Neurosurgical focus最新文献

{"title":"Single-fraction versus multifraction stereotactic radiosurgery for spinal metastases: systematic review and meta-analysis.","authors":"Mohammad Amin Dabbagh Ohadi, Pouria Delbari, Muhammad Hussain Ahmadvand, Raha Zamani, Amirmasoud Karimi, Neshat Ohadi, Constantinos G Hadjipanayis","doi":"10.3171/2025.2.FOCUS24985","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24985","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic radiosurgery (SRS) plays an important role in the treatment of spinal metastases by delivering precise, high-dose radiation to the target region while sparing critical structures. Although various dosing and fractionation schemes have been reported, the optimal regimen remains a topic of debate. The aim of this study was to compare single- versus multifraction SRS (≤ 5 fractions) in the treatment of spinal metastases regarding oncological outcome, pain improvement, and complications, with special concern about vertebral compression fracture (VCF).</p><p><strong>Methods: </strong>A systematic review was conducted using the PubMed, Scopus, and Embase databases in October 2024 in accordance with PRISMA guidelines. The random-effects model was used for statistical analysis and quality appraisal was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool.</p><p><strong>Results: </strong>A total of 26 studies comprising 4125 patients and 5408 lesions were included in this study. Single-fraction treatment demonstrated superior local control (HR 0.58, p = 0.023), particularly at doses exceeding 20 Gy (HR 0.28, p < 0.0001). However, overall survival did not differ significantly between the two groups (HR 0.78, p = 0.761). Pain relief was comparable between the groups (OR 0.94, p = 0.63). Although the VCF rate was higher in the single-fraction group (OR 1.32, p = 0.32), the difference was not statistically significant, even at doses greater than 20 Gy. Additionally, no significant differences were observed in overall complication rates (OR 1.98, p = 0.12).</p><p><strong>Conclusions: </strong>This study highlights the superiority of high-dose single-fraction regimen in controlling spinal metastatic tumors compared with multifraction lower doses, with comparable overall survival, complication rates, and VCF incidence. However, prospective randomized studies are necessary to better determine the optimal regimen for different patient populations.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E16"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of schwannomas in schwannomatosis: a comprehensive analysis of clinical outcomes and determinants of local recurrence.","authors":"Abdel-Hameed Al-Mistarehi, Kelly Jiang, Jawad M Khalifeh, Avi N Albert, Carly Weber-Levine, Nicholas Orlando, William Blanks, Andrew M Hersh, Carlos G Romo, Jaishri Blakeley, Allan J Belzberg, Daniel Lubelski","doi":"10.3171/2025.2.FOCUS24751","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24751","url":null,"abstract":"<p><strong>Objective: </strong>Schwannomatosis is a rare genetic predisposition to develop multiple nonintradermal schwannomas affecting the spine and peripheral nerves, excluding vestibular schwannomas. Schwannomatosis-associated schwannomas can present with pain or motor deficits, prompting resection. In this study, the authors reported the clinical characteristics, surgical interventions, and postoperative outcomes of patients with schwannomatosis-related schwannomas treated with resection.</p><p><strong>Methods: </strong>This was a retrospective cohort study of adult patients with schwannomatosis who had undergone resection of a symptomatic peripheral or spinal schwannoma at the authors' institution from September 2003 to June 2023. Data were extracted from electronic health records and provider notes.</p><p><strong>Results: </strong>A cohort of 85 patients (57.6% women) had a mean follow-up of 68.4 ± 58.2 months after surgery. The mean age at the time of surgery was 44.6 ± 16.5 years. Pain was the most common presenting symptom (94.1%), followed by motor weakness (36.4%) and sensory deficits (32.9%). Just under two-thirds of the patients (64.7%) had undergone prior surgery for schwannoma, 20 (36.4%) of whom had a prior resection in the same exact location. Gross-total resection (GTR) was achieved in 88.2% of cases and en bloc resection in 69.4%. There were significant improvements in pain, motor weakness, and sensory deficits at the last postoperative follow-up visit. There was local tumor recurrence in 14 patients (16.5%), and the overall mortality rate was 4.7%. Univariate and multivariate analyses identified GTR as the strongest predictor of a decreased risk of local recurrence (HR 0.09, 95% CI 0.02-0.48, p = 0.005).