Objective: To compare perioperative burden, hardware outcomes, and oncologic control between sagittal vertebral resection (SVR) and total vertebral resection (TVR) for thoracolumbar tumors, and to propose a practical framework for SVR surgical decision making.Methods: Clinical data, operative parameters, and follow-up outcomes were retrospectively analyzed. To address baseline imbalances in tumor volume and preoperative embolization, a 1:1 propensity score matching was performed based on 5 critical covariates, resulting in a matched cohort of 78 patients (39 per group). Groups were compared using Student t-test or Mann-Whitney U-test for continuous variables and chi-square/Fisher exact test for categorical variables.Results: In the total cohort (39 SVR vs. 84 TVR), SVR significantly reduced blood loss (median 1,200 mL vs. 1,500 mL, p=0.016), transfusion (800 mL vs. 1,200 mL, p<0.001), complication rate (51.3% vs. 77.4%, p=0.004), and hospital stay (13.7 days vs. 19.0 days, p=0.012). Bilateral nerve root sacrifice was less frequent in SVR (41.0% vs. 69.0%, p<0.001). Negative surgical margins (71.8% vs. 73.8%, p=0.814) and local recurrence (12.8% vs. 13.1%, p=0.965) were comparable. Postmatching analysis (n=78) confirmed that even after balancing for tumor volume and embolization, the SVR group maintained significant advantages in blood loss (p=0.035) and operation time (p=0.041). Hardware failure occurred in 3 TVR patients (3.6%) but in none after SVR.Conclusion: SVR significantly reduces perioperative morbidity while maintaining comparable oncologic outcomes relative to TVR. The superiority of SVR remains robust after propensity score adjustment for tumor complexity. By formalizing a type-based surgical decision-making framework, this study provides practical guidance for when and how SVR may be safely adopted as a standardized alternative to TVR in appropriately selected thoracolumbar tumors.

Background Total en bloc spondylectomy (TES) has emerged as an effective surgical intervention for spinal tumor management. The selection of prosthesis for spinal reconstruction significantly influences patient's postoperative outcomes. This study aims to analyze and compare the biomechanical effects of two types of 3D-printed prostheses and titanium mesh cage (TMC) after TES.Methods An intact finite element model (FEM) of L1-L5 segment was developed and validated for simulation. Three L3 TES models were constructed. Model A utilized a 3D-printed prosthesis with an artificial pedicle, model B employed a stand-alone 3D-printed prosthesis, and model C used a TMC. Following parameters were recorded and analyzed to evaluate the biomechanical effects of the three models: (1) the range of motion (ROM), (2) stress of the internal fixation systems, and (3) stress of the L2 inferior endplate and L4 superior endplate.Results The ROMs of all three models were significantly restricted in all directions. Compared with TMC, the implantation of 3D printed prosthesis significantly enhanced spinal stability during extension. The ROMs of models A and B were significantly lower than that of model C during extension, decreasing by 15.2% and 36.4%, respectively. The use of 3D-printed prosthesis for anterior column reconstruction could reduce the stress of prosthesis itself and adjacent endplates. Compared with model C, the maximal decrease in the stress of the endplate of models A and B was 41.5% during flexion and 49.1% during right lateral bending, respectively. In all directions, the stress of the prosthesis was largest in model C, followed by model A and smallest in model B, with statistically significant differences observed.Conclusion After single-segmental TES, 3D-printed prosthesis with favorable endplate matching could obtain better biomechanical effects, thereby reducing the risk of internal fixation failure and increasing the postoperative spinal stability.

