• Journal of Korean Neurosurgical Society
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• v.39 no.6
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• pp.451-454
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• 2006

We present a case of a 68-year-old female with an atypical form of spinal tuberculosis, which involved posterior elements with multiple foci in two noncontiguous vertebral levels. The lesions caused spastic paraparesis and urinary hesitation. There was no evidence of pulmonary or other extrapulmonary tuberculous disease. Based on clinical and radiographic findings, this atypical spinal tuberculosis was preoperatively misdiagnosed as metastatic spine tumor. The histopathologic finding confirmed tuberculosis and the patient was treated successfully with surgery and antituberculous therapy. In case of a spinal lesion of unknown origin, it is important to be aware that atypical spinal tuberculosis can mimic metastatic spine tumor and tuberculosis should always be considered.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.1004-1012
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• 2001

Objective : The spinal cord tumors(including vertebral tumors) are increasingly diagnosed and operated due to development of refined diagnostic and therapeutic tools. It is necessary to re-evaluate clinical features and surgical results of spinal cord tumors with increasing cases and developing treatment modalities. The authors reviewed the spinal cord tumor cases to evaluate their clinical characteristics. Material and Methods : The retrospective review of 654 cases of spinal cord tumors between 1973 and 1999 was done. The clinical features, pathological analysis and surgical results were analyzed and compared to the literature. The results of the study are analyzed with a more detailed consideration of each of major pathologies : neurogenic tumors, meningeal tumors, neuroepithelial tumors, and metastatic tumors. Results and Conclusion : The spinal cord tumor was most common in the 5th decade of age(145 cases, 22.1%) and 78 cases(11.9%) were found in children under 15 years of age. The ratio of male to female was 1.2 : 1. The pathologic diagnosis was neurogenic tumor in 266 cases(40.7%), neuroepithelial tumor in 131(20.0%), metastatic tumor in 118(18.0%), and meningeal tumor in 94(14.4%) in the order of frequency. The tumor was located most frequently in the thoracic area(36.5%) and in the intradural extramedullary space(38.1%). The most common initial presentation was pain(40.1%) and the mean duration for presentation to operation was 14.8 months. The total or gross total removal was possible in 404 cases(61.7%) and the surgical result on the postoperative one month was recovery or improvement in 424 cases(64.8%), stationary in 188(28.7%), progression in 42(6.4%). As a surgical complication, there was a spinal deformity(12 cases), wound infection(5 cases), aspiration pneumonia(5 cases) etc. Neurogenic tumors and menigiomas showed good surgical results, whereas neuroepithelial tumors(except ependymoma) and metastatic tumors showed relatively poor prognosis.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.216-223
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• 2011

Objective : The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. Methods : We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. Results : The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). Conclusion : Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.1
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• pp.37-42
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• 2007

Purpose: Because of the anatomical characteristics, it is difficult to perform radical operation in spinal tumor. Numerous operations on primary and metastatic spinal tumor have been performed and among those total en bloc spondylectomy has produced decent clinical result. Clinical and radiological results have been analyzed based on five total en bloc spondylectomy on primary and metastatic spinal tumor. Materials and Methods: Patients included in this study were one with primary and four with metastatic spinal tumors, from June 1997 to January 2006. Two of the four were originated form kidney. One was from breast and the other one was not identified. McAfee's 4 point scale, VAS and Frankel's classification have been used as clinical assessment of pain and neurological symptoms. Clinical assessment have been conducted for every 3 months after operation including local recurrence, bone union and complications. Results: Assessment of pain decreased from average of 3 before operation to 1.6 after operation in McAfee's scale and VAS decreased from average of 9.2 to 1.6. Neurological deficit after operation improved from C to D in Frankel's category. Local recurrence has been detected on metastatic adenocarcinoma of L4 during follow up. Conclusion: Total en bloc spondylectomy is evidently useful operational method for primary and metastatic spinal tumor since it completely decompresses spinal nerves, decreases axial pain immediately and improves the quality of remaining life.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.1
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• pp.14-21
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• 2007

