Neurosurgical focus最新文献

{"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":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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}

{"title":"Napsin A as a key prognostic biomarker in spinal metastases of lung cancer: implications for survival and neurological function.","authors":"Albert Antar, Abdel-Hameed Al-Mistarehi, A Daniel Davidar, Yuanxuan Xia, Pritika Papali, Shreya Sriram, Melanie Alfonzo Horowitz, Shahab Aldin Sattari, Sushanth Neerumalla, Carly Weber-Levine, Sang Hun Lee, Kristin J Redmond, Ali Bydon, Timothy F Witham, Nicholas Theodore, Mark H Bilsky, Daniel Lubelski","doi":"10.3171/2025.2.FOCUS24897","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24897","url":null,"abstract":"<p><strong>Objective: </strong>Lung cancer's propensity for metastasizing to the spine significantly impacts morbidity and mortality. Understanding the impact of somatic mutations on the prognosis of these metastases is crucial for treatment development and optimization.</p><p><strong>Methods: </strong>A retrospective analysis was performed on a neurosurgical cohort of 76 patients with lung cancer with spinal metastasis (LCSM) at a single comprehensive cancer center from 2013 to 2023. Data on patient demographics, tumor biomarkers, treatment modalities, and outcomes were collected and analyzed.</p><p><strong>Results: </strong>Of the 76 patients, 72 (95%) had non-small cell lung cancer, predominantly adenocarcinoma (83%). Patients with EGFR (epidermal growth factor receptor) mutations (n = 19, 25%) had an increased median overall survival (OS) of 3.40 years compared with 1.39 years for those without EGFR mutations (p = 0.01) as well as increased median survival after spinal metastasis (1.73 years vs 0.98 years, p = 0.01). Patients with KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations (n = 16, 21%) had a decreased median OS of 0.71 years compared with 2.60 years for those without KRAS mutations (p = 0.03). Napsin A expression was associated with an improved median OS of 5.41 years compared with 1.39 years (p = 0.01), an increased median survival after spinal metastasis (2.29 years vs 0.71 years, p = 0.01), and better postoperative Frankel grades (OR 10.011, p < 0.01) compared with those without expression. Cytokeratin 7 (CK7) expression was associated with decreased OS in an accelerated failure time (AFT) model (time ratio [TR] 0.562, p = 0.025). Targeted therapy was associated with an increased median OS (3.40 years vs 1.28 years, p < 0.01) and an improved median survival after spinal metastasis (1.73 years vs 0.70 years, p < 0.01). In an AFT model, immunotherapy (TR 2.15, p = 0.007) and targeted therapy (TR 2.20, p = 0.001) were associated with improved OS, while spinal radiotherapy was negatively associated with OS (TR 0.46, p = 0.015).</p><p><strong>Conclusions: </strong>Somatic mutations in EGFR and KRAS and expression of napsin A and CK7 significantly influence survival in patients with LCSM. Mutations in EGFR and expression of napsin A, along with targeted therapy, were associated with better patient outcomes, emphasizing the need for personalized treatment strategies to improve survival and neurological function.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E18"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991353","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":"Durability of carbon fiber-reinforced PEEK spinal instrumentation in spine oncology: a single-institution longitudinal experience.","authors":"Mark Damante, Seth B Wilson, Jacob Ward, Kofi Mensah-Arhin, Shivam Gandhi, Anas Bardeesi, David Xu, Joshua Palmer, J Bradley Elder, Vikram B Chakravarthy","doi":"10.3171/2025.2.FOCUS24976","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24976","url":null,"abstract":"<p><strong>Objective: </strong>Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is increasingly being used in patients with spine tumors as the body of literature supporting its benefit in local disease surveillance and radiation planning grows. Small single-institution experiences with short-term follow-up have yet to demonstrate issues with construct durability despite different biomechanical properties of CFR-PEEK compared to titanium. In this study the authors evaluated CFR-PEEK hardware failures in patients with surgically treated spine tumors who had long-term follow-up.</p><p><strong>Methods: </strong>This is an IRB-approved retrospective cohort study of patients with spine tumors who underwent instrumented spinal fusion with CFR-PEEK or titanium instrumentation at a single tertiary care center. Inclusion criteria were as follows: 1) age > 18 years; 2) pedicle screw fixation with CFR-PEEK or titanium; and 3) minimum 6 months of follow-up. The surgical indication was reviewed and agreed upon at a multidisciplinary spine tumor board meeting.