This scoping review aimed to systematically map reported ligand–receptor (L–R) interactions in chordoma, classify the strength of supporting evidence, and integrate mechanistic, spatial, and clinical findings to inform translational prioritization. A systematic search of PubMed, Embase, and Web of Science (2000–2024) identified original studies reporting L–R signaling in chordoma. Data on experimental models, signaling axes, functional assays, and clinical correlations were extracted using a predefined template. Evidence for each axis was graded as level A (causal/functional validation), level B (protein or spatial confirmation), or level C (inferred transcriptomic evidence). The review followed PRISMA-ScR and JBI scoping methodology. Thirty studies met inclusion criteria. Ten recurrent signaling circuits were identified. Receptor tyrosine kinase pathways—EGF → EGFR and PDGF → PDGFR—were the most consistently validated, supported by multi-modal experimental evidence and limited clinical activity. IL-6 → IL-6R → STAT3 emerged as a stromal–immune–tumor axis with level A functional validation, linking CAF and macrophage activation to tumor invasion. TGF-β → TGFβR signaling and the newly defined ER-stress CAF–derived IER2 → GMFG → ITGB1 axis were supported by single-cell/spatial profiling with early functional evidence. PD-1/PD-L1 expression showed consistent prognostic correlations but lacked mechanistic validation. This review provides the first evidence-weighted map of intercellular signaling in chordoma. While RTK autocrine loops remain the most established, emerging cytokine- and CAF-mediated pathways highlight new biological mechanisms and potential therapeutic targets. Bridging single-cell discovery with functional validation and clinical translation will be essential to advance microenvironment-directed therapies in chordoma.

Chordoma is a rare malignant bone tumor with limited effective systemic treatment options. Conventional chemotherapy generally shows minimal benefit, highlighting the need for predictive preclinical models to explore therapeutic vulnerabilities. Patient-derived organoids (PDOs) have emerged as a promising three-dimensional culture system that preserves tumor architecture and molecular features while enabling functional testing. However, mechanistic studies linking pathway activity to drug response in chordoma PDOs remain limited. Fresh surgical specimens from five patients with primary spinal chordoma were used to attempt generation of three-dimensional PDO cultures, of which primary three-dimensional cultures were successfully established. Organoids were characterized by histology, immunohistochemistry, and quantitative PCR analysis of chordoma-associated markers. Functional drug screening was performed using a panel of clinically relevant agents in a representative PDO model, followed by dose–response testing of gemcitabine. The role of TP53 in drug response was examined using small interfering RNA–mediated knockdown, with assessment of cell viability, Ki-67 expression, and DNA-damage response–related proteins. Statistical analyses were performed using one-way analysis of variance, with p < 0.05 considered statistically significant. The established PDOs recapitulated the histopathological and molecular characteristics of their matched primary tumors and maintained stable growth across six passages. Among the screened agents, gemcitabine showed the strongest growth-inhibitory effect in PDO-based functional assays. Dose–response experiments confirmed significant gemcitabine-induced growth suppression. Importantly, TP53 knockdown markedly attenuated gemcitabine-induced cytotoxicity, increased proliferative activity, and reduced activation of DNA-damage response signaling, indicating a TP53-dependent vulnerability. This study establishes a spinal chordoma PDO platform for functional precision oncology. Our findings identify a TP53-dependent DNA-damage vulnerability engaged by gemcitabine in patient-derived three-dimensional models, supporting biomarker-informed hypothesis generation rather than routine chemotherapy in unselected patients. This PDO-based approach provides a translational framework for exploring pathway-defined therapeutic susceptibilities in rare tumors such as chordoma.

Thoracic spinal stenosis (TSS) is a severe spinal disorder that can lead to thoracic myelopathy, particularly in non-ambulatory patients. Thoracic ossification of the posterior longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF) are the primary etiologies, but their differences in clinical characteristics and surgical outcomes remain unclear. This study aimed to compare the clinical features and surgical efficacy between non-ambulatory T-OPLL and T-OLF patients. A retrospective analysis was conducted on 126 non-ambulatory patients (70 in T-OPLL group, 56 in T-OLF group) who underwent decompression surgery between 2012 and 2023. Demographic data, surgical details, perioperative complications, and neurological outcomes were compared between groups. T-OPLL patients were younger (51.3 vs. 58.2 years, P < 0.001) and more frequently female (74.3

