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Metastatic disease commonly involves the spine with an increasing incidence due to a worldwide rise of cancer incidence and a longer survival of patients with osseous metastases. Metastases compromise the mechanical integrity of t...
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Metastatic disease commonly involves the spine with an increasing incidence due to a worldwide rise of cancer incidence and a longer survival of patients with osseous metastases. Metastases compromise the mechanical integrity of the vertebra and make it susceptible to fracture. Patients with pathological vertebral fracture often become symptomatic, with mechanical pain generally due to intervertebral instability, and may develop spinal cord compression and neurological deficits. Advances in imaging, radiotherapy, as well as in spinal surgery techniques, have allowed the evolution from conventional palliative external beam radiotherapy to modern stereotactic radiosurgery and from traditional open surgery to less-invasive, and sometimes prophylactic stabilization surgical treatments. It is therefore clear that fracture risk prediction, and maintenance or restoration of intervertebral stability, are important objectives in the management of these patients. Correlation between imaging findings and clinical manifestations is crucial, and a common knowledge base for treatment team members rather than a compartmentalized view is very important. This article reviews the literature on the imaging and clinical diagnosis of intervertebral instability and impending instability in the setting of spine metastatic disease, including the spinal instability neoplastic score, which is a reliable tool for diagnosing unstable or potentially unstable metastatic spinal lesions, and on the different elements considered for treatment.
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Surgical treatment for spinal metastasis has benefited from improvements in surgical techniques. However, the trends in treatment and outcomes for spinal metastasis surgery have not been well established in a pediatric population....
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Surgical treatment for spinal metastasis has benefited from improvements in surgical techniques. However, the trends in treatment and outcomes for spinal metastasis surgery have not been well established in a pediatric population. Patients <20 years old with metastatic spinal tumors undergoing spinal surgery were identified in the KID database. Trends for spinal metastases treatment and patient outcomes were analyzed using weight-adjusted ANOVAs. 333 patients were identified in the KID database. The top five primary diagnoses were metastatic brain/spinal cord tumor (19.8%), metastatic nervous system tumor (15.9%), metastatic bone cancer (13.2%), spinal cord tumor (4.2%), and tumor of ventricles (3.0%). There was an increased incidence of spinal metastasis diagnoses from 2003 to 2012 (88.5-117.9 per 100,000; p < 0.001) and an increased trend in the incidence of surgical treatment for spinal metastasis from 2003 to 2012 (p = 0.014). The average age was 10.19 +/- 6.33 years old and 38.4% were female. The average length of stay was 17.34 +/- 24.36 days. Average CCI increased over time (2003: 7.87 +/- 1.40, 2012: 8.44 +/- 1.39; p = 0.006). The most common surgeries were excision of spinal cord/meninges lesions (69.1%) and decompression of spinal canal (38.1%). Length of hospital stay and in-hospital mortality did not change over time (17.34-18.04 days, p = 0.337; 1.6%-2.9%, p = 0.801). 10.5% of patients underwent a posterior fusion and 22.2% had at least one complication (nervous system, respiratory, dysphagia, infection). The overall complication rate remained stable over time (23.4%-21.8%, p = 0.952). Surgical treatment for spinal metastasis in the last decade has increased, though the complication rates, in-hospital mortality, and length of stay have remained stable. (C) 2018 Elsevier Ltd. All rights reserved.
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Pediatric spinal trauma is a broad topic with nuances specific to each anatomic region of the spinal column. The purpose of this report is to provide a brief review highlighting the most important and common clinical issues regard...
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Pediatric spinal trauma is a broad topic with nuances specific to each anatomic region of the spinal column. The purpose of this report is to provide a brief review highlighting the most important and common clinical issues regarding the diagnosis and management of pediatric spine trauma. Detailed descriptions of imaging findings along with specific operative and nonoperative management of each fracture and dislocation type are beyond the scope of this review.
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Pediatric spinal trauma is relatively rare with roughly 5% of injuries occurring in this group. Cervical spinal trauma is most common in the pediatric population, followed by thoracic and lumbar injuries. The biomechanics of the e...
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Pediatric spinal trauma is relatively rare with roughly 5% of injuries occurring in this group. Cervical spinal trauma is most common in the pediatric population, followed by thoracic and lumbar injuries. The biomechanics of the evolving pediatric anatomy alter the injury characteristics and radiographic interpretation of pediatric spinal trauma patients. Systematic assessment paradigms are necessary in the evaluation and treatment of pediatric spinal cord trauma patients. Common treatment modalities for this subgroup of patients include halo fixation, bracing, and surgical instrumentation. While the surgical management options for pediatric spinal injuries have improved, the anatomical considerations associated with the size and growth potential of pediatric patients provide room for improvement of these modalities.
