Background and Objectives: Metastasectomy of spinal lesions from renal cell carcinoma (RCC) is a promising strategy. However, its clinical outcome after spinal metastasectomy is unknown owing to the difficulty of curative surgical resection. This is the first study to examine the survival rates of patients who underwent metastasectomy of solitary spinal metastases from RCC.Methods: A retrospective cohort study of 36 consecutive patients with RCC who underwent nephrectomy and complete removal of solitary spinal lesions between 1995 and 2010 at our institution. Cancer-specific survival (CSS) time from the spinal metastasectomy to death or last follow-up was the main endpoint. Potential factors associated with survival were evaluated with Kaplan-Meier analysis and the long-rank test.Results: For all patients, the estimated median CSS time was 130 months. The 3, 5, and 10-year CSS rates were 77.8%, 69.1%, and 58.0%, respectively, for all patients, and 72.7%, 54.5%, and 27.3%, respectively, for patients with lung metastases at the time of surgery. Only the presence of liver metastases was significantly associated with short-term survival after spinal metastasectomy.Conclusions: Liver metastases were associated with short-term survival, although lung metastases were not. For selected patients, curative resection of solitary spinal metastases can potentially prolong survival. (C) 2016 Wiley Periodicals, Inc.

Study Design. A retrospective review (phase 1) and prospective clinical study (phase 2). Objectives. To identify independent risk factors for surgical site infection (SSI) and to evaluate the positive effect of prostaglandin E1 (PGE1) to decrease the risk of SSI in patients with spinal metastasis. Summary of Background Data. Surgery for spinal metastasis is associated with an increased risk of SSI. Although previous reports have evaluated risk factors of SSI for spinal metastasis, most of the studies lack multivariate analysis. A recent study demonstrated the utility of PGE1 in decreasing wound complications in patients with prior irradiation. The role of PGE1 in surgery for spinal metastasis has not been previously evaluated. Methods. One hundred ten patients with spinal metastasis were retrospectively reviewed (phase 1). Risk factors for SSI were analyzed using logistic regression. Phase 2 was a prospective clinical trial investigating the utility of PGE1 at reducing the rate of SSI. Ninety-four patients with spinal metastasis were treated at our institute. The infection rate and risk factors identified in phase 1 and 2 were compared. Results. The rate of SSI during phase 1 was 7.1%. Independent risk factors identified by multivariate logistic regression were diabetes, and preoperative irradiation. The rate of SSI for patients who had irradiation before surgery was 32%, whereas the rate for patients without irradiation was 1.1%. This difference was statistically significant. The rate of SSI in phase 2 was 3.1%. In phase 2 patients who received preoperative irradiation, the rate of SSI was 4.5%. The difference between phase 1 and phase 2 was statistically significant. Conclusion. This study identified diabetes and preoperative irradiation to be independent risk factors for SSI in patients with spinal metastasis. PGE1 administration was found to significantly decrease the incidence of SSI in patients with spinal metastasis who underwent preoperative irradiation.

STUDY DESIGN:Segmental arteries were interrupted bilaterally at up to three levels to study the influence on spinal cord blood flow (SCBF) and function in dogs. OBJECTIVES:Considering the need to limit blood loss during surgery for spinal tumors, such as total en bloc spondylectomy, we studied the SCBF and function after experimental interruption of segmental arteries at up to three levels. SUMMARY OF BACKGROUND DATA:Interruption of bilateral segmental arteries at three consecutive levels (T11, T12, and T13) has reduced blood flow to the vertebral body of T12 by one fourth of the control flow, but effects on the spinal cord have not been determined. METHODS:SCBF was measured in spinal cord gray matter at T12 using a hydrogen clearance method after ligation of bilateral segmental arteries at 1 to three levels (T11, T12, and T13) in 6 dogs. Spinal cord function was evaluated by spinal cord evoked potentials, motor-evoked potentials, and neurologic assessment in 6 dogs. RESULTS:SCBF at T12 decreased to 92.4%, 87.8%, and 84.6% of control flow after ligation of bilateral segmental arteries at T12, T11 plus T12, and T11-T13, respectively. Spinal cord evoked potentials and motor-evoked potentials showed no significant changes in any dog after ligation at three levels. No neurologic degradation was observed in any dog. CONCLUSIONS:Interruption of bilateral segmental arteries at three levels did not damage spinal cord function in dogs, suggesting that in patients, preoperative embolization at three levels to reduce blood loss during surgery for spinal tumors would not compromise spinal cord function.