ABSTRACT Objective To investigate the incidence and treatment of cerebrospinal fluid leakage due to late presentation of dural tears (LPDT) after lumbar surgery and provide new ideas and treatment options for clinical management. This study addresses a significant knowledge gap in the specific context of delayed CSF leaks, where diagnosis and management remain particularly challenging despite existing literature on CSF leaks in general. Methods Patients who underwent posterior lumbar surgery from January 2021 to December 2024 were selected. General patient information, cerebrospinal fluid leakage (CSF) characteristics, follow‐up results, and re‐examination data were analyzed using chi‐squared tests, Fisher's exact tests, t‐tests, and ANOVAto identify cases of LPDT, their treatment methods, complications, and clinical outcomes. Results A total of 2359 patients who underwent lumbar surgery were included in the study. CSF leakage occurred in 43 patients (1.82%). Dural tears (DT) leading to CSF leakage intraoperatively or within 5 days postoperatively were observed in 36 patients (1.53%), with 23 (0.98%) identified intraoperatively. Seven patients (0.30%) experienced CSF leakage due to LPDT: two of them underwent dural repair surgery 3 weeks and 4 months postoperatively, respectively; five patients received conservative treatment involving wound pressure bandage and bed rest. Clinical outcomes were favorable (good or excellent) in five patients (71.4%) and poor in two patients (28.6%) with LPDT, whereas in contrast, no poor outcomes were observed in non‐LPDT patients. Conclusion This study found a 0.30% incidence of CSF leakage due to LPDT following lumbar surgery, with these patients demonstrating worse outcomes compared to those with nondelayed CSF leaks. CSF leakage secondary to unrecognized LPDT is an uncommon but clinically significant complication of spine surgery, necessitating heightened awareness and appropriate management.

OBJECTIVE:Surgical management of nonambulatory patients with beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) remains challenging, and the optimal extent of decompression is unexplored. This study aimed to evaluate neurological outcomes and perioperative characteristics of a selective posterior decompression with fusion (PDF)-first strategy, with circumferential decompression (CD) performed only when indirect decompression was deemed insufficient based on intraoperative assessment. METHODS:Nonambulatory patients with beak-type T-OPLL who underwent thoracic spine surgery between September 2012 and July 2022 were retrospectively reviewed. All patients initially underwent PDF. Conversion to CD via a posterior approach was performed intraoperatively when persistent ventral spinal cord compression was identified based on dural sac refilling, spinal cord pulsation, and findings on intraoperative ultrasonography and neurophysiological monitoring. Neurological outcomes were assessed using the modified Japanese Orthopaedic Association (mJOA) score, recovery rate, ambulation status, and health-related quality of life (EQ-5D-5L score). Perioperative parameters and complications were recorded. RESULTS:A total of 31 patients met the inclusion criteria, including 19 treated with PDF alone and 12 who required additional CD. At final follow-up, significant neurological improvement was observed in the overall cohort, with 93.6% of patients regaining ambulatory ability. Both groups demonstrated significant postoperative improvements in mJOA and EQ-5D-5L scores compared with baseline. Patients who underwent CD had significantly longer operative times and greater estimated blood loss. The incidence of cerebrospinal fluid leakage was high but was successfully managed without permanent neurological sequelae. CONCLUSIONS:In nonambulatory patients with beak-type T-OPLL, a selective PDF-first surgical strategy resulted in favorable neurological recovery in the majority of patients. CD served as an effective adjunct when intraoperative findings indicated inadequate indirect decompression. These findings support an individualized, intraoperatively guided approach rather than the routine use of CD in this high-risk population.

