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Brian J. Williams, Patrick J. Karas, Ganesh Rao, Laurence D. Rhines and Claudio E. Tatsui

Presentation varies by location but symptoms are usually nonspecific. 2 Chordoma is a locally aggressive disease that uncommonly metastasizes. 1 Survival is dependent primarily on radical surgical excision. If there is residual disease or recurrence then focused, high-dose radiation is the treatment of choice. 7 There is no approved medical treatment for chordoma, thus metastases can present a clinical dilemma. 7 Given the palliative nature of treatment of chordoma metastases, open resection is not always feasible. Laser interstitial thermal therapy (LITT) is an emerging

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Nelson Moussazadeh, Linton T. Evans, Roxana Grasu, Laurence D. Rhines and Claudio E. Tatsui

Spinal laser interstitial thermal therapy has been developed as a minimally invasive modality to treat epidural spinal tumors percutaneously. The safe and effective use of this technology requires meticulous preoperative trajectory planning and an intraoperative workflow incorporating navigation and MR thermography. Instrumented stabilization can be performed during the same operation if needed. Operative considerations and technical aspects are reviewed.

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Claudio E. Tatsui, Ganesh Rao and Laurence D. Rhines

instability due to involvement of the middle and posterior columns at the transitional CTJ. We have shown previously that radiation therapy can effectively treat MM in the cervical spine, even in cases of instability. 4 Whereas surgery should be considered for cases of significant spinal instability or deformity, in this case we demonstrated that after radiotherapy an osteolytic MM lesion can remineralize and the structural integrity of the spinal elements can be restored. This case illustrates that for patients at risk of spinal instability associated with MM

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Stephen J. Hentschel, Ehud Mendel, Sanjay Singh and Laurence D. Rhines

paresthesias. In 1995 prostate carcinoma had been diagnosed, and he underwent chemo-, radio-, and brachytherapy. The back pain worsened with coughing, sneezing, straining, and particularly recumbency. Only partial pain control was achieved despite maximal medical therapy. He did not complain of headache, weakness, or sphincter dysfunction. Examination On examination, he was neurologically intact with normal strength, tone, reflexes, and sensation in his extremities. There was no clonus, and plantar responses were downgoing. The remaining aspects of neurological

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Robert J. Bohinski, Ehud Mendel, Kenneth D. Aldape and Laurence D. Rhines

addition, the clinical, neuroimaging, and histological characteristics of these tumors as they affect the spine are discussed. Emphasis is placed on the differentiation of solitary fibrous tumor from other more common spindle cell neoplasms that affect the spine. Case Report History This 49-year-old woman presented with a 1-year history of neck pain and stiffness. During the course of these symptoms, she sought various forms of medical therapy without relief. Eventually, she experienced a burning sensation in her left hand that gradually progressed more

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Novel use of a threadwire saw for high sacral amputation

Technical note and description of operative technique

Robert J. Bohinski, Ehud Mendel and Laurence D. Rhines

any major complications. A 5-cm-long superficial wound dehiscence developed as a result of skin edge necrosis at the inferior Y-shaped confluence of the dorsal incision; this was successfully managed without reoperation. Following the second stage of surgery, neurological status was significant for Grade 2/5 plantar and dorsiflexion strength on the left and Grade 4/5 plantar and dorsiflexion strength on the right. Physical therapy was begun on postoperative Day 3. The patient was transferred to the inpatient rehabilitation service on postoperative Day 7. She was

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En bloc resection of multilevel cervical chordoma with C-2 involvement

Case report and description of operative technique

Laurence D. Rhines, Daryl R. Fourney, Abdolreza Siadati, Ian Suk and Ziya L. Gokaslan

radiation therapy. Although there are several reports of en bloc excisions for thoracic and lumbar tumors, 5, 10, 12 the peculiar anatomical complexities of the cervical spine—including the intricate bone architecture, the encased VAs, and the need to preserve the cervical nerve roots—significantly increase the potential for intralesional margins. 3, 6 We present the case of a 54-year-old man who harbored a chordoma of the upper cervical spine (C2–4) with both a large retropharyngeal component and epidural extension. The method of en bloc removal of this lesion and

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Stephen J. Hentschel, Allen W. Burton, Daryl R. Fourney, Laurence D. Rhines and Ehud Mendel

Object. The purpose of this study was to examine a group of patients with cancer who underwent a vertebroplasty or a kyphoplasty for a vertebral body (VB) fracture, even though the procedure may have been considered contraindicated based on previous reports in the literature.

Methods. The electronic database maintained by the Departments of Neurosurgery and Anesthesiology—Pain Management at the University of Texas M. D. Anderson Cancer Center was searched for patients who underwent vertebroplasty or kyphoplasty between January 2001 and July 2003. The criteria defining a contraindicated procedure were based on a review of the literature. Group I consisted of patients who did not undergo a contraindicated vertebroplasty or kyphoplasty, whereas Group II consisted of patients who underwent one of these procedures even though it may have been considered contraindicated.

There were 53 patients with fractures at 132 levels who met the criteria for the study. Of these, 17 patients with fractures at 18 levels (14% of total) were considered to have undergone a contraindicated vertebroplasty or kyphoplasty (Group II). There were 12 complications (11%) in the 114 levels in Group I and seven complications (39%) in the 18 levels in Group II (p = 0.03). The most common complication was cement extrusion from the anterior VB that did not involve the venous system. No patient required an open surgical procedure to remove extruded cement.

Conclusions. Vertebroplasty and kyphoplasty appear to be safe and effective in the setting of severe back pain caused by VB fracture that is unresponsive to other therapies, even in the presence of relative contraindications to the procedures.

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Stephen J. Hentschel, Laurence D. Rhines, Franklin C. Wong, Ziya L. Gokaslan and Ian E. McCutcheon

clinically at initial presentation. Thus, it is important to recognize this condition and to have a systematic method of evaluating and treating patients with this condition. The purpose of this study was to examine the experience with iatrogenic postoperative SPF manifesting after resection of spinal tumors and to propose guidelines for investigation and therapy. Clinical Material and Methods Our database was searched for cases of SPF following resection of spinal tumors between 1993 and 2002. We found nine patients (six men and three women) who ranged in age from

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Ben A. Strickland, Ian E. McCutcheon, Indro Chakrabarti, Laurence D. Rhines and Jeffrey S. Weinberg

-stage cancer, and another showed that 6% of patients with cancer who had myelopathy had one or more IMs. 6 , 27 With survival increasing among cancer patients due to improved therapies, IM will probably be seen more frequently. When left untreated, neurological decline usually follows, with progression to paraparesis or quadriparesis. 13 Although advances in radiographic imaging now enable the detection of tumors at an earlier stage, even in recent series treatment often consists of steroids and radiotherapy. 19 , 21 , 26 Here we outline the clinical parameters and