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Surbhi Jain, Eric Sommers, Matthias Setzer and Frank Vrionis

; no metastases Stage IV any T any N M1 tumor of any size; any nodes; any metastases * Based on reference 37 . M = metastasis; N = nodes; T = tumor. Different surgical methods have been described for advanced Pancoast tumors that involve VB resection. 12 , 16 , 20 , 21 , 23 , 63 However, all the described methods involve at least 2 stages. Typically, spinal stabilization is performed through a posterior approach (first stage) followed by a posterolateral or trap-door thoracotomy for definitive resection (second stage). We report and elaborate on a

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Jae-Won Doh, Andrea L. Halliday, Nevan G. Baldwin and Edward C. Benzel

, et al : Surgical management of metastatic renal carcinoma of the spine. Spine 16 : 265 – 271 , 1991 King GJ, Kostuik JP, Mcbroom RJ, et al: Surgical management of metastatic renal carcinoma of the spine. Spine 16: 265–271, 1991 7. Kostuik JP , Errico TJ , Gleason TF , et al : Spinal stabilization of vertebral column tumors. Spine 13 : 20 – 256 , 1988 Kostuik JP, Errico TJ, Gleason TF, et al: Spinal stabilization of vertebral column tumors. Spine 13: 20–256, 1988 8. Krag MH

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Yoshihisa Kotani, Kuniyoshi Abumi, Yasuo Shikinami, Masahiko Takahata, Ken Kadoya, Tsuyoshi Kadosawa, Akio Minami and Kiyoshi Kaneda

R ecent treatments for spinal disorders have rapidly progressed, and new motion preservation technologies such as AID replacement or flexible spinal stabilization have evolved. 3–5, 7, 8, 10, 13–21, 24, 37, 38, 41 The AID technology includes several different designs and surgery-related concepts. To date, some devices are undergoing multicenter clinical trials for clinical approval; 17, 19 however, a paucity of information exists regarding appropriate design concepts of unconstrained or constrained interface material and its modification, and their in vivo

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Kevin D. Harrington

patient who deteriorated neurologically after surgery. The final three patients who derived little benefit from surgery (Cases 1, 43, and 51) suffered displacement of their acrylic “grafts” within 3 weeks of operation, but refused further operative attempts at spinal stabilization. None of these three suffered from neurological compromise postoperatively, but all suffered a recurrence of mechanical spine pain (one cervical, one thoracic, and one lumbar), only partially relieved by rigid external bracing. In two of these patients, the operations were performed early in

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Frank D. Vrionis and John Small

Object

In this study the authors retrospectively review outcomes in patients treated for metastases to the spine. Surgery for metastatic tumors to the spine remains an important part of the treatment armamentarium. Maximum tumor resection with a minimum number of complications is one of the goals of surgery. Current surgical procedures include tumor resection and spinal stabilization for optimal results.

Methods

The records of 96 patients who underwent surgery for a metastatic spine tumor at the authors' institution were reviewed. Spinal instrumentation was used in the majority of patients. Ambulatory status was maintained in 91% and pain improved in 94% of patients. Complications included infection (5.2%), cerebrospinal fluid leak (2%), and delayed hardware failure (3.1%). The mortality rate was 4.1%; the main cause was due to tumor progression.

Conclusions

Surgery is indicated in a select group of patients with metastatic tumors to the spine. A multidisciplinary approach is recommended for patient selection and complication avoidance. Surgical options, including approach, type of reconstruction and extent of resection (including en bloc spondylectomy) need to be addressed for optimal outcomes.

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Claudio E. Tatsui, Telmo A. B. Belsuzarri, Marilou Oro, Laurence D. Rhines, Jing Li, Amol J. Ghia, Behrang Amini, Heron Espinoza, Paul D. Brown and Ganesh Rao

decompression and spinal stabilization. A secondary analysis of one patient treated with sLITT 60 days prior to SRS demonstrated an improvement of almost 2 Gy in the minimum dose prescribed to cover the gross target volume of a metastatic pheochromocytoma affecting T11–12. In this case, we obtained long-lasting local control (currently 18 months) and avoided a thoracolumbar stabilization. 9 Here, we introduce the concept of percutaneous separation surgery by combining the application of sLITT to minimally invasive percutaneous stabilization with and without cement

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Mark J. Cuffe, Mark N. Hadley, Guillermo A. Herrera and Richard B. Morawetz

cardiopulmonary reserve. The placement of a halo ring and jacket for periods of 3 months or more may add an additional restrictive lung defect to an already compromised patient. Three of the four deaths in this series that occurred in the first 2 months following surgery were due to cardiopulmonary arrest in patients equipped with halo immobilization devices. Internal fixation should be considered as an alternative to long-term rigid external immobilization if spinal stabilization is deemed necessary. Platelet dysfunction associated with chronic azotemia may lead to

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Use of “MAPS” for determining the optimal surgical approach to metastatic disease of the thoracolumbar spine: anterior, posterior, or combined

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Daryl R. Fourney and Ziya L. Gokaslan

nutritional depletion, 58 corticosteroid agent use, 58 advanced age, 52 significant medical comorbidity, 15 and paraparesis. 52, 59 Some patients may be medically unsuitable for transthoracic, thoracoabdominal, and retroperitoneal approaches; however, in our experience, these exposures are well tolerated in most patients. 15–18, 25 Spinal Stabilization Various criteria have been proposed to define spinal stability; 11, 33, 34 however, no validated clinicoradiological system for grading instability has gained general acceptance in the setting of neoplasia. 17

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Lennart Brandt, Carsten Feldborg Nielsen, Hans Säveland and Hans Wingstrand

biomechanical evaluation of cervical spinal stabilization methods in a bovine model. Static and cyclic loading. Spine 13 : 795 – 802 , 1988 Sutterlin CE, McAfee PC, Warden KE, et al: A biomechanical evaluation of cervical spinal stabilization methods in a bovine model. Static and cyclic loading. Spine 13: 795–802, 1988 6. Zygmunt S , Säveland H , Brattström H , et al : Reduction of rheumatoid periodontoid pannus following posterior occipito-cervical fusion visualized by magnetic resonance imaging. Br J Neurosurg 2

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Shurei Sugita, Hirotaka Chikuda, Katsushi Takeshita, Atsushi Seichi and Sakae Tanaka

outcomes. 8 , 9 , 12 , 20 Anterior decompression is technically demanding, and the technique is associated with a high rate of complications. 13 , 16 Spinal fixation with instrumentation is believed to diminish spinal cord damage and suppress further ossification by eliminating dynamic effects and reducing mechanical stress. 19 Although the long-term progression of OPLL may compromise the surgical benefits, it remains unclear whether thoracic OPLL continues to grow after spinal stabilization. We hypothesized that spinal stabilization decreases the rate of OPLL