Aggressive vertebral hemangiomas (VHs) are rare benign tumors but can cause neurological deficits. Currently, the optimal treatment strategy for aggressive VHs remains controversial. The purpose of study is to evaluate the safety and efficacy of decompression surgery with intraoperative vertebroplasty for the treatment of aggressive VHs. A total of 85 aggressive VH patients with neurological deficits who underwent decompression surgery with intraoperative vertebroplasty between January 2010 and May 2024 were included in this study. Clinical data such as patient demographics, symptoms, neurological function, pain levels, radiologic features, surgical information, pathology, and perioperative complications, were recorded and analyzed. Enneking staging was determined based on radiological findings. Neurological function and pain levels were assessed using the Frankel grade and the Visual Analogue Scale (VAS), respectively. The minimum follow-up duration was 12 months. The average age of 85 patients (49 male and 36 female) was 51.1 ± 14.3 (21–77) years. Lesions were located in the cervical spine in 1 case, the thoracic spine in 67 cases, and the lumbar spine in 17 cases. All surgery procedures were completed successfully with an average surgery duration of 168.2 ± 83.3 (90–500) minutes and an average blood loss of 670.1 ± 674.8 (50–2500) ml. Preoperative embolization significantly reduced intraoperative blood loss (P < 0.01). Postoperatively, the pain levels of patients were significantly alleviated (P < 0.01). The average follow-up duration was 76.1 ± 55.1 (12–182) months and all patients remained alive at the final follow-up. Recurrence was observed in eight patients, one of whom underwent surgery combined with radiotherapy, while the remaining seven received radiotherapy alone, and at the last follow-up, these patients were symptom-free. Adequate and satisfactory intraoperative filling of bone cement could reduce the risk of recurrence (P < 0.01). Decompression surgery with intraoperative vertebroplasty can effectively reduce blood loss, alleviate neurological symptoms and reduce the risk of recurrence, and is a safe and effective approach in the management of aggressive VHs.

Study Design Retrospective cohort study.Objective To comprehensively evaluate the clinical and radiological characteristics across intramedullary increased signal intensity (ISI) grades (Grade 0, 1, and 2) on T2-weighted magnetic resonance imaging (MRI) and identify preoperative predictors of ISI severity as well as risk factors for poor postoperative recovery in patients with thoracic ossification of the ligamentum flavum (T-OLF).Methods A total of 148 patients who underwent posterior laminectomy surgery for T-OLF between January 2017 and August 2023 was retrospectively analyzed. Demographic, imaging, surgical, and clinical outcome data were collected. ISI grades were independently assessed by three blinded spinal surgeons. Univariate and multivariate logistic regression analyses were performed to identify independent predictors and risk factors.Results Higher ISI grades were associated with worse preoperative neurological status, greater spinal canal compression, more complex OLF morphology, and increased intraoperative blood loss. Multivariate analysis identified a high canal occupying ratio (COR) (Odds ratio [OR] = 3.20, P = .012) and beak-type configuration on sagittal MRI (OR = 4.24, P = .003) as independent predictors of higher ISI grades. Moreover, multi-segment OLF (OR = 2.23, P = .028) and ISI Grade 2 (OR = 3.67, P = .044) independently predicted poor postoperative recovery.Conclusion Preoperative ISI grade serves as a critical prognostic indicator in T-OLF. High COR and beak-type configuration on sagittal MRI predict severe ISI grades, whereas multi-segment OLF and ISI Grade 2 independently predict poor postoperative outcomes. Incorporating these parameters into preoperative assessment may improve risk stratification, patient counseling, and surgical planning.

