K. Tomita

Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group.

Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours.

Schmorl's nodes and low-back pain

SummaryMagnetic resonance imaing (MRI) findings in cases with symptomatic and asymptomatic Schmorls nodes have been analysed. In all symptomatic cases, the vertebral body marrow surrounding the Schmorls node was seen as low signal intensity on T1-weighted images and as high signal intensity on T2-weighted images. It was confirmed by histological examination that the MRI findings indicated the presence of inflammation and oedema in the vertebral bone marrow. These MRI findings were not seen in asymptomatic individuals. Inflammatory changes in the vertebral body marrow induced by intraosseous fracture and biological reactions to intraspongious disc materials might cause pain. We postulate that after fracture healing and subsidence of inflammation, the Schmorls nodes become asymptomatic, in analogy with old vertebral compression fractures. MRI is not only useful in detecting the recently developed Schmorls nodes but also in differentiating between symptomatic and asymptomatic Schmorls nodes.

CSF tau protein is a useful marker for effective treatment of superficial siderosis of the central nervous system: Two case reports

We report two cases of superficial siderosis (SS) of the central nervous system (CNS), which is caused by chronic haemorrhaging into the subarachnoid space with haemosiderin deposition in the superficial portion of the CNS. Patient 1 had fluid collection in the spinal canal, which was reported as the source of the chronic bleeding. Patient 2 was bleeding from thickened dura at the level of the sacral vertebrae. Both of the patients had xanthochromic cerebrospinal fluid. We surgically repaired the sources of bleeding. Subsequently the cerebrospinal fluid (CSF) cleared and their symptoms were not aggravated for about 1 year. We measured several CSF markers of SS before and after surgery. Total tau protein (CSF-t-tau), phosphorylated tau protein (CSF-p-tau), iron (CSF-iron) and ferritin (CSF-ferritin) in the CSF were highly elevated at diagnosis. After surgery, the levels of CSF-t-tau and CSF-p-tau were markedly reduced while CSF-iron and CSF-ferritin had not decreased. It is suggested that CSF-t-tau and CSF-p-tau reflected the neural damage in SS and were useful to evaluate the effectiveness of SS therapies.

Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery

BACKGROUND With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. PURPOSE We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. STUDY DESIGN We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. PATIENT SAMPLE There were 1,266 patients recruited between March 2001 and October 2014. OUTCOME MEASURES Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. METHODS We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: <70, 70-80, and >80 years. RESULTS Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients <70 years, p=.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients <70 years old (p=.02). Furthermore, neurologic recovery after surgery was lower in patients >80 years old. CONCLUSIONS Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.

Musculoskeletal Analysis of Spine with Kyphosis Due to Compression Fracture of an Osteoporotic Vertebra

Mechanical stress analysis of vertebral bone is required to determine compressive strength of vertebra for osteoporosis patients in clinical situation of orthopedics. Stress occurred in vertebrae depend on condition of musculoskeletal system of spine. Spine structure is mainly constructed of many vertebrae and flexible intervertebral disks, and it is unstable by itself under standing condition. Supporting by erector muscles and ligaments keep the spine standing condition, so that loading condition of each vertebra depend on the muscle and ligament forces. Biomechanical simulation of musculoskeletal model taking into account of muscle and ligament forces and intervertebral joint forces is necessary to determine the loading condition for vertebral stress analysis. Commercial software to deal with the musculoskeletal system, e.g. AnyBody Modeling System (AnyBody Technology Inc.), is available nowadays, and it has been applied to clinical, ergonomic or sport biomechanics problem.

Biomechanical Analysis of Influence of Spinal Fixation on Intervertebral Joint Force by Using Musculoskeletal Model

Evaluation of the intervertebral joint force in vivo is very important for clinical spine problems, for example, spinal instability, disorder of intervertebral disc, compressive fracture of osteoporotic vertebra, etc. Direct measurement of the joint force is difficult to get permission, so computational method to calculate the force is expected. Spine structure is mainly constructed of many vertebrae and flexible intervertebral disks, and it is unstable by itself under standing condition. Supporting by erector muscles and ligaments keep the spine standing condition, so that loading condition of each vertebra depend on the muscle and ligament forces. Biomechanical analysis of musculoskeletal system taking into account of large number of muscle and ligament forces is necessary to determine the intervertebral joint force. Commercial software to deal with the musculoskeletal system is available nowadays, and it has been applied to clinical, ergonomic or sport biomechanics problem.