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Primary Bone Tumor of the Spine-An Evolving Field: What a General Spine Surgeon Should Know.

ABSTRACT: Study Design:A narrative review of the literature. Objective:This article reviews the general principles of treatment and investigation for primary bone tumors of the spine. Furthermore, it explores the emerging alternatives. Methods:A review was performed using Medline, Embase, and Cochrane databases. Results:Primary bone tumors of the spine are rare entities that general spine surgeons may encounter only a few times in their career. The treatment algorithm of these complex tumors is filled with nuances and is evolving constantly. For these reasons, patients should be referred to experienced tertiary or quaternary centers who can offer a comprehensive multidisciplinary approach. For most malignant spinal bone tumors, surgery remains the cornerstone of treatment. Respecting oncologic principles has been associated with improved survival and decreased local recurrence in multiple settings. However, even in experienced centers, these surgeries carry a significant risk of adverse events and possible long-term neurologic impairment. The associated morbidity of these procedures and the challenges of local recurrence have encouraged professionals caring for these patients to explore alternatives or adjuncts to surgical treatment. Conclusions:Over the past few years, several advances have occurred in medical oncology, radiation oncology and interventional radiology, changing the treatment paradigm for some tumors. Other advances still need to be refined before being applied in a clinical setting.

SUBMITTER: Charest-Morin R

PROVIDER: S-EPMC6512194 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Primary Bone Tumor of the Spine-An Evolving Field: What a General Spine Surgeon Should Know.

Charest-Morin Raphaële R Fisher Charles G CG Sahgal Arjun A Boriani Stefano S Gokaslan Ziya L ZL Lazary Aron A Reynolds Jeremy J Bettegowda Chetan C Rhines Laurence D LD Dea Nicolas N

Global spine journal 20190508 1 Suppl

<h4>Study design</h4>A narrative review of the literature.<h4>Objective</h4>This article reviews the general principles of treatment and investigation for primary bone tumors of the spine. Furthermore, it explores the emerging alternatives.<h4>Methods</h4>A review was performed using Medline, Embase, and Cochrane databases.<h4>Results</h4>Primary bone tumors of the spine are rare entities that general spine surgeons may encounter only a few times in their career. The treatment algorithm of these ...[more]

PMID: 31157142

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Project description:ObjectivesFor years, many efforts have been invested to prepare patients, in particular, those with reduced physical and psychic status, much better to provide and finally achieve better outocme if there is time available to provide several beneficial measures.MethodsTherefore, the objective was to illustrate the concept and various single elements of a complex prehabilitation concept based on (i) selective references from the medical literature and (ii) own clinical experiences from clinical practice in general and abdominal surgery.ResultsPrehabiliation can be considered the solution of the efforts to improve preoperative status for patients in a disadvantageous status for almost all types of surgery and all other operative and/or interventional procedures. It is the targeted process to improve individual functionality and organ function before a planned (elective) surgical intervention; P. comprises basically nutritional, physical and psychological measures; P. focusses especially onto the elderly, frail and malnourished patients before a planned surgical intervention; the overall aim is to significantly improve final outcome characterized by shorter length of stay, lower complication rate and mortality as well as cost efficiency; P. is especially important in cancer surgery, in which the beneficial effects can be particularly implemented; P. programs and/or "Standard Operating Protocols" (SOP) may help to establish and materialize its single aspects and enhanced recovery after surgery (ERAS). There is still further potential to reliably establish and to utilize the options of prehabilitation measures as listed above.ConclusionsPrehabiliation is an indispensable aspect in today's preparation for elective surgery, which needs to become obligatory part of the preparation measures to planned surgical interventions, which can further contribute to a better final outcome and ERAS as well as, in addtion, needs to be further developed and accomplished.