The low incidence of cervical metastases and complex anatomical structure of cervical spine complicate surgical strategy formulation and make it controversial. By summarizing and analyzing clinical data of patients with metastatic cervical spine tumors, this study aims to investigate treatment decisions of separation surgery and outcomes of different approaches to provide clinical evidence and references. For atlantoaxial metastases, occipitocervical fixation with decompression (OPFD) was performed. In cases involving lower cervical spine, anterior cervical corpectomy (ACCP) or posterior cervical fixation with decompression (PCFD) was performed. When both vertebral body and appendices were affected, the choice of approach was based on surgeons’ personal preference and patient’s specific condition. Baseline characteristics, clinical manifestations, surgical approach, perioperative complications, and postoperative outcomes, including neurological function, pain level, and survival were compared between the surgical approaches. The most common symptom was neck pain (116/124). Twenty-three patients underwent posterior OPFD, 47 patients underwent ACCP, and 42 patients underwent PCFD. There were no significant differences in perioperative complications, and postoperative therapy among patients with lower cervical metastases. For cases with simultaneous involvement of vertebral body and appendices, patients who underwent PCFD had significantly longer survival than those who underwent ACCP (29.4 ± 14.9 vs. 19.7 ± 12.5, p = 0.028). The same phenomenon was observed in other two comparisons. All patients experienced varying degrees of pain relief with those undergoing posterior approach demonstrating significantly greater pain relief (p < 0.05). No neurological deterioration was observed postoperatively. Perioperative complication rate was 26.6

Several modified muscle-sparing laminoplasty (LP) techniques have been developed to prevent axial symptoms in the treatment of multilevel degenerative cervical myelopathy (MDCM). However, the postoperative changes in posterior muscle volume (PMV) and cervical alignment following these procedures remain controversial. This study aimed to compare the short-term postoperative changes in PMV and cervical alignment between conventional LP and three types of muscle-sparing LPs: unilateral muscle-preservation laminoplasty (UL), double-door laminoplasty (DL), and intermuscular “raising roof” laminoplasty (RL). Consecutive MDCM patients who underwent LP, DL, UL, or RL between February 2022 and May 2022 at a same ward were enrolled. Baseline data and surgical characteristics were collected. Preoperative and postoperative PMV were semiautomatically segmented and evaluated, and cervical alignment was measured. The PMV loss ratio was calculated as the change in PMV divided by the preoperative PMV. A total of 79 MDCM patients were included in this study (LP: 20, DL: 20, UL:23, RL:16). No significant differences were observed in the preoperative demographic data, surgical characteristics and radiological variables. The preoperative C2-7 cobb angles of four groups were 11.59 ± 8.80, 9.54 ± 11.18, 11.08 ± 11.32 and 10.75 ± 10.90, respectively(p = 0.962). The preoperative PMV were 2.726 ± 0.79, 2.607 ± 0.752, 2.808 ± 0.724, 2.686 ± 0.674*105mm3, respectively(p = 0.802). At 1-year follow-up, all four groups showed favorable and comparable JOARR(p = 0.443). The postoperative PMV of four groups were 2.430 ± 0.68, 2.355 ± 0.621, 2.416 ± 0.667, and 2.602 ± 0.666 *105mm3(p = 0.606), and the PMV loss ratio were 10.0

Study Design Retrospective cohort study.Objective To describe the clinical characteristics and surgical outcomes of non-ambulatory patients with thoracic ossification of the posterior longitudinal ligament (T-OPLL), and to identify predictors of independent walking recovery.Methods This retrospective study analyzed 70 non-ambulatory T-OPLL patients treated with either circumferential decompression (CD) or posterior decompression with fusion (PDF) surgery at a single center over 10 years (2012-2022). Outcomes included neurological recovery rate, independent walking recovery, and complications.Results Overall, 71.4% of patients regained independent walking. The CD group showed superior functional outcomes (90% vs 64% walking recovery, P = 0.030) but higher complication rates (70% vs 38% CSF leakage, P = 0.015). Shorter disease duration (P = 0.018) and lower BMI (P = 0.027) independently predicted better walking recovery.Conclusions For non-ambulatory T-OPLL patients, CD surgery provides better functional recovery while PDF surgery offers a safer alternative. Early surgical intervention and individualized approach selection based on disease duration and BMI are critical for optimizing outcomes.