</p><p><strong>Conclusions: </strong>Patients with schwannomatosis commonly presented with neurological symptoms of pain, sensory deficits, or motor weakness associated with their schwannomas. Resection significantly improved their preoperative symptoms, and GTR was associated with a decreased risk of local recurrence.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management for chordoma of the spine and sacrum with stereotactic radiosurgery.","authors":"Samuel Adida, Suchet Taori, Roberta K Sefcik, Steven A Burton, John C Flickinger, Peter C Gerszten","doi":"10.3171/2025.2.FOCUS24935","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24935","url":null,"abstract":"<p><strong>Objective: </strong>Resection for spinal and sacral chordoma is associated with significant morbidity and high rates of local recurrence. Stereotactic radiosurgery (SRS) offers radiobiological benefits over conventional radiation therapy and has emerged as a viable treatment option for these historically radioresistant tumors. There are relatively few studies that have reported on the treatment of spinal chordoma with SRS, given its rarity. Thus, the aim of this study was to identify long-term outcomes after SRS in patients with spinal and sacral chordoma.</p><p><strong>Methods: </strong>A prospectively collected database analysis of patients with chordomas in the mobile spine and sacrum treated with SRS was conducted at a large quaternary referral center from February 2002 to January 2024. Patient demographic and histological data, prior treatment history, dosimetry, fractionation, and outcomes, including local control (LC), overall survival (OS), and resolution of neurological deficits and pain, were identified. SRS was used alone (9 tumors, 20%), as postoperative adjuvant therapy (12 tumors, 27%), and as salvage therapy for recurrent disease (23 tumors, 52%). The median single-fraction prescription dose was 21.25 Gy (range 13.5-25 Gy). Multifractionated treatment used prescription doses of 21-42 Gy in 3-5 fractions.</p><p><strong>Results: </strong>Twenty-four patients (median age 65 years) with 44 chordomas were included. The median follow-up duration was 20 months (range 1-203 months). The 1-, 2-, and 5-year LC rates were 87%, 64%, and 49%, respectively. The 1- and 2-year LC rates were 100% and 83% for SRS alone and 90% and 80% for postoperative adjuvant SRS, respectively. Rates of OS were 90%, 84%, and 51% at 1, 2, and 5 years, respectively. Univariate analysis showed that multifractionated SRS was associated with superior LC (HR 0.26, 95% CI 0.10-0.71; p = 0.008); however, no significant difference in LC was observed when accounting for the biologically effective dose. Among patients presenting with neurological deficits, complete or partial resolution occurred for 8 of 20 tumors (40%). In symptomatic patients, pain was fully or partially alleviated for 27 of 36 tumors (75%). Six adverse radiation events (14%) were observed following treatment, including vertebral compression fracture (n = 2, 5%), pharyngoesophageal toxicity (n = 1, 2%), and transient peripheral neuropathy (n = 1, 2%).</p><p><strong>Conclusions: </strong>This series is among the largest to date evaluating outcomes of SRS for spinal and sacral chordomas, demonstrating durable LC and symptom relief with acceptable rates of toxicity when used alone and as an adjunct to surgery. SRS is also an effective treatment option for patients with recurrent disease who seek noninvasive treatment or are not candidates for resection.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E17"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency neoplastic spinal cord compression without known histology: should we operate?","authors":"Harsh Jain, Tyler Zeoli, Anthony E Bishay, Sameer Sundrani, Ranbir Ahluwalia, Iyan Younus, Hani Chanbour, Keyan Peterson, Julian Lugo-Pico, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.3171/2025.2.FOCUS24989","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24989","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Patients presenting emergently with neoplastic spinal cord compression without known histology pose a complex decision for spine surgeons. In this patient population, the authors sought to 1) describe presentation/histology, 2) determine if emergency surgery was indicated, and 3) compare survival to that of patients with known histology prior to surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective, cohort study of patients who underwent extradural spine tumor surgery between 2010 and 2021 was undertaken. The inclusion criteria were neoplastic spinal cord compression and emergency department or emergency clinical presentation without known tumor histology or cancer history. Histology was classified as radiosensitive (lymphoma, leukemia, small cell lung cancer, germ cell cancer), radio-intermediate (breast, prostate), and radioresistant (all others). Stability was determined with the Spine Instability Neoplastic Score (SINS). Descriptive/bivariate and multivariable Cox regression statistics were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 371 patients who underwent surgery for extradural spine tumors, 80 (21.6%) had emergency presentation without a known histological diagnosis. The mean ± SD age was 60.5 ± 12.4 years, 65% of patients were male, and the mean follow-up was 530.5 ± 738.0 days. Although spinal cord compression was seen in all (100%) patients, a neurological deficit was seen in only 43 (53.7%). Final pathology revealed that 59 (73.7%) patients had radioresistant tumors, 12 (15.0%) radio-intermediate, and 9 (11.3%) radiosensitive; of note, 2/80 (2.5%) had primary bone tumors. Accepting that those patients with radioresistant pathology would need separation surgery regardless, 11 of the 21 (52.4%) patients with radio-intermediate or radiosensitive pathology had a neurological deficit, and thus surgery was indicated. In the remaining 10 patients without a neurological deficit, SINS was stable/indeterminate in 8 patients (10% of patients with unknown diagnosis), for whom surgery may have been avoided. Multivariable Cox regression showed that patients without known histology at the time of surgery had decreased overall survival compared to those with known histology preoperatively (HR 1.64, 95% CI 1.17-2.30, p = 0.004).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among 80 patients with emergency presentation of neoplastic spinal cord compression without known histology, 90% ultimately had histology, neurological status, or instability favorable for surgery, thus affirming the surgeons' choice to operate. However, 1 in 10 patients could have potentially been treated with radiation and/or systemic treatment alone. Two patients (3%) had primary bone tumors, foregoing the chance of a negative margin resection. Not knowing histology preoperatively was independently associated with decreased overall survival. These results provide empirical data for a challenging yet not uncommon situation for spine surgeons and reinfo","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E5"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and prognosis of surgically treated thoracic spinal meningiomas: a multicenter cohort study.","authors":"Qingping Joseph Feng, A Aravin Kumar, Jun Kai Yeong, Shane Zaw, Zhiquan Damian Lee, Krishan Kumar, Dinesh Shree Kumar, Ji Min Ling, Lester Lee","doi":"10.3171/2025.2.FOCUS24955","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24955","url":null,"abstract":"<p><strong>Objective: </strong>Thoracic spinal meningiomas (TSMs) are common intradural extramedullary tumors and are usually surgically treated. Although surgery generally results in positive outcomes, some patients experience residual or new neurological impairments. The authors conducted a multicenter cohort study to investigate prognostic factors that affect functional recovery following TSM resection.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study from 3 tertiary centers was conducted and included all patients who underwent TSM resection between 2015 and 2023. Patients had a minimum 6-month follow-up with preoperative MRI and clinical evaluation. Functional outcomes were measured using the American Spinal Injury Association (ASIA) motor component score of the ASIA Impairment Scale and modified Japanese Orthopaedic Association thoracic myelopathy (mJOA-TM) score. The secondary outcome was postoperative complications.</p><p><strong>Results: </strong>A total of 74 patients were included, with the majority presenting with lower limb radiculopathy and midthoracic tumors. Postoperative outcomes showed improvement in the median ASIA motor and mJOA-TM scores at 6 months. Univariate analysis identified significant predictors of ASIA motor score improvement to include age at diagnosis (p = 0.038), anteroposterior tumor dimension (p = 0.005), transverse dimension (p = 0.007), need for inpatient rehabilitation (p = 0.002), and worsened incontinence (p = 0.003). Significant predictors of mJOA-TM improvement were tumor volume (p < 0.001), craniocaudal dimension (p = 0.040), rehabilitation requirements (p = 0.045), presence of complications (p < 0.001), worsened motor deficits (p < 0.001), sensory deficits (p < 0.001), and incontinence (p < 0.001). Multivariate analysis confirmed that tumor dimensions (anteroposterior, p = 0.043; transverse, p = 0.039) and postoperative incontinence (p < 0.001) were independently associated with recovery in the ASIA motor score at 6 months; and age at diagnosis (p = 0.024), meningioma volume (p = 0.004), and worsened postoperative numbness (p < 0.001) were associated with recovery in the mJOA-TM score.