</p><p><strong>Results: </strong>A total of 190 patients undergoing CFR-PEEK instrumentation were identified during the study period; 148 had at least a 6-month follow-up. Of those 148, the median follow-up was 13.7 months. In total, there were 861 CFR-PEEK pedicle screws, 266 CFR-PEEK spinal rods, and 15 CFR-PEEK corpectomy cages included in the study. Percutaneous CFR-PEEK instrumentation was performed in 13 cases. There were 6 (4.1%) CFR-PEEK cases of mechanical/hardware failure, with a median interval time to failure of 5.51 (range 2.74-9.38) months. There were no hardware-related complications in the 26 patients who received CFR-PEEK instrumentation and who had a > 24-month follow-up.</p><p><strong>Conclusions: </strong>This institutional experience provides the largest cohort with long-term follow-up to evaluate CFR-PEEK-related instrumentation failure in patients with spine tumors. The rate of hardware failure among CFR-PEEK instrumented constructs was comparable to that in the current literature for titanium implants used in degenerative spine and spine oncology treatment. Importantly, there were no hardware failures noted among patients with extended long-term survival, reinforcing the durability of CFR-PEEK instrumentation.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E10"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002923","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":"Impact of surgery and radiation on radicular pain and myotomic weakness in patients with metastatic spine disease.","authors":"Arthur R Bartolozzi, Ori Barzilai, Ilya Laufer, Arjun Sahgal, Laurence D Rhines, Daniel M Sciubba, Aron Lazary, Michael H Weber, James M Schuster, Stefano Boriani, Chetan Bettegowda, Paul M Arnold, Michelle J Clarke, Michael G Fehlings, Ziya L Gokaslan, Charles G Fisher, Mark Bilsky, Nicolas Dea","doi":"10.3171/2025.2.FOCUS24915","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24915","url":null,"abstract":"<p><strong>Objective: </strong>Surgery is typically indicated for mechanical pain in metastatic spine disease or severe neurological compromise, but how radicular pain responds to oncological treatment is not well described. The primary aim of this study was to describe how radicular pain responds to oncological treatment, while secondary aims included pain outcomes between patients with mechanical and tumoral pain and motor improvement in patients with weakness due to nerve root compression.</p><p><strong>Methods: </strong>Patients treated with surgery and/or radiotherapy for spinal metastases were identified from an international multicenter prospective cohort. The primary outcome was the numeric rating scale (NRS) score for pain at 3 months posttreatment. Motor recovery from radicular compression in patients with myotomic weakness and low-grade epidural compression was also analyzed.</p><p><strong>Results: </strong>Of 284 patients, 129 (45%) had radicular pain ± axial pain and 155 (55%) had axial pain alone. The two groups did not significantly differ in age, comorbidities, tumor characteristics, or treatment. Two hundred two patients (71%) underwent surgery ± radiotherapy, whereas 82 (29%) had radiotherapy alone. The NRS score of patients with radicular pain improved from 6.7 to 3.4 at 3 months, a statistically significantly higher magnitude than in patients with isolated axial pain (p = 0.021). The NRS score at 3 months was similar for both groups (p = 0.876). Patients with radicular pain experienced a larger improvement with surgery compared with radiotherapy alone (p = 0.007) but had higher pretreatment pain (mean NRS score 7.0 vs 5.6, p = 0.013). Twenty-three patients identified with radicular/myotomic weakness (mean American Spinal Injury Association score 96.3 ± 3.2) at baseline improved 2.1 ± 3.8 points at 3 months.</p><p><strong>Conclusions: </strong>The magnitude of pain improvement for patients with radicular pain following surgery and radiotherapy for metastatic spine disease is higher than for patients with axial pain alone. Surgery is associated with a larger improvement in radicular pain than radiotherapy alone. These results will allow clinicians to tailor treatment options for patients with metastatic spine disease.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E14"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035641","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}