The management of spinal metastases presents a significant challenge for spine surgeons, especially in cases of lung cancer, which is associated with the poorest prognosis among primary cancer types. This study aimed to evaluate the postoperative quality of life of patients with symptomatic spinal metastases from lung cancer and identify clinical factors associated with improved outcomes regarding quality of life. This was a retrospective review of a prospectively maintained database from November 2009 to November 2020, including 128 patients who underwent surgery for symptomatic spinal metastases from lung cancer. The primary outcome was the change in Karnofsky Performance Status (KPS) at 1 week and 6 months post-operation. Patients were dichotomized into an “improvement” group (KPS increased) and a “non-improvement” group (KPS stable or decreased). Binary logistic regression was used to identify independent preoperative factors associated with KPS improvement. A total of 72 males and 56 females, with a mean age of 60 ± 10 years, were enrolled in the current study. Male sex was associated with improved quality of life in the short-term post-operation (odds ratio [OR] = 0.42, 95% confidence interval [CI] [0.716–0.962]). Conversely, the number of total bone metastatic sites was negatively associated with short-term improvements in quality of life (OR = 3.66, 95% CI [1.55–8.67]). Additionally, a higher number of total bone metastatic sites was linked to reduced long-term improvements in quality of life, with an OR of 1.94 and a 95% CI of [1.05–3.59]. The number of bone metastasis sites is closely associated with postoperative quality of life in patients with spinal metastases from lung cancer. Careful patient selection is crucial and has the potential to significantly enhance the quality of life for these vulnerable individuals with limited life expectancy.

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate the prognostic value of preoperative increased signal intensity (ISI) grade on T2-weighted magnetic resonance imaging (MRI) and to identify risk factors associated with poor neurological recovery after surgery in adult cervical spinal cord injury without radiographic evidence of trauma (SCIWORET).MethodsA total of 128 consecutive SCIWORET patients who underwent surgical treatment between January 2016 and June 2023 were retrospectively analyzed. Patients were classified into 3 groups (Grade 0, 1, and 2) according to ISI grade on preoperative MRI. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score and recovery rate (RR). Multivariate logistic regression analysis identified predictors of poor RR (< 50%), and receiver operating characteristic (ROC) analysis determined the optimal age cutoff for prognosis.ResultsSignal intensity alterations were observed in 111 patients (86.7%). Higher ISI grades correlated with lower preoperative JOA scores (r = -0.303, P < 0.001) but not with postoperative RR (r = -0.067, P = 0.450). Multivariate analysis identified age as the only independent predictor of poor RR (OR = 1.10, 95% CI: 1.04-1.16, P < 0.001). ROC curve analysis yielded an optimal age cutoff of 58.5 years.ConclusionsPreoperative ISI grade reflected the severity of spinal cord injury but did not predict postoperative neurological recovery. Older age (> 58.5 years) independently predicted poorer outcomes, highlighting the importance of integrating patient age into prognostic counseling and individualized surgical decision-making in SCIWORET.

Retrospective Cohort Study. Chondrosarcoma of mobile spine is a rare aggressive malignant tumor and postsurgical local recurrence rates remain high. En bloc resection is currently the preferred treatment. Resection that achieves tumor-free margin removal of the tumor may enable more complete removal of tumor tissue but significantly increases the complexity and risk of surgery and results in more postoperative complications. We sought to compare surgical outcomes, complications, and prognoses between patients who underwent en bloc resection with and without intralesional removal of the tumor. We reviewed 56 patients with spinal chondrosarcoma who underwent en bloc tumor resection and reconstructive surgery at our center between 2000 and 2024 with a minimum postoperative follow-up of 1 year. We collected and analyzed data regarding surgical procedures, complication characteristics, and local tumor control and recurrence. We included 56 patients. Of these, 36 patients underwent the first surgery, and 20 experienced recurrences. All patients underwent en bloc tumor resection; 36 and 20 underwent intralesional and tumor-free margin resections, respectively. We recorded 83 complications; the incidence and the number of major complications were significantly higher in the tumor-free margin surgery group. Thirty patients experienced tumor recurrence and 26 patients died. Tumor-free margin en bloc resection and conventional-type chondrosarcoma were predictive factors for reduced long-term postoperative recurrence and mortality risk. Tumor-free margin resection carries higher risks and is associated with a greater number of perioperative complications, but reduces the risk of local tumor recurrence and prolongs recurrence-free survival and overall survival, providing patients with better prognoses.

