• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.937-938
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• 2016

Stereotactic body radiation therapy (SBRT) appears an effective and safe treatment modality for spinal bone metastasis, which can enhance local control and improve quality of life. Life expectation, predicted fracture risk, localization, quality, size and number of metastasis and presence or absence of nerve compression seem to be important factors in decision-making for treatment. Further studies are needed to identify subsets of patient which will most benefit from treatment.

• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.415-423
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• 2018

Objective : To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. Methods : We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. Results : There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). Conclusion : When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1503-1510
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• 2014

Breast cancer bone metastasis causing severe morbidity is commonly encountered in daily clinical practice. It causes pain, pathologic fractures, spinal cord and other nerve compression syndromes and life threatening hypercalcemia. Breast cancer metastasizes to bone through complicated steps in which numerous molecules play roles. Metastatic cells disrupt normal bone turnover and create a vicious cycle to which treatment efforts should be directed. Bisphosphonates have been used safely for more than two decades. As a group they delay time to first skeletal related event and reduce pain, but do not prevent development of bone metastasis in patients with no bone metastasis, and also do not prolong survival. The receptor activator for nuclear factor ${\kappa}B$ ligand inhibitor denosumab delays time to first skeletal related event and reduces the skeletal morbidity rate. Radionuclides are another treatment option for bone pain. New targeted therapies and radionuclides are still under investigation. In this review we will focus on mechanisms of bone metastasis and its medical treatment in breast cancer patients.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.57-63
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• 2022

Objective : To study the factors relating to operative treatment for spinal metastasis in Thailand during 2005-2014 and to determine the hospital costs, mortality rate, and incidence of perioperative complication. Methods : Inpatient reimbursement data from 2005 to 2014 was reviewed from three national healthcare organizations, including the National Health Security Office, the Social Security Office, and the Comptroller General's Department. The search criteria were secondary malignant neoplasm of bone and bone marrow patients (International Classification of Diseases 10th revision, Thai modification codes [ICD 10-TM], C79.5 and C79.8) who underwent spinal surgical treatment (ICD 9th revision, clinical modification procedure with extension codes [ICD 9-CM], 03.0, 03.4, 03.09, and 81.0) during 2005-2014. Epidemiology, comorbidity, and perioperative complication were analyzed. Results : During the study period, the number of spinal metastasis patients who underwent operative treatment was significantly increased from 0.30 to 0.59 per 100000 (p<0.001). More males (56.14%) underwent surgical treatment for spinal metastasis than females. The most common age group was 45-64 (55.1%). The most common primary tumor sites were the unknown origin, lung, breast, prostate, and hepatocellular/bile duct. Interestingly, the proportion of hepatocellular/bile duct, breast, and lung cancer was significantly increased (p<0.001). The number of patients who had comorbidity or in-hospital complication significantly increased over time (p<0.01); however, the in-hospital mortality rate decreased. Conclusion : During the last decade, operative treatment for spinal metastasis increased in Thailand. The overall in-hospital complication rate increased; however, the in-hospital mortality rate decreased.

• Nuclear Medicine and Molecular Imaging
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• 제42권3호
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• pp.218-228
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• 2008

목적 : 본 연구의 목적은 골스캔이 없이 FDG PET/CT가 단독으로 척추골전이 평가에 사용될 경우 간과될 수 있는 척추골전이의 양상을 알아보기 위한 것이며 이와 더불어 척추골전이에서 FDG PET/CT와 골스캔간에 불일치 소견을 보이는 병소의 특징을 파악하고자 하는 것이었다. 대상 및 방법 : 척추골전이가 있는 43명의 환자군의 FDG PET/CT와 골스캔을 후향적으로 분석하였다. FDG PET/CT와 골스캔상 불일치하는 소견을 보인 병소를 주의깊게 분석하였다. FDG PET/CT 단독과 골스캔을 참조한 FDG PET/CT 결과들을 McNemar 검정을 이용하여 분석하였다. FDG PET/CT 단독분석상 간과된 척추골전이 병소의 특징을 알아보기 위하여 일방항카이스퀘어 검정을 시행하였다. 척추골전이 병소의 Tc-99m MDP 섭취와 연관이 있는 인자를 확인하기 위하여 로지스틱 회귀분석을 시행하였다. 독립변수는 위치(경추부, 흉추부, 요추부), 전이 병소 크기(큼, 작음), 및 최대 SUV로 설정하였으며, 종속변수는 골스캔의 섭취(양성 및 음성 MDP 섭취)로 하였다. 결과 FDG PET/CT 단독 분석의 결과는 FDG PET/CT와 골스캔을 함께 참조한 경우와 유의하게 달랐다(p<0.01). FDG PET/CT 단독 분석상에서 미만성조골전이는 유의하게 높은 빈도로 간과되는 경향이 있었다(p=0.04). 척추골전이의 Tc-99m MDP 섭취에 연관이 있는 인자를 확인하기 위한 단변량 로지스틱 회귀분석상 경추부 병소 및 작은 전이 병소는 음성 MDP 섭취와 관련이 있었으며, 흉추부 병소 및 큰 전이 병소는 양성 MDP 섭취와 연관이 있었다. 그러나, 다변량 로지스틱 회귀분석상 오직 전이 병소의 크기만이 양성 MDP 섭취와 연관이 있었다(p<0.01). 결론 : 골스캔은 척추골전이 평가에 있어 FDG PET/CT에 추가적인 역할을 하며, 특히 미만성조골전이에서 더욱 그러하다. 척추골전이 병소의 크기와 골스캔상 섭취가 연관이 있는 듯 하다.