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Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the d...
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Although the traditional method of diagnosing spine fractures (SF) has been plain radiography, Spiral Computed Tomography (SCT) is being used with increasing frequency. Our institution adopted SCT as the primary modality for the diagnosis of SF. The purpose of this study was to determine whether SCT scan can be used as a standalone diagnostic modality in the evaluation of SF.Retrospective review of all blunt trauma patients over a two year period (1/01 - 12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 codes.There were 3,537 blunt trauma patients evaluated, with 236 (7%) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19%) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment. SCT of the spine identified 99.3% of all fractures of the cervical, thoracic, and lumbar spine, and those missed by SCT required minimal or no treatment. SCT is a sensitive diagnostic test for the identification of SF. Routine plain radiographs of the spine are not necessary in the evaluation of blunt trauma patients.
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By 2026, Korea is expected to surpass the UNs definition of an aged society and reach the level of a superaged society. As a result, degenerative spinal disease and the related surgical procedures will increase exponentially. To p...
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By 2026, Korea is expected to surpass the UNs definition of an aged society and reach the level of a superaged society. As a result, degenerative spinal disease and the related surgical procedures will increase exponentially. To prevent unnecessary spinal surgery and support scientific diagnosis of spinal disease and systematic prediction of treatment effects, we have been developing e-Spine which is a computerized simulation model of human spines. In this paper, we present the Korean spine database and ontology that are used as a background data for realizing e-Spine. Generally, Korean physical function is different from foreign physical function. For example, ossification of posterior longitudinal ligament is only occurred in Asians. However, developed countries are currently constructing digital human data to improve themedical and biomedical researches,while the digital human data for Korean are inadequate. Therefore, we constructed Korean spine database on Korean with normal spine or degenerative spinal diseases. To date, we have collected spine data from 72 cadavers and 298 patients. The spine data consists of 2D images such as CT, MRI, or X-ray, 3D shapes, geometry data and property data. The volume and quality of Korean spine database are now the worlds highest. Also, we constructed spinal ontology to provide a wealth of information related to spine. The spinal ontology contains anatomy of spine, method of treatment, cause, classification information related to spine. Finally,we implemented amanagement service for efficiently searching and managing the data. As a result, our database and ontology will offer great value and utility in the diagnosis, treatment, and rehabilitation of patients suffering from spinal diseases.
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Metastatic disease to the cervical spine is a relatively infrequent occurrence. Management requires a multidisciplinary approach, and nonoperative treatment is often successful. There are specific indications for surgical interven...
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Metastatic disease to the cervical spine is a relatively infrequent occurrence. Management requires a multidisciplinary approach, and nonoperative treatment is often successful. There are specific indications for surgical intervention for cervical spine metastases, including instability, neurologic deterioration from compression by bone or soft tissue, progressive deformity threatening neurologic compromise, pain unresponsive to nonoperative measures, and the need for biopsy material for tissue diagnosis. Successful surgical strategies take into consideration tumor location, tumor type, medical comorbidities, and overall patient prognosis. Different reconstructive challenges exist in the occipitocervical and subaxial regions. In both regions the surgeon must ensure that the reconstruction accomplishes neurologic decompression and affords enough stability to minimize external immobilization postoperatively and maximize patient function. Newer techniques of instrumentation and alternatives to surgical reconstruction such as vertebroplasty need further evaluation and assessment of intermediate-term results before assuming a prominent role in the treatment of cervical metastatic disease. < copyright > 2002 Lippincott Williams & Wilkins, Inc.
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Background: Spinal cord hemangioblastomas (HBs) account for 2–15% of all spinal cord neoplasms. They are the third most common primary intramedullary tumor (1–5%). Here, 72-year-old female presented with a thoracic intramedullar...
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Background: Spinal cord hemangioblastomas (HBs) account for 2–15% of all spinal cord neoplasms. They are the third most common primary intramedullary tumor (1–5%). Here, 72-year-old female presented with a thoracic intramedullary spinal HB that responded well to surgery. Case Description: A 72-year-old female presented with a 3–4 years of progressive paresthesias and paraparesis. On examination, she exhibited diffuse distal weakness of the lower extremities. The magnetic resonance scan showed an intramedullary expansive lesion at the T1–T2 level that markedly enhanced with contrast with both proximal and distal hydromyelia. Surgery included a C7 partial and T1–T2 total laminectomies performed under microscope visualization with intraoperative monitoring. At surgery, there was a well-documented cleavage plane between the tumor and the cord; excision was facilitated using the cavitron ultrasonic surgical aspirator device. Conclusion: Surgery is the gold standard treatment for treating/resecting HBs and should include utilization of an operating microscope and intraoperative monitoring.
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