Study DesignRetrospective Cohort Study.ObjectivesTherapeutic strategies for Aneurysmal Bone Cysts (ABCs) of the spine remain controversial and encompass several modalities, including open surgery (ie, intralesional curettage and/or en bloc resection), localized injections, and pharmacotherapy. This study was designed to retrospectively analyze the clinical data from patients treated at our institution, with the objective of evaluating the clinical outcomes, safety profile, and efficacy of different treatments including open surgery, percutaneous injections of a doxycycline-albumin suspension, and Denosumab therapy in the management of these lesions, thereby establishing a basis for a comprehensive treatment algorithm.MethodsFrom January 2010 to December 2024, 27 patients who had no/minor neurological deficits (modified Frankel scale D or E) were included in the study, of whom 6 were treated with open surgery (surgery group), 14 were treated with percutaneous doxycycline/albumin injection (injection group) and 7 were treated with Denosumab (Denosumab group). The demographic and clinical information of these groups were recorded and compared.ResultsIn the surgery cohort (n = 6), complete neurological recovery was achieved in 5 patients (83.3%), while 1 patient experienced residual minor paresthesia; their mean Visual Analogue Scale (VAS) score decreased from 4.9 to 0.8. Two patients developed local recurrence over a mean follow-up period of 46.6 months (range, 15-113 months). In the injection cohort (n = 14), all patients demonstrated a significant reduction in lesion size and resumed normal daily activities. Complete symptomatic resolution was reported in 10 patients; 4 achieved partial resolution, with only mild, exertion-related local pain. Their mean VAS score decreased from 4.9 to 0.7. During a mean follow-up of 68.1 months (range, 7-117 months), no complications or recurrences were observed. In the Denosumab cohort (n = 7), all patients exhibited a significant reduction in lesion size and resumed normal activities. Complete symptomatic resolution was achieved in 6 patients, while 1 experienced partial resolution, characterized by intermittent, mild upper extremity weakness. Their mean VAS score decreased from 4.8 to 0.24. No complications or recurrences were documented over a median follow-up of 9.5 months (range, 1-88 months). No significant differences were observed among the cohorts regarding the rates of recurrence (P = 0.227) or complications (P = 0.304).ConclusionsFor patients presenting with spinal ABCs characterized by an absence of severe neurological deficits, both intralesional injection and systemic drug therapy are effective minimally invasive treatment options and can be considered as first-line choices. However, while both approaches demonstrate favorable short-term efficacy, their long-term outcomes require further investigation. Although not the preferred initial treatment, open surgery remains a crucial option for rapidly correcting spinal instability and reversing neurological deficits.

Spinal metastases often require surgical resection with 3D-printed artificial vertebrae for reconstruction. Precise segmentation is crucial for assessing bone fusion via CT Hounsfield Unit (HU) analysis, yet existing methods struggle with irregular implant shapes and edge details. While convolutional neural networks (CNNs) and Transformers dominate spinal segmentation, they have distinct limitations: CNNs lack global context, and Transformers struggle with local details and high computational costs. Existing studies primarily focus on accurately locating vertebrae in images and determining their relative positions to adjacent vertebrae, with insufficient attention given to vertebral edge details and no public datasets address this gap. In this paper, we construct a spine CT image dataset containing artificial vertebrae (AV SpineCT) and propose a novel segmentation model, CT-UNet. CT-UNet is an end-to-end U-Net model that integrates a Convolutional-Transformer Encoder (CT Encoder) and a Spatial-Channel attention module based on edge prior knowledge (ESCA). Additionally, we introduce Edge-based Focal Loss, designed to enhance focus on edge information and mitigate blurred edge segmentation issues. Experimental results demonstrate that CT-UNet outperforms existing models, with a 5.61% improvement in edge segmentation accuracy (Boundary IoU) compared to TransUnet.