• 대한영상의학회지
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• 제85권1호
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• pp.77-94
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• 2024

고령의 환자에서 척추에 단일 병소의 병변을 만나게 되면 골전이를 가장 먼저 염두하게 된다. 골전이는 어느 부위든 가능하지만 척추체에서 가장 많이 발생한다. 그러나 항상 골전이에 전형적인 영상 소견을 보이지 않을 수도 있고 단일 병소로 발견하게 되면 다른 모방하는 병변과 감별이 어려울 수 있다. 그러면 원발암의 진단 및 치료가 늦어지게 된다. 본 종설에서는 골전이의 영상검사 및 임상지침에 대해서 살펴보고 골전이 외에도 고령 환자에서 척추에 단일 병소로 생길 수 있는 다양한 질환들의 영상 소견 및 감별 포인트에 대해서 알아보고자 한다.

• Journal of Korean Neurosurgical Society
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• 제51권1호
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• pp.1-7
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• 2012

Objective : The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis. Methods : A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets. Results : Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild. Conclusion : In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.

• Journal of Korean Neurosurgical Society
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• 제38권4호
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• pp.259-264
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• 2005

Objective : The vertebroplasty is an excellent procedure in spine compression fracture, but there are some problems such as cement leakage and difficulties in bone biopsy. Recently, the osteoplasty system is developed to solve these problems, so we will report the usefulness of the osteoplasty system. Methods : From January 2003 to November 2003, there are 9patients with simple osteoporotic spine compression fracture, 2 compression fracture patients combined with suspicious spinal metastasis, 1patient with suspicious primary bone tumor, and 2patient with infection on spine. All patients were treated using the osteoplasty system. Results : All 11 compression fracture patients were relived the back pain after the osteoplasty and there is no complication. The bone biopsies in 3 suspicious cancer patients were also effectively performed using the osteoplasty system; negative result in 2patients and positive result in 1patient. The culture result of spontaneous discitis was no growth for 48hours. The spine tuberculosis was confirm using the osteoplasty system. Conclusion : The osteoplasty system has distinguished advantages in comparison with the vertebroplasty. That is, the risk of cement leakage is lower than vertebroplasty because of low pressure delivery system. And we can obtain the specimen effectively in bone biopsy because of large cannula. In conclusion, we emphasize that the osteoplasty system is a more useful procedure in spine compression fracture especially in the patient needed bone biopsy for diagnosis.

• 척추신경추나의학회지
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• 제10권1호
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• pp.117-127
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• 2015

Objectives : Most of pains are important symptoms caused by cancer transpered to spine. Harpagophyti Radix Pharmacopuncture is highly effective in reducing fever, pain, inflammation but was never used to reduce pain from cancer transpered to spine. So I intended to use Harpagophyti Radix Pharmacopuncture to control pain. The purpose of this study is to evaluate the clinical application of Harpagophyti Radix Pharmacopuncture for Bone Metastasis of Breast Cancer and Spinal Stenosis. Methods : We examined patient with Bone Metastasis of Breast Cancer and Spinal Stenosis who admitted Jaseng Korean Medicine Hospital. The patient was treated by Korean Medicine treatment and Harpagophyti Radix Pharmacopuncture. This case was assessed by Numerical Rating Scale(NRS), Oswestry Low Back Pain Disability Index(ODI), Short-Form 36 Health Survey(SF-36), ROM(Range of Movement) and Special Test. Results : In this study, the patient's pain was controlled and NRS, ODI were decreased. I could identify the improvement in life quality from the positive change of SF-36 and also found out that treatment was successful from the improvement of ROM, Special test. Conclusions : Harpagophyti Radix Pharmacopuncture with Korean Medicine treatment for Bone Metastasis of Breast Cancer and Spinal Stenosis was proved to be useful to the pain relief and function recovery, but further research should take place for clear understanding of the exact amount of dosage and safety. Moreover it must be accompanied by long term follow up research.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.4-12
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• 2021

Spinal metastases can present with varying degrees of mechanical instability. The Spinal Instability Neoplastic Score (SINS) was developed as a tool to assess spinal neoplastic-related instability while helping to guide referrals among oncology specialists. Some previous papers suggested that the SINS was accurate and reliable, while others disagreed with this opinion. We performed a systematic review regarding the SINS to evaluate its accuracy and precision in predicting vertebral compression fractures (VCFs). The 21 included studies investigated a total of 2118 patients. Thirteen studies dealt with the accuracy of SINS to predict post-radiotherapy VCFs, and eight dealt with the precision. Among 13 studies, 11 agreed that the SINS categories showed statistically significant accuracy in predicting VCF. Among eight studies, body collapse was effective for predicting VCFs in six studies, and alignment and bone lesion in two studies. Location has no statistical significance in predicting VCFs in any of the eight studies. The precision of SINS categories was substantial to excellent in six of eight studies. Among the six components of the SINS, the majority of the included studies reported that location showed near perfect agreement; body collapse, alignment, and posterolateral involvement showed moderate agreement; and bone lesion showed fair agreement. Bone lesion showed significant accuracy in predicting VCFs in half of eight studies, but displayed fair reliability in five of seven studies. Although location was indicated as having near perfect reliability, the component showed no accuracy for predicting VCFs in any of the studies and deleting or modifying the item needs to be considered. The SINS system may be accurate and reliable in predicting the occurrence of post-radiotherapy VCFs for spinal metastasis. Some components seem to be substantially weak and need to be revised.