Study Design. The effect of ligation of the bilateral segmental arteries at the levels of T11, T12, and T13 on blood flow of the T12 vertebra was studied in a dog model.Objectives. To determine the reduction of the vertebral blood flow resulting from interruption of bilateral segmental arteries at one to three vertebral levels.Summary of Background Data. Intraoperative hemorrhage can be sometimes massive in patients with hypervascular spinal tumors, especially in radical resection such as total en bloc spondylectomy. The recent development of new embolization techniques ensures more aggressive, more extensive, and safer preoperative embolization for spinal tumors.Methods. The blood flow of the T12 vertebra of 12 female dogs was measured after ligation of the bilateral segmental arteries at one to three levels, including the T12. Spinal cord evoked potentials were recorded in this procedure. Spinal angiography using a silicon compound was performed on another 10 dogs after clipping and section of the bilateral segmental arteries.Results. The blood flow of the T12 vertebra decreased to 70.13 +/- 6.37% of the control value after ligation of the bilateral segmental arteries of T12, to 46.48 +/- 8.97% after ligation of the bilateral segmental arteries of T12 and either T11 or T13, to 24.11 +/- 8.31% after ligation of T11, T12, and T13, respectively. The angiogram after ligation and section of T12 and the two levels including T12 showed thick and clear contrast medium in the cut distal ends of the T12 segmental arteries. After interruption at three levels ( T11, T12, and T13), however, the cut distal ends of the T12 segmental arteries were seen thin and faint on the angiogram. No significant changes occurred in spinal cord evoked potentials after ligation of the segmental arteries at three levels in all six dogs.Conclusion. Interruption of the bilateral segmental arteries at three levels, one target vertebra and the two adjacent vertebrae, reduced the blood flow of the target vertebra to one fourth of the control value in the lower thoracic spine in dogs. This result suggests that preoperative embolization at three levels, the levels of the tumor vertebra and the adjacent vertebrae above and below it, may reduce intraoperative hemorrhage effectively during total en bloc spondylectomy for hypervascular spinal tumors.

BACKGROUND CONTEXT: Intraoperative hemorrhage can be sometimes massive in patients with hypervascular spinal tumors, especially in radical resection such as total en bloc spondylectomy. The recent development of embolization techniques ensures more aggressive, more extensive, and safer preoperative embolization for spinal tumors. To reduce intraoperative blood loss during total en bloc spondylectomy more effectively, we need to clarify the influence of ligation of bilateral segmental arteries.

BACKGROUND CONTEXT: Total en bloc spondylectomy (TES) is an effective treatment modality for spinal tumors. However, one of the main difficulties of this procedure is massive intraoperative bleeding. To reduce intraoperative bleeding more effectively, we have studied the effect of ligation of bilateral segmental arteries at three levels on the vertebral blood flow, spinal cord blood flow and neurological function in dogs. The results showed that the blood flow of the middle vertebra decreased to about 30% of the control values, whereas the spinal cord blood flow remained at 85% of the control values and there was no neurological deficit.

Study Design. A case of idiopathic focal vertebral body osteonecrosis without vertebral collapse is reported. Objectives. To report a rare case of focal vertebral osteonecrosis and to clarify the features of imaging studies. Summary of Background Data There are no previous reports describing focal vertebral body necrosis without collapse in the literature. Methods. A case report and literature review are presented. Results. Imaging studies demonstrated: 1) sclerotic change on computed tomography scan; 2) low intensity on T1, high intensity on T2 with clear margin, and no gadolinium enhancement on magnetic resonance imaging; and 3) no uptake on bone scan. Histologic examination revealed empty lacunas, fatty necrosis with vacuolar degeneration, and cell debris compatible with bone marrow necrosis. Conclusion. Vertebral body osteonecrosis must be considered a possible diagnosis of patients presenting with low intensity on T1, high intensity on T2 with clear margin, and no gadolinium enhancement on magnetic resonance imaging.

This study reviewed 14 patients with thyroid cancer spinal metastases treated between December 1984 and July 2000. In total the 14 patients had undergone 25 operations (average 1.8 operations/ patient). The operations were at the thoracic (15), cervical (7) and lumbar (3) levels and operations included piecemeal excision (14), total en bloc spondylectomy (7), posterior decompression and stabilization (2), posterior decompression (laminectomy) (1) and posterior stabilization (1). Re-operations were due to local recurrence (8) or metastases to another level (2) or both (1). One patient died in the third postoperative day due to disseminated intravascular coagulopathy (DIC), 5 died due to the original illness after a mean of 67.8 months, while 8 patients are still. living after a mean of 53.1 months. As long survival should be anticipated, in cases of thyroid cancer spinal metastases,. a radical therapeutic attitude must be considered in decision-making. This should avoid the morbidity associated with local recurrence and revision surgery.