Study designRetrospective cross-sectional study.ObjectivesGiven the aggressive nature of primary spinal tumors, postsurgical local recurrence rates remain high. En bloc resection is currently the preferred treatment. However, the presence of a large thoracic cavity mass increases the surgical difficulty, risk, and likelihood of extensive complications. We report diagnostic and therapeutic characteristics, surgical strategies, and perioperative complications of such tumors treated with en bloc resection.MethodsWe reviewed 25 patients with primary spinal tumors and extensive thoracic cavity involvement who underwent en bloc resection at our center between 2012 and 2023 with a minimum postoperative follow-up of 1 year. We collected and analyzed data on surgical procedures, complication characteristics, and local tumor control and recurrence, and compared our findings with previous studies.ResultsWe included 25 patients (14 males and 11 females; mean age, 41.3 years). Of these, 14 patients underwent the first surgery, and 11 experienced recurrences. All patients underwent en bloc resection; 9 and 16 underwent intralesional and extralesional resections, respectively, 16 and 9 underwent posterior-only and combined approaches, respectively. The average surgery duration was 674 min, with an average estimated intraoperative blood loss of 2,388 mL. Eighty complications were recorded; 24 patients (96%) experienced at least one perioperative complication.ConclusionFor primary spinal tumors with huge thoracic cavity involvement, en bloc resection remains the optimal treatment for achieving local tumor control. Suitability for this procedure depends on the patient’s fitness for major surgery, the absence of distant metastases, and tumor resectability. Surgery can be performed via posterior-only or combined anteroposterior approaches.

PurposeIn this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).MethodsSex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses.ResultsOf the 83 patients, there were 42 males and 41 females. Hypertension (P = 0.003), fusion level (P < 0.001), and surgery time (P < 0.001) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (P < 0.001) and surgery time (P < 0.001) were independent risk factors for HBL.ConclusionIn patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.

Abstract Purpose To evaluate the perioperative clinical outcomes of en bloc resection and anterior column reconstruction for thoracolumbar spinal tumors. Methods This study conducted a retrospective analysis of prospective data collection of 86 consecutive patients, including 40 males and 46 females, with an average age of 39 years (ranged from 10 to 71 years). There were 35 cases of a malignant primary tumor,42 cases of an aggressive benign tumor, and nine cases of metastases. The main lesions were located in 65 cases of thoracic spine, 17 cases of lumbar spine, and 4 cases of thoracolumbar spine. Tumors involved one level in 45 patients, two levels in 12 patients, three levels in 21 patients, four levels in five patients, five levels in two patients, and six levels in one patient. Results According to the Weinstein-Boriani-Biagini surgical staging system, all patients achieved en bloc resections, including 74 cases of total en bloc spondylectomy and 12 cases of sagittal resections. The mean surgical time was 559 min (210–1208 min), and the mean total blood loss was 1528 ml (260–5500 ml). A total of 122 complications were observed in 62(72.1%) patients, of which 18(20.9%) patients had 25 major complications and one patient (1.2%) died of complications. The combined approach (P = 0.002), total blood loss (P = 0.003), staged surgery (P = 0.004), previous surgical history (P = 0.045), the number of involved vertebrae (P = 0.021) and lumbar location (P = 0.012) were statistically significant risk factors for major complication. When all above risk factors were incorporated in multivariate analysis, only the combined approach (P = 0.052) still remained significant. Conclusions En bloc resection and anterior column reconstruction is accompanied by a high incidence of complications, especially when a combined approach is necessary.