patients. We observed no in-hospital death and a major complications rate of 32.3%, including 5 patients with early neurologic complications. There were 61.3% primary lung carcinomas, 12.9% extrapulmonary primaries, 9.7% metastases, and 16.1% benign tumors. Mean follow-up was 32.1 months. The 5-year overall survival rate was 81.3% in the entire cohort and 75.0% in patients with a malignant tumor. Occurrence of an early postoperative major complication was the only factor significantly associated with shorter overall survival (p= 0.03). The 5-year disease-free survival rate was 37.0% in malignancies. Delayed complications occurred in 35.5% of patients, including persistent neurologic deficit in 12.9%, instrumentation migration in 19.4%, and local infection in 12.9%. En bloc resection of spinal thoracic tumors offers long-term survival and few recurrences in highly selected patients but is associated with significant delayed mechanical or infectious complications.

Spinal Ewing Sarcoma Debuting with Cord Compression: Have We Discovered the Thread of Ariadne?

Ewing's sarcoma (ES) of the spine with cord or radicular compression as an initial sign is infrequent. It is unclear, in alleviating a neurological deficit, whether decompressive laminectomy is preferred over chemotherapy. Herein, a literature review of the treatment approaches to the primary or metastatic ES of the spine has been performed. Collected data included clinical features of the patients, treatment, and outcome. There are reported 69 cases with initial presentation of cord or radicular compression of spinal cord, arising from primary or metastatic ES, treated either with initial chemotherapy and/or radiotherapy (RT) (33.33%, n=23), or decompressive surgery (66.66%, n=46). The median age at diagnosis was 17.95 years old (range=0.06-60), and 38 patients (55.07%) were male. Eighteen (78.26%) were initially treated with chemotherapy combined with RT, whereas 3 (13.04%) were managed with RT alone. One patient (4.35%) received only corticosteroids, while there are not available data for the treatment of another one (4.35%). The remaining 46 patients (66.66%) were initially treated with decompressive surgery. Among them, 40 (57.97%) received postoperative chemotherapy, RT or combined modality therapy, whereas 6 patients (8.69%) were not treated adjuvantly. Sixteen out of 23 patients (69.6%) treated with systemic therapy, and 37 from 46 (80.43%) of those managed with decompressive laminectomy were still alive at a mean follow-up period of 2.11 years (range=0.16-6) and 3.45 years (range=0.16-26.08), respectively. To summarize, spinal resection and reconstruction followed by adjuvant treatment reduce the risk of local recurrence, and improve long-term survival. However, ES of the spine is not a distinct clinical entity and can be either managed with chemotherapy and/or RT, similarly to other localization.

The establishment of a decision tree model for the individualized treatment of spinal metastases based on RPA

Objective To evaluate the prognostic factors of spinal metastases by recursive partitioning analysis (RPA) and establish a decision tree model that can guide clinicians to select individualized treatment. Methods Between January 2011 and December 2015, three institutional databases were searched to identify 169 patients with metastatic spinal tumors underwent surgery. The ratio of male and female was 1.48∶1 (102 males and 67 females). The average age was 59.2±11.1 years. One-hundred eighteen cases of patients were randomly selected as training samples and the remaining 51 cases were verified samples. Preoperative factors were collected and analyzed by RPA methods, including primary tumor, KPS score, Frankel grade, gender, age, visceral metastasis, bone metastasis, spinal metastasis, blood glucose, blood pressure, surgery site, symptoms, surgery interval, serum albumin level and other risk factors. Pearson's Chi-square test was performed to judge the segmentation point of the decision tree model. The decision tree model is built using the Chi-square automatic interaction detector (CHIAD) algorithm and sensitivity and specificity was automatically calculated. Results The median postoperative survival time was 12.6±1.2 months [95%CI(10.1, 15.0)]. 70% were randomly selected as the experimental group (118 cases), and 30% were the verification group (51 cases). The sensitivity was 96.9%. The specificity was 89.8%. The Kappa coefficient was 0.874 in the experimental group. The sensitivity was 95.4%. The specificity was 90.8%. The Kappa coefficient was 0.810 in the test group. The prognostic factors (weight from high to low) based on RPA were Frankel grade (F=8.132, P=0.005), the primary tumor and the KPS score (Equal, F=9.871, P=0.000 and F=11.945, P=0.003), serum albumin and movement time (Equal, F=7.566, P=0.018 and F=9.966, P=0.008). The decision tree model consists of 7 types. Survival time was 51 months, 18 months, 13 months, 8 months, 4 months, 5 months, 9 months in the class I~VII, respectively. According to the difference of RPA survival time, the operation was classified as 3 grade. Total spinal resection was regarded as grade 1, including class I and class II, with an average survival time of over 18 months. Limited operation was regarded as grade 2, including class III, V and VII with survival time in 6-18 months. The conservative treatment was regarded as grade 3, including class Ⅳ and Ⅵ with the survival time was less than 6 months. Conclusion The decision tree model based on RPA for predicting the survival time of spinal metastases can not only identify the prognostic factors, but also classify and grade various prognostic factors; the decision tree model is simple and can guide clinicians to choose the best surgical plan by predicting the survival time. Key words: Methods; Decision trees; Multicenter study; Individualized medicine

