Xiao Jianru

Giant Cell Tumor of the Cervical Spine : A Series of 22 Cases and Outcomes

Study Design. A consecutive series of 22 giant cell tumor (GCTs) of the cervical spine which underwent surgical treatment was observed from 1990–2003. Objective. This study reviews the clinical patterns and follow-up data of (GCT) of bone arising in the cervical spine which underwent surgical treatment. We attempt to correlate treatment and outcomes over time. Summary of Background Data. GCTs of bone are common, aggressive, or low-grade malignant tumors that occur infrequently in the spine above the sacrum, and their presence in the cervical vertebrae is even more exceptional. Though surgical resection of GCT arising in the cervical spine is commonly regarded as a recommended treatment method, it is still a challenge to achieve satisfactory results, especially for the late or recurrent cases, and there are few large series of cases reported with long-term follow-up of this tumor that are found in special segments in the literature. Methods. All clinical and follow-up data of 22 cases of GCT arising in cervical spine which received surgical treatment in our spine center from January 1990–December 2003 were collected. The choice of surgical intervention was based on the Weinstein-Boriani-Biagini grading system. Two meanly different protocols of surgical treatment were applied: 8 patients underwent subtotal resection (one of them died shortly after surgery and could not be followed up), 13 cases received total spondylectomy. One special lesion located in the posterior element of C7 received “en bloc” resection. For reconstructing the stability of the cervical spine, we used autologous ilium for pure bone graft, or titanium plate and titanium mesh for anterior instrumented fusion or anterior and posterior combined instrumented fusion. Postoperative radiation therapy was given in 18 cases as an adjunctive therapy method. Results. One patient with C1–C2 GCT (vertebral body and posterior element involvement) who received subtotal resection of the tumor showed aggravation of neurologic deficit and died shortly after the surgery. So we had 21 cases for mid and long-term follow-up, with an average of 67.8 months, that ranged from 36 to 124 months. The symptom of radicular pain almost disappeared, and patients suffering from spinal cord compression recovered well with at least 1 or 2 levels based on Frankel gradingsystem when re-evaluated at 3 months after operation. The rate of fusion for the bone graft is 100%. All the internal fixations were well fused and no spine instability could be seen in our series. Local recurrence was detected in 5 of 7 cases (71.4%) that underwent subtotal resection, but in only 1 of the 13 cases (7.7%) for total spondylectomy. Four cases died within follow-up and all these patients were recurrent cases. One patient developed pulmonary metastases. Conclusion. GCT of the cervical spine easily onsets between 20 and 40 years of age. As a kind of benign but local aggressive or low potential malignancy tumor, we should take an aggressive attitude to excise the tumor as much as possible while reserving the neural function as a precondition. Unlike in the thoracic and lumbar spine, a strictly “en bloc” resection is often not a feasible option because of the involvement of critical neurovascular structures. Total spondylectomy (even intralesional) with radiation therapy as an adjunctive treatment has significantly lowered the local recurrence rate of the GCT in the special segments.

Outcome and Prognosis of Myelopathy and Radiculopathy From Osteochondroma in the Mobile Spine: A Report on 14 Patients

Study Design: A retrospective study of 14 spinal osteochondroma (OC) patients with compressive myelopathy or radiculopathy who underwent excision of the lesions. Objective: To evaluate the surgical results of a series of cases of symptomatic OCs and the risk of recurrence and malignant transformation in the mobile spine. Summary of Background Data: Intraspinal OC with symptomatic spinal cord or nerve root compression is a rare disease. Most of the lesions require surgical treatment. However, some patients may relapse or malignant transformation may occur after surgery. Methods: Fourteen symptomatic spinal OC cases, including 2 hereditary multiple exostoses, were treated surgically from 2001 to 2010. The clinical history, plain radiographs, computed tomography, magnetic resonance imaging, pathologic characteristics, surgical treatments, and outcomes were reviewed. All the patients were followed up for an average of 48.9 months. Results: The 14 patients included 8 with lesions in the cervical spine, 3 with lesions in the thoracic spine, and 2 with lesions in the lumbar spine. One patient had a particularly large lesion which extended from C7 to T6. The OCs originated from the lamina (4), lateral mass (3), vertebral body (3), processus transversus (1), spinous process (1), pedicle of vertebral arch (1), and an indeterminate location (1). Six patients presented with myelopathy from spinal cord compression and 8 with radiculopathy from nerve root compression. Operative approaches included posterior (11) and combined posterior anterior (3) patients. The surgical outcome was satisfactory in 79% (11) of patients. Two recurrent lesions were notable for sarcomatous transformation. Conclusions: We recommend gross total resection of all diagnosed OCs involving the mobile spine because of the risk of malignant transformation. Early detection and total excision of symptomatic spinal lesions in these cases may be the key to providing the best outcome. The neurological defect arising from OC can be improved by surgical intervention in most patients.

Construction of metastatic spinal cancer tissue microarrays

Abstract Objective To explore the construction of metastatic spinal cancer (MSC) tissue microarrays and validate its value in immunohistochemical study of MSC. Methods Paraffin-embedded specimens from 71 MSC cases and 6 primary tumor cases were selected as donor blocks and prepared into MSC tissue microarrays by tissue array arrangement, the steps of which included location, punching, sampling, sample seeding, and re-diagnosis by hematoxylin-eosin (HE) as well as MMP-9 and MMP-14 immunohistochemical staining. Results The MSC tissue microarrays thus constructed were intact and crackless, containing 154 complete and well arranged microarray points. None of the sectioned tissue microarrays was lost, and the results of HE staining was consistent with the primary pathologic diagnoses. Immunohistochemical staining was also good without non-specific or marginal effect. Conclusion The MSC tissue microarrays have a high value in the immunohistochemical study of MSC.

Syringomyelia after operation: diagnosis and its formational mechanism

Abstract Objective To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years (range 2–10 months) by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid (CSF). The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.