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Samuel Ryu, Jack Rock, Mark Rosenblum and Jae Ho Kim

radiosurgery in patients with spinal cord compression was also performed (unpublished data). This study showed similar results. Further studies are needed to improve patient selection relative to the role of the different treatment modalities. The Henry Ford Hospital spinal radiosurgical experience now includes 250 treatments in 230 patients. In light of the many questions surrounding the efficacy and use of stereotactic radiosurgery for malignant spinal lesions, we performed this analysis to establish a clinical rationale of treating only the involved spinal metastasis

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Predictors of survival in patients with prostate cancer and spinal metastasis

Presented at the 2009 Joint Spine Section Meeting 

Dan Michael Drzymalski, William K. Oh, Lillian Werner, Meredith M. Regan, Philip Kantoff and Sagun Tuli

exists. Survival 1 year after the diagnosis of spinal metastasis was found to be 83.3% in one study. 19 Williams et al. 21 showed that the Gleason score, total number of metastases, and degree of spinal cord compression were independent predictors of survival after surgery for spinal metastasis, but few studies have described factors predictive of survival at the time of diagnosis of the spinal metastasis. Therefore, we performed an observational study to determine predictors of death in patients with prostate cancer who have spinal metastasis. We hypothesized that

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Richard G. Perrin, Kenneth E. Livingston and Bizhan Aarabi

S ymptomatic spinal metastasis represents a serious complication of systemic cancer. The devastating morbidity associated with relentlessly progressing cord compression due to spinal metastases is well recognized. 6 The vast majority of symptomatic spinal metastases occur in the extradural space. Intramedullary metastases are unusual by comparison. Intradural extramedullary spinal metastasis causing spinal cord and/or root compromise is seldom encountered and has rarely been reported. We describe here the management of 10 such cases. Summary of Cases

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Claudio E. Tatsui, Frederick F. Lang, Joy Gumin, Dima Suki, Naoki Shinojima and Laurence D. Rhines

–19 1: normal to tail dragging 19–14 2: tail dragging to dorsal stepping 14–8 3: dorsal stepping to hindlimb sweeping ≤8 4: hindlimb sweeping to paralysis TABLE 2: Timeframe for occurrence of key neurological events (milestones) in a mouse model of spinal metastasis Affected Limb Median Days to Milestone (95% CI) Tail Dragging Dorsal Stepping Hindlimb Sweeping Paralysis rt hindlimb 12 (10.8–13.2) 23 (20.6–25.4) 28 (27.1–28.9) 30 (28.1–31.9) lt hindlimb 12 (10.8–13.2) 21 (19.4–22.6) 26

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Claudio E. Tatsui, Dima Suki, Ganesh Rao, Stefan S. Kim, Abhijit Salaskar, Mustafa Aziz Hatiboglu, Ziya L. Gokaslan, Ian E. McCutcheon and Laurence D. Rhines

and location of first metastasis, date and location of the spinal metastasis, previous treatments (including chemo-, immuno-, and/or radiotherapy), neurological deficits prior to spine surgery, total number of spinal and extraspinal sites, and disease status (none, concurrent, stable, or progressing) of extraspinal metastases at the time of surgery. Date of death, when available, was confirmed using the Social Security Death Index. Preoperative Evaluation and Classification of the Status of Systemic Disease All patients in our series were monitored by

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Darryl Lau, Matthew R. Leach, Frank La Marca and Paul Park

pain; 35 , 38 myelopathy; 11 and in many cases, loss of ambulation. 2 , 32 Surgical management of spinal metastasis is widely considered a palliative intervention, and prognosis remains poor, with survival times commonly less than a year after surgery. 13 , 27 , 40 In the current literature there are very few large studies that directly examined risk factors and predictors of survival in patients who underwent surgery for spinal metastasis using multivariate analysis, and it remains elusive as to which methods are truly reliable. 3 , 13 , 28 , 41 , 42 There are

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Claudio E. Tatsui, R. Jason Stafford, Jing Li, Jonathan N. Sellin, Behrang Amini, Ganesh Rao, Dima Suki, Amol J. Ghia, Paul Brown, Sun-Ho Lee, Charles E. Cowles, Jeffrey S. Weinberg and Laurence D. Rhines

responses 22 , 33 with a significant subset of patients deriving little palliative benefit or tumor control from this modality alone. 24 , 35 In subsequent years, a better understanding of spinal biomechanics and the development of internal spinal fixation revitalized the role of surgery in the management of spinal metastasis, resulting in improved functional outcomes and local control. A randomized controlled trial 32 demonstrated the superiority of circumferential decompression and stabilization surgery followed by cEBRT in the maintenance and recovery of ambulation

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Edward W. Akeyson and Ian E. McCutcheon

T he modern concept of surgery for spinal metastasis involves radical excision with the primary goal of local cure and secondary goals of alleviating pain, preserving neurological status, and stabilizing the spine. 42, 45 The surgical approach that best accomplishes these goals remains uncertain. Anterior and lateral approaches directed at the site of primary tumor encroachment on neural elements have achieved good results, superseding those of laminectomy alone; 4, 8, 11–14, 19, 27–29, 33–35, 43, 46, 48 however, they may not be ideal in all situations. 31

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Brad E. Zacharia, Sweena Kahn, Evan D. Bander, Gustav Y. Cederquist, William P. Cope, Lily McLaughlin, Alexa Hijazi, Anne S. Reiner, Ilya Laufer and Mark Bilsky

.05 considered statistically significant. All statistical analyses were performed in SAS (version 9.4, SAS Institute Inc.). Results Patient Demographics We identified 314 consecutive patients undergoing surgery for spinal metastasis at our institution from January 2012 through December 2014. The median age for the overall study population was 60 years (range 16–92 years; Table 1 ). The majority of patients (89%) underwent posterolateral decompression with posterior instrumented fusion while the remaining underwent percutaneous instrumented stabilization (8%) or resection

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Neurosurgical Forum: Letters to the Editor To The Editor Charles Davis , F.R.C.S. Royal Preston Hospital Preston, England 150 150 The article by Weller and Rossitch (Weller SJ, Rossitch E Jr: Unilateral posterolateral decompression without stabilization for neurological palliation of symptomatic spinal metastasis in debilitated patients. J Neurosurg 82: 739–744, May, 1995) redresses the imbalance caused by the recent trend in fixative surgery for the common condition of spinal cord compression due to cancer