MS 11.03 Surgical Approaches in Superior Sulcus Tumor

Complete en bloc resection is the corner stone of the treatment of solid tumors. Those located in the superior sulcus (SS) or thoracic inlet are known to have bad reputation because their resection represents a real technical challenge. The complexity of such surgery is due to the congestion of a very tight space (SS) by major neurovascular structures as well as to the proximity of the esophagus, the trachea and the spine. The preoperative work-up, in order to assess the involvement of such structures by SS tumors, may include, further to the routine bronchoscopy and cervico thoracic CT scan, an MRI to rule out spinal extension, venous angiography, subclavian arteriography or esophagoscopy. Many surgical approaches to remove SS tumors and many anatomical classifications have been reported during the last 6 decades. The goal of the surgical approach is to allow a wide and safe exposure of the SS, complete en-bloc resection of the tumor and all the involved structures and a potential arterial or spinal resection and reconstruction. The main goal of an anatomical classification is to facilitate the choice of the most appropriate surgical approach according to the extension of the tumor. After an anatomical description of the SS, we will review all the surgical approaches described in the literature to remove benign or malignant tumors developed in the SS. The emergence of new surgical techniques during the last 2 decades, such video-assisted and robotics surgeries had modify the surgical approaches in thoracic surgery. We will describe all the surgical approaches currently available to resect SS tumors with their advantages and their limits. Based on our experience we will describe a simplified anatomical classification of SS tumors. After identification of all contra-indications to SS tumor resection, we will describe the surgical approaches we use currently allowing when needed arterial and spinal resections and reconstructions.

Soft-Tissue Reconstruction of Large Spinal Defects: A 12-Year Institutional Experience.

Spinal resections can lead to defects requiring soft-tissue reconstruction. The purpose of this study was to review the authors' institutional experience with reconstruction of spinal defects and identify risk factors predictive of wound complications, focusing on timing of reconstruction with ablative surgery. The authors retrospectively reviewed patients who underwent spinal resection and required soft-tissue reconstruction from 2002 to 2014. Logistic regression was performed to identify risk factors for complications. Of 289 reconstructions performed in 259 patients, 64 cases (22.1 percent) had major wound complications requiring reoperation. Lumbosacral defects were the most common location (43.6 percent) and paraspinous muscle flaps were the preferred reconstructive method used for all defect regions. A total of 224 reconstructions (77.5 percent) were performed immediately at the time of spinal surgery, and 65 (22.5 percent) were performed in delayed fashion as a result of wound complications from previous spinal surgery. Patients undergoing immediate reconstruction had significantly lower rates of instrumentation removal (0.9 percent versus 4.6 percent; p = 0.043), unplanned reoperations (0.5 versus 1.3; p < 0.001), and mortality (0.9 percent versus 9.2 percent; p < 0.001) compared with those undergoing delayed reconstruction. On logistic regression analysis, presence of instrumentation (OR, 3.2; p = 0.012), requirement for a free flap (OR, 9.0; p = 0.016), and spinal cord exposure (OR, 2.6; p = 0.036) were associated with increased odds of a major wound complication. Spinal resections carry significant surgical-site morbidity, and selection of high-risk patients for immediate reconstruction with locoregional muscle flaps may be beneficial for improving wound-related outcomes. Therapeutic, III.

Postoperative dysesthesia in lumbar three-column resection osteotomies.

Three-column lumbar spinal resection osteotomies including pedicle subtraction osteotomy (PSO), vertebral column resection (VCR), and total en bloc spondylectomy (TES) can potentially lead to dorsal root ganglion (DRG) injury which may cause postoperative dysesthesia (POD). The purpose of retrospective study was to describe the uncommon complication of POD in lumbar spinal resection osteotomies. Between January 2009 and December 2013, 64 patients were treated with lumbar three-column spinal resection osteotomies (PSO, n=31; VCR, n=29; TES, n=4) in investigator group. POD was defined as dysesthetic pain or burning dysesthesia at a proper DRG innervated region, whether spontaneous or evoked. Non-steroidal antiinflammatory drugs, central none-opioid analgesic agent, neuropathic pain drugs and/or intervertebral foramen block were selectively used to treat POD. There were 5 cases of POD (5/64, 7.8%), which consisted of 1 patient in PSO (1/31, 3.2%), 3 patients in PVCR (3/29, 10.3%), and 1 patient in TES (1/4, 25%). After the treatment by drugs administration plus DRG block, all patients presented pain relief with duration from 8 to 38days. A gradual pain moving to distal end of a proper DRG innervated region was found as the beginning of end. Although POD is a unique and rare complication and maybe misdiagnosed as nerve root injury in lumbar spinal resection osteotomies, combination drug therapy and DRG block have an effective result of pain relief. The appearance of a gradual pain moving to distal end of a proper DRG innervated region during recovering may be used as a sign for the good prognosis.