Project description:BackgroundOccupation-related noise-induced hearing loss (NIHL) has both negative economic and quality of life implications. The risk spine surgeons undertake in regards to NIHL during operative intervention is unknown. Governing bodies, including the National Institute for Occupational Safety and Health, have recommended exposure limits not to exceed 85 decibels (dB) over 8 hours. The purpose of this study is to characterize noise exposure to spine surgeons in the operating room (OR).MethodsProspective collection of intraoperative recordings of spinal surgeries (cervical and thoracic/lumbar) was undertaken. Data gathered included procedure, operative duration, presence of background music, and noise information. Noise information included maximum decibel level (MDL), Peak level (LCPeak), Equivalent continuous sound pressure level, time weighted average (TWA), dose, and projected dose. Noise measurements were compared with baseline controls with and without music (empty ORs).ResultsTwo hundred seven noise recordings were analyzed. One hundred eighteen of those being spinal surgeries, 49 baseline recordings without music, and 40 with music. Maximum decibel level reached a maximum value of 111.5 dBA, with an average amongst surgical recordings of 103 dBA. Maximum decibel level exceeded 85 dBA in 100% of cases and was greater than 100 dBA in 78%. The maximum LCPeak recorded was 132.9 dBC with an average of 120 dBC. Furthermore, the average dose was 7.8% with an average projected dose of 26.5%. The highest dose occurred during a laminectomy at 72.9% of daily allowable noise. Maximum projected dose yielded 156% during a 3-level anterior cervical discectomy and fusion.ConclusionsSpine surgeons are routinely exposed to damaging noise levels (>85 dBA) during operative intervention. With spine surgeons often performing multiple surgeries a day, the cumulative risk of noise exposure cannot be ignored. The synergistic effects of continuous and impact noise places spine surgeons at risk for the development of occupation-related NIHL.

Project description:Background:Traditionally trained spine surgeons may want to transition from open spinal surgeries to endoscopic decompressions. The aspiring endoscopic spine surgeon may have to overcome multiple hurdles to master a learning curve without readily available training. Replacing traditional time-proven open spinal surgeries with endoscopic decompression may put the surgeons' reputation at risk and have an additional negative impact on his or her practice due to reduced revenue. The authors report on the utility of the mentor- and proctorship concepts to facilitate the transition from traditional open to endoscopic outpatient spine surgeries. Methods:The study population (learning curve groups) was provided by two traditionally trained "apprentice" surgeons who have been in practice for 12 and 28 years, respectively. They trained with the remaining two authors under mentorship and proctorship arrangements. A VAS and Macnab outcomes analysis was performed by one surgeon laminectomy versus endoscopy in relationship to the case log representative of the initial learning curve. The second surgeon performed a postoperative narcotic utilization analysis as a representative way of favorable clinical outcomes in relation to his increasing case log with spinal endoscopy. Results:The learning curve study by the first author (NA Ransom-under the proctorship program) consisted of 40 patients with 20 patients each divided into the traditional laminectomy control group and 20 patients in the endoscopic group. There were 22 females and 18 males with an average age of 57.38 years and a mean follow-up of 38.58 months. The preoperative VAS for patients in both groups was 7.95 compared to the postoperative VAS at final follow-up of 4.01 with a statistically significant postoperative VAS reduction (P<0.001) but without any significant difference between open laminectomy control- and endoscopic decompression groups. The endoscopic learning curve group outcomes improved significantly after 15 cases (P<0.048). The second author (S Gollogly-under mentorship program) performed a similar review of his surgical cases log and noted a significant reduction of postoperative narcotic utilization as a result of improved outcomes after an initial learning curve of 15 cases. Clinical outcomes for both authors showed improved Macnab outcomes in the majority of patients (NA Ransom =65%; S Gollogly =57%) with a slightly higher success rate in the laminectomy group (70%) versus the endoscopy group (65%) at a statistical significant level (P=0.036). Conclusions:The mentorship and proctorship approach is useful in helping traditionally trained spine surgeons to integrate spinal endoscopy into their well-established spine practices. Under the close guidance of an endoscopic master spine surgeon, the endoscopic learning curve may be comprehended by the experienced traditionally trained spine surgeon in approximately 15 lumbar decompression cases. During this initial 15-case learning curve, clinical outcomes with endoscopy may be slightly inferior to open laminectomy but may ultimately improve to equivalent levels.

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Primary Bone Tumor of the Spine-An Evolving Field: What a General Spine Surgeon Should Know.

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Primary Bone Tumor of the Spine-An Evolving Field: What a General Spine Surgeon Should Know.

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