</p><p><strong>Conclusions: </strong>This multicenter study is the largest series of surgically treated TSMs reported to date. Resection of TSMs is associated with significant functional recovery despite the potential for postoperative complications. Tumor dimensions, tumor volume, and worsened postoperative neurological deficits are key determinants of functional recovery in surgically treated TSMs.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for early pathological fracture following stereotactic body radiation therapy for spinal metastases.","authors":"Juliana C Capp, Zach Pennington, Abdelrahman Hamouda, Anthony L Mikula, Nikita Lakomkin, Arjun S Sebastian, Brett A Freedman, Peter S Rose, S Mohammed Karim, Ahmad Nassr, Mohamad Bydon, William E Krauss, Jeremy L Fogelson, Roman O Kowalchuk, Kenneth W Merrell, Michelle J Clarke, Benjamin D Elder","doi":"10.3171/2025.2.FOCUS24905","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24905","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to determine independent risk factors for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) in metastatic spine disease.</p><p><strong>Methods: </strong>Patients treated with SBRT for spinal metastasis at a single tertiary care center between 2008 and 2019 were retrospectively identified. Patients with CT scans obtained within 1 year of SBRT completion were included. Variables collected included demographics, Spine Instability Neoplastic Score (SINS), primary tumor pathology, Weinstein-Boriani-Biagini (WBB) classification, chemoradiation treatment details, and bone quality as assessed by Hounsfield units (HUs) on CT. HUs were measured for the medullary bone of the metastatic level, the tumor, and the vertebral bodies cephalad and caudal to the metastasis. Multivariable logistic regression was used to identify predictors of post-SBRT pathological fracture.</p><p><strong>Results: </strong>A total of 292 patients (mean age 66 years) with 392 unique lesions were included. The most common pathologies were prostate (n = 193), kidney/renal cell (n = 46), and lung (n = 33). The most common tumor levels were thoracic (n = 206 lesions) and lumbar (n = 128 lesions). SBRT was generally delivered in 1-3 fractions with doses ranging from 16 to 24 Gy in 1 fraction and 24-36 Gy in 3 fractions. Of the 392 lesions, 73 suffered VCF: 21 (29%) with < 25% height loss, 15 (21%) with 25%-40% height loss, and 37 (51%) with > 40% height loss. On univariate analysis, patients with VCF had lower average HUs (156 ± 52 vs 202 ± 89, p < 0.001), more WBB sectors involved (3 ± 2 vs 3 ± 1, p < 0.001), higher SINSs (8 ± 3 vs 6 ± 2, p < 0.001), were more commonly female (33% vs 22%, p = 0.05), and more commonly had nonprostate pathology (67% vs 47%, p = 0.003). VCF rates were similar between moderate (< 20 Gy in 1 fraction, < 30 Gy in 3 or 5 fractions) and high-dose (> 20 Gy in 1 fraction, > 30 Gy in 3 or 5 fractions) radiation schema (15% VCF vs 16% no VCF, respectively; p = 0.99). On multivariable logistic regression, independently significant predictors of VCF were HUs ≤ 229 (OR 6, p < 0.001), affected levels ≥ 3 WBB segments (OR 3, p < 0.001), and an SINS ≥ 8 (OR 2, p = 0.02).</p><p><strong>Conclusions: </strong>Low pre-radiation HUs, involvement of more WBB sectors, and a higher SINS were independent predictors of VCF following SBRT for metastatic spine disease.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E13"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of open and percutaneous instrumented fixation for the treatment of spinal metastases.","authors":"Arkady Bilenkin, Anna Barnes, Amanda Brisco, Junmin Whiting, Nam D Tran, Andre Beer-Furlan, Michael A Vogelbaum, James K C Liu","doi":"10.3171/2025.2.FOCUS24925","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24925","url":null,"abstract":"<p><strong>Objective: </strong>The primary goals in surgical treatment of spinal metastases are neural decompression and spinal stabilization. Understanding a patient's functional and oncological status plays a key role in patient selection. Careful patient selection and determining the ideal surgical strategy are paramount to achieving successful outcomes in spinal oncology given the high risk for perioperative morbidity. The aim of this study was to examine instrumented fixation for treatment of spinal metastatic disease and compare outcomes of open versus percutaneous fixation to understand factors that might influence short- and long-term survival.</p><p><strong>Methods: </strong>A retrospective study of patients with metastatic spine tumors who underwent instrumented fixation with or without decompression from 2018 to 2023 at a single institution was performed. Demographic and oncological information, and preoperative and postoperative performance and pain scores, as well as history of surgical or radiation treatment, were collected. The cohort was divided into those who underwent open fixation versus those who underwent percutaneous fixation, and surgical data and instability scores were collected.