Long-term quality of life after en-bloc vertebrectomy: 25 patients followed up for 9 years

ObjectiveAssess quality-of-life results in patients who have undergone extensive curative surgery for spinal tumor and compare them to the general population in France. IntroductionLife expectancy is not the only criterion to assess the outcomes after massive tumor resections. Residual quality of life is also crucial. An indication for major surgery for spinal tumor should take the patient's long-term functional status into account, but the literature is limited on this question. Materials and methodsTwenty-five living patients from a group of 120 operated were assessed, all of whom were operated on by the same surgeon between 1984 and 2007. The mean follow-up was 9 years (range, 3–25 years). The mean age at surgery was 49 years. The patients completed different functional and quality-of-life questionnaires: the Oswestry Disability Index version 2 (ODI), the PROLO, the Karnofsky Index of performance status (KI), the Eastern Cooperative Oncology Group performance status (ECOG), the Short Form-36 Health Survey (SF-36), and the EuroQol-5 Dimensions (EQ5D). In addition, each patient was clinically and radiographically evaluated. Subgroups were identified considering the number of levels resected and histology. Their results on the SF-36 were compared with the results from the general population in France. ResultsThe mean PCS (physical component summary of the SF-36) was 52.4, the MCS (mental component summary, the psychological component of the SF-36) was 47.7, the ODI was 18.2, the PROLO was 7, the ECOG was 1, and the KI was 80%. The resections at three levels were associated with worse results in terms of quality of life, but overall, the results were similar to the French general population data for all categories of the SF-36. ConclusionAppropriate indications for massive spinal resection give good oncological and functional results. Although the expected life expectancy justifies this aggressive surgery, postoperative quality of life shows that it can also be successful on a functional level. Level of evidenceLevel IV; retrospective clinical study.

Thoracic aortic endografting facilitates the resection of tumors infiltrating the aorta

We and others have reported the early experience with off-label use of thoracic aortic endografts to facilitate the resection of tumors infiltrating the aorta. We describe our extended experience and long-term outcome using this innovative approach. Patients with preoperative suspected thoracic aortic infiltration who underwent endografting followed by en bloc tumor resection including the aortic wall were retrospectively reviewed and data were analyzed. Between 2008 and 2012, 5 patients (4 female) with a median age of 52 years (34-63 years) were included. Tumors infiltrating the aorta were non-small cell lung carcinomas (n=3) and sarcomas (n=2). Both patients with sarcoma had neoadjuvant radiation, whereas patients with non-small cell lung carcinomas had neoadjuvant (n=2) or adjuvant chemoradiation (n=1). Aortic endografting was performed 1 to 17 days before resection of the tumor. The proximal end of the stent-graft was deployed in the aortic arch (n=2) or the descending aorta (n=3). The tumor was resected en bloc in all patients and combined with chest wall and 2 to 3 levels of spinal resection in 4 of the 5 patients. Two patients with full-thickness aortic wall resection had additional buttressing of the defect. Cardiopulmonary bypass was never required. One patient had an empyema requiring debridements and thoracic window. After a median follow-up of 39 months (range, 9-62 months), all patients were alive and disease-free. None of them had overt endograft-related complications. Thoracic aortic endografting allowed safe en bloc resection of tumors invading the aortic wall. Therefore, the indication for thoracic aortic endografts could be extended to specific oncologic cases.

Two-stage, combined, three-level en bloc spondylectomy for a recurrent post-radiation sarcoma of the lumbar spine

En bloc or extralesional resection means resection of the tumor in one piece together with a layer of healthy tissue: the margin is either marginal or wide. The prerequisite for an en bloc or extralesional spondylectomy is a tumor involvement of no more than one side of the posterior structures, so that a corridor can be created through which the spinal cord is released. This article presents a two-stage, combined anterior and posterolateral, three-level en bloc spondylectomy, and local flap wound coverage for a patient with a recurrent post-radiation sarcoma of the lumbar spine and infected wound after intralesional treatment. The patient had radiation therapy for an L4 Hodgkin's lymphoma 5 years before the development of the post-radiation sarcoma. Two-stage, three-level en bloc spondylectomy was done through a combined anterior and posterolateral approach. The resection margins were microscopically negative. Dural tear occurred intraoperatively because of tightly adherent dense scar tissue. Two years after spondylectomy, there was no evidence of tumor or infection recurrence; however, the patient died from her lymphoma. In surgically difficult spinal resections, we recommend the two-stage, combined anterior and posterolateral approach for en bloc spondylectomy. The staged procedure may provide for reduced perioperative complications and mortality, and meticulous dissection in the irradiated area, especially if infected. The combined approach provides for easier and safer dissection of the tumor and the spine from the anterior elements under direct visual control, and wide tumor resection.