Bone is a common site for metastatic spread from many kinds of malignancies. The morbidity associated with this metastatic spread can be significant, including severe pain. When it comes to spinal metastasis, occupying nearly 40% of skeletal metastases, the risks of complications, such as vertebral body collapse, nerve root impingement, or spinal cord compression, are also significant. Because of the necessity of preserving the integrity of the spinal column and the proximity of critical structures, surgical treatment has limitations when durable local control is desired. Radiotherapy, therefore, is often used as an adjunct treatment or as a sole treatment. A considerable limitation of standard radiotherapy is the reported recurrence rate or ineffective palliation of pain, either clinically or symptomatically. This may be due to limited radiation doses to tumor itself because of the proximity of critical structures. CyberKnife is an image-guided robotic radiosurgical system. The image guidance system includes a kilovoltage X-ray imaging source and amorphous silica detectors. The radiation delivery device is a mobile X-band linear accelerator (6 MV) mounted on a robotic arm. Highly conformal fields and hypofractionated radiotherapy schedules are increasingly being used as a means to achieve biologic dose escalation for body tumors. Therefore, we can give much higher doses to the targeted tumor volume with minimizing doses to the surrounding critical structures, resulting in more effective local control and less severe side effects, compared to conventional fractionated radiotherapy. A description of this technology and a review of clinical applications to bone metastases are detailed herein.

• Radiation Oncology Journal
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• v.32 no.4
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• pp.221-230
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• 2014

Purpose: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. Materials and Methods: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. Results: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. Conclusion: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.

• Investigative Magnetic Resonance Imaging
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• v.20 no.1
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• pp.1-8
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• 2016

The spine is the most common location for skeletal metastases, and the incidence of spinal metastasis shows an increasing tendency. Because metastatic spinal tumors progress from an anterior element to a posterior element resulting in continuing destruction of the pedicles, epidural extension and involvement of neural structures of the metastatic tumor are eventually visible. Therefore, it is clinically significant for radiologists to understand the pathophysiology of spinal metastasis and to assess the involvement of neural structures and the disintegration of spinal instability related to the pathophysiology. As MRI is also the best imaging modality for diagnosing spinal metastasis, radiologists should accurately assess spinal metastasis and provide practical information to physicians. Therefore, we will describe some analysis points focusing on the understanding of pathophysiology of spinal metastasis and the next step toward a more extensive clinical approach using MR imaging.

• International Journal of Contents
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• v.13 no.4
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• pp.12-15
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• 2017

Among the possible stereotactic body radiation therapy (SBRT) modalities used to treat patients with metastatic spinal tumors, this study compared Cyberknife, tomotherapy, and volumetric modulated arc radiotherapy (VMAT). We established treatment plans for each of them modality and quantitatively analyzed the dose evaluation factors of the dose-volume histogram (DVH) for all spinal bones, focusing on the tumor and spinal cord, in order to examine the usefulness of VMAT. For the treatment planning dose, the mean dose ($D_{max}$) and $D_{5%}$ showed statistical differences in the target dose, but no difference was shown in the spinal cord dose. For the DVH indices, tomotherapy showed the best performance was the best in terms of uniformity index, while VMAT showed better performance was better than the other two modalities in terms of the conformity index and the dose gradient index. VMAT had a much shorter treatment time than Cyberknife and tomotherapy. These findings suggest that VMAT FFF is the most effective therapy for SBRT of patients with metastatic spinal tumors for whom a high dose of radiation is prescribed.

• The Journal of the Korean bone and joint tumor society
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• v.12 no.2
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• pp.148-154
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• 2006

Purpose: Numerous operations on primary and metastatic spinal tumor have been performed and among those total en bloc spondylectomy has produced decent clinical result, This article introduce 1 case of metastatic spine tumor of C3,C4 who treated with total en bloc spondylectomy.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.157-161
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• 2010

Primary central nervous system (CNS) melanoma is a rare condition that accounts for only 1% of all melanomas. A 34-year-old Korean female presented with a two-month history of progressive weakness in both legs. Spinal magnetic resonance image (MRI) revealed a spinal cord tumor at the level of T4, which was hyperintense on T1-weighted imaging and hypointense on T2-weighted imaging. The intradural and extramedullary tumor was completely resected and diagnosed as melanoma. There were no metastatic lesions. At three years after surgery, the patient is still alive, with no evidence of tumor recurrence. We present the details of this case along with a comprehensive review of spinal cord melanoma.