</p><p><strong>Results: </strong>A total of 273 patients (127 female and 146 male, mean age 63.6 ± 11.9 years) who underwent instrumented fixation for the treatment of spinal metastases were identified. Univariate analysis showed that the Karnofsky Performance Status (KPS) score at the time of surgery, postoperative hospital length of stay (LOS), and total LOS correlated with both 3- and 12-month survival. Multivariate analysis showed that sex, KPS score, previous radiation therapy, and postoperative LOS were associated with 3- and 12-month survival. There was no significant difference between groups in the mean KPS score at the time of surgery (73.6 vs 73.1, p = 0.354), but the percutaneous fixation group had a higher mean KPS score at 1 year (80.5 vs 84, p = 0.038). Preoperative pain scores were higher in the percutaneous group (mean 6.7 vs 7.6, p = 0.035) than the open fixation group, but there was no difference between groups at 1 year (mean 2.4 vs 2.6, p = 0.861).</p><p><strong>Conclusions: </strong>Preoperative performance status, prior radiation therapy, and postoperative hospital LOS were associated with overall survival following instrumented fixation for spinal metastases. Overall outcomes were equivocal in open versus percutaneous fixation procedures, with a higher KPS score at 1 year in the percutaneous cohort.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E12"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Separation surgery with cement-augmented short-segment fixation for spinal metastasis: early experience with carbon fiber-reinforced polyetheretherketone instrumentation.","authors":"Anas Bardeesi, Seth Wilson, Jacob Ward, Mark Damante, Joshua D Palmer, David Xu, J Bradley Elder, Vikram B Chakravarthy","doi":"10.3171/2025.2.FOCUS24994","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24994","url":null,"abstract":"<p><strong>Objective: </strong>The concept of hybrid therapy as separation surgery, followed by stereotactic radiation therapy or stereotactic body radiation therapy, is becoming the new standard of care in the management of metastatic epidural spinal cord compressions (MESCCs). Nevertheless, this new concept remains a form of palliative treatment, and surgical efforts to minimize morbidity and prolong survival serve to maximize palliation. Such strategies include short-segment fixation with cement augmentation, described as 1 level above and below the index level of the MESCC (single vertebral body level). The use of carbon fiber-reinforced polyetheretherketone (CFRP) instrumentation has allowed precise contouring in radiation planning and earlier detection of tumor recurrence, while being biomechanically comparable to standard titanium instrumentation. Therefore, the authors wanted to explore the feasibility of short-segment cement-augmented CFRP instrumentation for patients with spinal metastasis requiring separation surgery.</p><p><strong>Methods: </strong>A retrospective review was conducted from April 2022 to May 2024. Inclusion criteria were as follows: 1) patients who had open separation surgery for MESCC, 2) with short-segment cement-augmented CFRP instrumentation (defined as 1 level above and below the index disease level), 3) who underwent postoperative radiation therapy, with 4) a minimum 6 months of survival.</p><p><strong>Results: </strong>Twenty-eight patients met the inclusion criteria. The mean survival was 14.9 months, mean radiographic follow-up was 7.9 months, median estimated blood loss was 300 ml, and mean operative time was 214 minutes. There were no cement- or hardware-related complications. There were 3 cases of postoperative kyphosis, one of which was symptomatic, but all were managed nonoperatively. One patient required a reoperation for repair of a CSF leak.</p><p><strong>Conclusions: </strong>Short-segment cement-augmented fixation is a feasible strategy in open separation surgery for MESCC. This is the first clinical study to incorporate the use of CFRP instrumentation in such a surgical strategy. Additional studies with larger sample sizes and longer durations of follow-up would support both the durability and potential survival benefit over titanium instrumentation.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E9"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating long-term construct stability in metastatic spine cancer patients with carbon fiber-reinforced polyetheretherketone instrumentation.","authors":"Gavril Rosoklija, Skanda Sai, Garrett Q Barr, Ahmed M Meleis","doi":"10.3171/2025.2.FOCUS24995","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24995","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Metastatic spine disease significantly impacts the oncological population, often requiring surgical intervention to address spinal instability. Traditional constructs, including titanium-based long-segment instrumentation and short-segment cement augmentation, have been the mainstay in managing these patients. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) hardware and shorter-segment instrumentation have demonstrated benefits of improved surveillance, earlier recurrence detection, and shorter operative time. This study evaluated the long-term experience of a single center with CFR-PEEK constructs in patients with metastatic spine disease. It also investigated the clinical durability of short-segment constructs and evaluated the necessity of cement augmentation in maintaining construct stability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, single-center study included patients with metastatic disease to the spine who underwent surgical fixation using CFR-PEEK hardware between 2021 and 2024. Inclusion criteria required perioperative radiation therapy and a minimum of 6 months of radiographic follow-up. Patients were stratified into short-construct (n = 13) and long-construct (n = 7) groups based on the number of vertebral levels spanned. Subgroup analysis of cement-augmented versus nonaugmented short constructs was performed. Variables analyzed included preoperative scores (American Spinal Injury Association grade, Karnofsky Performance Scale score, Spine Instability Neoplastic Score, and epidural spinal cord compression grade), estimated blood loss, length of hospital stay, and postoperative outcomes. Radiographic failure and revision surgery rates were primary endpoints. Statistical analyses were conducted using nonparametric methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At 14 months of mean follow-up time, no radiographic failures or revision surgeries were observed within the 20 patients included in this study. Patients in the long-construct group had more vertebral levels involved (2.00 vs 1.15, p = 0.024), lower preoperative Karnofsky Performance Scale scores (58.57 vs 76.15, p = 0.01), and more frequent use of mixed constructs with titanium rods (p = 0.007). Short constructs demonstrated equivalent durability without the routine need for cement augmentation. Within the short-construct cohort, cement augmentation was associated with longer hospital stays (8.8 vs 3.63 days, p = 0.008) but did not reduce failure rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CFR-PEEK instrumentation demonstrates excellent durability and stability in metastatic spine disease, even in patients receiving perioperative radiation therapy. Short-segment instrumentation demonstrates comparable durability to long-segment constructs while reducing operative risks and hospitalization duration. While cement augmentation has traditionally been used to enhance construct strength, the findings in this study suggest that its routine use","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E11"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological decline due to a vascular etiology in patients with spine tumors: a patient series and cautionary tale.","authors":"Scott L Zuckerman, Hani Chanbour, Harsh Jain, Alexandra Giantini-Larsen, Jacob P Schwarz, Mark H Bilsky","doi":"10.3171/2025.2.FOCUS24958","DOIUrl":"10.3171/2025.2.FOCUS24958","url":null,"abstract":"<p><strong>Objective: </strong>Patients harboring spine tumors may experience neurological decline due to vascular etiology, such as hypoperfusion or vascular steal. Spinal cord ischemia or stroke in the setting of spine tumors is a rarely reported but potentially catastrophic complication. Therefore, the authors sought to report a case series of patients with spine tumors who experienced neurological decline due to vascular reasons, with a proposed etiology and alternative management strategies.</p><p><strong>Methods: </strong>A dual-institution, retrospective case series was conducted of patients with spine tumors who experienced neurological decline due to vascular etiologies between 2004 and 2021. Inclusion criteria were as follows: diagnosis of a primary or metastatic spine tumor and a neurological decline due to anterior spinal cord ischemia or stroke. A description of each case is outlined, as well as the etiology of neurological decline, real-time interventions, and preventative alternative management strategies.</p><p><strong>Results: </strong>Five patients were identified who experienced a neurological decline due to vascular reasons at the following times: 2 occurred preoperatively, 2 intraoperatively, and 1 postoperatively.</p><p><strong>Conclusions: </strong>Patients with spine tumors are at risk of spinal cord ischemia or stroke with a catastrophic neurological decline. Early recognition of vascular events in patients with spine tumors is critical to initiating timely interventions that can lead to spinal cord recovery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E6"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}