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Purpose: To investigate risk factors for instrumentation failure (IF) in titanium (Ti) mesh reconstruction for thoracic and lumbar tumors. Patients and Methods: The clinical data of patients with thoracic or lumbar tumors who received Ti mesh reconstruction via the posterior approach in our hospital from 2013 to 2018 were analyzed retrospectively. The observation indexes included sex, age, BMI, the vertebra resection mode, the number of resected vertebral segments, application of bone cement, radiotherapy, chemotherapy, revision or primary surgery, and primary tumor metastasis. Correlations between these factors and IF were analyzed by Kaplan–Meier survival and logistics regression analyses. Results: The 178 patients included 108 males and 70 females with a mean age of 48.09± 16.21 (6– 78) years and a mean follow-up period of 51.18 (24– 90) months. The data showed that 17 patients (9.55%) were inflicted with IF, involving the thoracic vertebra in 11 cases, thoracolumbar vertebrae (T12–L1) in 2 cases, and lumbar vertebrae in 4 cases. The mean interval between surgery to IF was 35.18± 14.17 (14– 59) months. Univariate analysis showed that total vertebral body resection, the number of resected vertebral segments, radiotherapy and multiple tumor resection were potential factors for IF, while multivariate analysis showed that only total vertebral body resection, the number of resected vertebral segments and radiotherapy were independent factors. Conclusion: Total vertebra resection, the number of resected vertebral segments (≥ 2) and radiotherapy before and after operation were significant risk factors related to IF. [ABSTRACT FROM AUTHOR]

Background: With the occurrence and improvement of immunohistochemistry and other pathological diagnostic techniques, gastrointestinal stromal tumor (GIST) has been gradually recognized. With the prolonged survival of patients with GISTs, reports about the bone metastasis of GIST increased. However, the knowledge of GISTs is rather limited due to its very low incidence. Methods: Cochrane and Medline database (via PubMed) were searched in July 2019 with related keywords to acquire the literature related to the bone metastasis of GIST. Then, the literature was reviewed and references were also scanned to identify the possible related reports. Study data comprising age, sex, primary location, metastasis interval time, immunohistochemistry index, management and prognosis were recorded and analyzed. Results: Forty-five patients with bone metastases of GIST, with a mean age of 61.09 years, were included. The small intestine and stomach were the most common primary sites, followed by the rectum. Patients with small intestine primary sites had bone metastases that occurred earlier than the bone metastases stomach and rectum primary sites. The spine was the most common site of bony metastases. The mean survival time after GIST diagnosis was more than 64.02 months. Patients younger than 60 years old had a worse prognosis than those older than 60 years old. Furthermore, patients with spinal involvement had a worse prognosis than those without spinal involvement. Surgical interventions combined with targeted therapies guaranteed a better prognosis. Conclusion: Bone metastasis of GIST, which mainly occurs in the spine, is rather rare. Patients with GISTs of the small intestine and stomach suffered from bone metastasis more frequently and earlier than patients with GISTs in other primary sites. Age, sex, primary tumor location, treatment mode for the primary lesions and metastases, and spine involvement may be potential factors that affect the prognosis of GIST patients with bone metastases. [ABSTRACT FROM AUTHOR]

Abstract Developing novel therapeutic agents against chondrosarcoma is important. SF2523 is a PI3K-Akt-mTOR and bromodomain-containing protein 4 (BRD4) dual inhibitor. Its activity in human chondrosarcoma cells is tested. Our results show that SF2523 potently inhibited survival, proliferation and migration, and induced apoptosis activation in SW1353 cells and primary human chondrosarcoma cells. The dual inhibitor was yet non-cytotoxic to the primary human osteoblasts and OB-6 osteoblastic cells. SF2523 blocked Akt-mTOR activation and downregulated BRD4-regulated genes (Bcl-2 and c-Myc) in chondrosarcoma cells. It was more efficient in killing chondrosarcoma cells than other established PI3K-Akt-mTOR and BRD4 inhibitors, including JQ1, perifosine and OSI-027. In vivo , intraperitoneal injection of SF2523 (30 mg/kg) potently inhibited subcutaneous SW1353 xenograft tumor growth in severe combined immunodeficient mice. Akt-mTOR inhibition as well as Bcl-2 and c-Myc downregulation were detected in SF2523-treated SW1353 tumor tissues. In conclusion, targeting PI3K-Akt-mTOR and BRD4 by SF2523 potently inhibited chondrosarcoma cell growth in vitro and in vivo. Highlights • SF2523 inhibits survival, proliferation and migration, and induces apoptosis in SW1353 cells. • SF2523 inhibits growth and migration, and induces apoptosis in primary chondrosarcoma cells. • SF2523 inhibits Akt-mTOR activation and downregulates c-Myc/Bcl-2 in chondrosarcoma cells. • SF2523 inhibits SW1353 xenograft tumor growth in SCID mice. [ABSTRACT FROM AUTHOR]

Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its limitations, especially for unresectable or recurrent tumors. Selective arterial embolization (SAE) is reported to be an option for treatment in several cases, but there are few systematic reviews on the effects of SAE on SGCT and/or PGCT. Medline and Embase databases were searched for eligible English articles. Inclusion and exclusion criteria were conducted before searching. All the clinical factors were measured by SPSS software, with P-values ≤0.05 considered statistically significant. A total of 9 articles were retrieved, including 44 patients receiving SAE ranging from 1 to 10 times. During the mean follow-up period of 85.8 months, the radiographic response rate was 81.8%, with a local control and overall survival rate of 75% and 81.8%, respectively. No bowel, bladder, or sexual dysfunction was observed. Three patients developed distant metastases and finally died. Patients with primary tumors tended to have better prognosis than those with recurrence (P = 0.039). The favorable outcomes of SAE suggest that it may be an alternative treatment for SGCT and PGCT patients for whom surgery is not appropriate. [ABSTRACT FROM AUTHOR]

Objective To investigate the feasibility and safety of en bloc resection of cervical primary malignant bone tumors by a combined anterior and posterior approach based on a three-dimensional (3- D) printing model. Methods Five patients with primary malignant bone tumors of the cervical spine underwent en bloc resection via a one-stage combined anteroposterior approach in our hospital from March 2013 to June 2014. They comprised three men and two women of mean age 47.2 years (range, 26-67 years). Three of the tumors were chondrosarcomas and two chordomas. Preoperative 3- D printing models were created by 3- D printing technology. Sagittal en bloc resections were planned based on these models and successfully performed. A 360° reconstruction was performed by spinal instrumentation in all cases. Surgical margins, perioperative complications, local control rate and survival rate were assessed. Results All patients underwent en bloc excision via a combined posterior and anterior approach in one stage. Mean operative time and estimated blood loss were 465 minutes and 1290 mL, respectively. Mean follow-up was 21 months. Wide surgical margins were achieved in two patients and marginal resection in three; these three patients underwent postoperative adjuvant radiation therapy. One vertebral artery was ligated and sacrificed in each of three patients. Nerve root involved by tumor was sacrificed in three patients with preoperative upper extremity weakness. One patient (Case 3) had significant transient radiculopathy with paresis postoperatively. Another (Case 4) with C4 and C5 chordoma had respiratory difficulties and pneumonia after surgery postoperatively. He recovered completely after 2 weeks' management with a tracheotomy tube and antibiotics in the intensive care unit. No cerebrovascular complications and wound infection were observed. No local recurrence or instrumentation failure were detected during follow-up. Conclusion Though technically challenging, it is feasible and safe to perform en bloc resection of cervical primary bone tumors. This is the most effective means of managing cervical spine tumors. Preoperative 3- D printing modelling enables better anatomical understanding of the relationship between the tumor and cervical spine and can assist in planning the surgical procedure. [ABSTRACT FROM AUTHOR]

Between June 2010 and June 2011, 176 patients were divided into 2 groups: a group with spinal metastasis of solid tumors (n=157) and a group with multiple myeloma (n=19). Both groups were further divided into 2 subgroups: a group receiving zoledronic acid before surgery and a control group. The zoledronic acid subgroup of the solid tumors group was group A (n=81), the control subgroup of the solid tumors group was group B (n=76), the zoledronic acid subgroup of the multiple myeloma group was group C (n=10), and the control subgroup of the multiple myeloma group was group D (n=9). The average intraoperative blood loss during spinal surgery was as follows: 1311±691 mL in group A and 1752±740 mL in group B (P=0.000) and 1994±810 mL in group C and 3134±795 mL in group D (P=0.000). Patients receiving zoledronic acid before surgery had significantly less intraoperative bleeding than those who did not receive it. Preoperative use of zoledronic acid can effectively reduce intraoperative bleeding during surgery for the treatment of spinal tumors. [ABSTRACT FROM AUTHOR]

Abstract  A retrospective study evaluating complications in 2,233 consecutive patients of subaxial cervical disorders treated with an anterior cervical locking plate was performed, and recommendations for prevention and treatment were made. The average length of follow-up was 1.3 years. Any loosening or breaking of the plates and screws or malpositions that threatened tracheoesophageal or neurovascular structures were defined as the complications. There were 239 cases (10.7%) with different kinds of complications. The complications included oblique plating in 56 cases in which the screw could irritate the nerve root. Screws were driven into the disc space in four cases, which ultimately led to plate loosening. Screws penetrated the endplate or passed excessively close to it producing a triangle fracture in 19 cases. Loosening or breaking of the plate and the screw was found in 115 cases. These phenomena were always associated with non-union. Three oesophageal perforations occurred and conservative treatments proved effective. Finally, overlong plates impinged on the adjacent level in 14 cases and promoted disc degeneration ultimately leading to revision surgery. Good training and careful operation may help to decrease the complication rate. Most hardware complications are not symptomatic and can be treated conservatively. Only a few of them need immediate reoperation. [ABSTRACT FROM AUTHOR]

Ossifying fibroma (OF) is a benign tumor commonly occurring in the mandible and maxilla. Spinal involvement of OFs is of great rarity. To the best of our knowledge, only 3 cases in the thoracic and lumbar spine have been reported. We present the case of a 22-year-old woman with an OF of the atlas, which, to the best of our knowledge, is the first described OF in the cervical spine. The related data were also reviewed. Only 3 spinal OFs involving the thoracic spine to the sacrum have been reported. Spinal involvement of OFs seldom occurs. To the best of our knowledge, we have reported the first OF involving the cervical spine. Differentiating OFs from primary spinal tumors is necessary. OFs have locally aggressive behavior and a high risk of recurrence. Complete resection, followed by regular examinations, should be the ideal choice for treatment. [ABSTRACT FROM AUTHOR]