Non-communicating hydrocephalus decades after spinal dermoid resection

Introduction: We present a case of acute non­ communicating hydrocephalus due to fat droplet obstruction of the cerebral aqueduct, fifty­one years after resection of a spinal dermoid tumor. Case Report: A 71­year­old male presented with sudden onset of neck pain and gait instability. He had prior complete surgical resection of a cervical dermoid cyst in 1959. Follow up magnetic resonance imaging (MRI) in 2007 showed intracranial fat signal droplets within the posterior fossa. An MRI examination obtained in 2012 demonstrated hydrocephalus consequent to fat droplet obstruction at the aqueduct of sylvius which was not present in MRI study done in 2007. Conclusion: To our knowledge there are no published reports of delayed post spinal dermoid resection subarachnoid fat droplet migration leading to acute non­communicating hydrocephalus.

Building Bridges for Spinal Cord Repair

For nearly a century, neuroscientists have sought to restore neurological function across spinal cord lesions. Lu etal. now present significant progress toward this goal, showing in rats that transplanted neural stem cells establish a functional bridge across completely transected spinal cords.

Dural Closure Using the U-clip in Minimally Invasive Spinal Tumor Resection

Technical case report. To report an alternative to suture for dual closure in minimally invasive spinal surgery. Dural closure in minimally invasive spinal intradural tumor resection can be technically challenging. The U-clip is a novel self-closing device that was originally designed to facilitate coronary arterial anastomosis by obviating the need for suture management and knot tying. Given its ability to achieve tissue approximation without knot tying, the U-clip is ideal for dural closure in the narrow surgical corridors provided by the retractors used in minimally invasive procedures. We report the results of 2 cases in which the U-clip device was used for dural closure after minimally invasive spinal resection of an intradural mass. Two patients presented with spinal intradural tumors. Patient 1 presented with severe upper back pain and was found to have an intradural extramedullary mass at T2 causing severe spinal cord compression. Patient 2 was incidentally found to have an intradural mass causing significant compression of the cauda equina at L2-3. Both patients underwent minimally invasive tumor resection using an expandable tubular retraction system. Dural closure was accomplished using the U-clip device in conjunction with Tisseal. Postoperatively, both patients were mobilized early and neither developed symptoms related to cerebrospinal fluid leakage. Successful dural closure can be achieved using the U-clip device, thereby eliminating the difficulty associated with suture management and knot tying during minimally invasive spinal procedures.

DIASTEMATOMYELIA AS A TANGLE OF VERTEBRAL, ORTHOPAEDIC, NEUROSURGICAL, AND SOMATIC PROBLEMS

Literature review presents an analysis of publications on diastematomyelia – a rare spine and spinal cord abnormality. Studies performed during the period of 1970–2006 were devoted to vertebral, orthopaedic, urological, and neurosurgical aspects of the given pathology. Absolute indications for surgery are described in the review. The attitude of surgeons to prophylactic spinal septum resection for diastematomyelia without neurological deficit is presented.

Complete Segmental Resection of the Spine, Including the Spinal Cord, for Telangiectatic Osteosarcoma

Two case reports of telangiectatic osteosarcoma treated with complete segmental resection of the spine, including the spinal cord. To report the en bloc tumor excision, including the spinal cord, for telangiectatic osteosarcoma, and discuss the indication of cord transection and influence after cutting the spinal cord. To our knowledge, there are no previous reports describing telangiectatic osteosarcoma of the spine and the subsequent en bloc excision of the spine, including the spinal cord. The clinical and radiographic presentations of 2 cases with telangiectatic osteosarcoma are presented. Because these 2 cases already had complete paralysis for at least 1 month, it was suspected that there was no possibility of recovering spinal cord function. Complete segmental spinal resection (total en bloc spondylectomy) was performed. At that level, the spinal cord was also cut and resected. En bloc excision of the tumor with a wide margin was achieved in both cases. In the resected specimen, the nerve cells in the spinal cord had lapsed into degenerative necrosis. The pathologic findings showed that there was no hope for recovery of spinal cord function. En bloc spinal resection, including the spinal cord, is an operation allowed when there is no hope for recovery of spinal cord function. This surgery should be accepted as an option in spine tumor surgeries.