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Spinal metastasis (SMs) are the most encountered tumors of the spine. Their occurrence is expected roughly around one to two years after primary tumor diagnosis. Since the advent of Magnetic Resonance Imaging (MRI), this technology has been considered the gold standard for SMs diagnosis and characterization due to its precise ability to comprehend the rate of soft tissue compression/invasion (dural sac/nervous tissue), which is one of the main drivers of management strategies. Computed Tomography (CT) remains unbeatable when a detailed bony anatomy and instability assessment is searched. Nuclear medicine technologies may have a role in diagnosis when standard MR or CT study findings are inconclusive or when the extent of the systemic metastatic disease is studied. The main objective of this study is to offer an update on the epidemiology and radiology of spinal metastasis (SMs), endorsed by the WFNS Spine Committee. A systematic review of the literature of the last ten years gave 1531 results with "spine/spinal metastatic tumors/metastasis AND radiology OR imaging OR classification" as search strings in all fields, of which 56 papers were fully analyzed. The results were discussed and voted on in two consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee, reaching a positive or negative consensus using the Delphi method. The committee stated nine recommendations on two main topics: (1) Incidence and epidemiology of SMs; (2) Radiology and classifications of SMs., Competing Interests: Declarations Ethics approval Not applicable. Consent to participate Not applicable. Consent to publish Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: A retrospective case series., Objective: This study developed a novel classification system based on imaging and anatomy to select optimal surgical approaches and reconstruction strategies to achieve total resection of cervical dumbbell tumors and restore spinal stability., Summary of Background Data: Total resection is necessary to decrease the recurrence rate of cervical dumbbell tumors. Previous cervical dumbbell tumor classifications are insufficient for determining surgical strategies; therefore, a practical classification is needed., Materials and Methods: This study included 295 consecutive patients with cervical dumbbell tumors who underwent total surgical resection. A novel classification of cervical dumbbell tumors was developed based on magnetic resonance imaging and computed tomography. Continuous variables were expressed as mean±SD and were compared using an unpaired two-tailed Student t test. The χ 2 test or the Fisher exact test was used for categorical variables. Kendall's W test assessed three independent raters' inter-rater and intrarater reliabilities on 140 cervical dumbbell tumors., Results: The inter-rater and intrarater consistency coefficient was 0.969 (χ 2 =404.3, P <0.001) and 0.984 (χ 2 =273.7, P <0.001). All patients with type I and II tumors underwent single-posterior surgeries to achieve total resection. Of the patients in this study, 86.1%, 25.9%, 75.9%, and 76.9% underwent posterior surgeries for types IIIa, IIIb, IVa, and V tumors, respectively. All patients with type IVb tumors underwent a combined anterior and posterior approach. Posterior internal fixation was used for all patients in posterior surgery. Anterior reconstruction was applied for patients with type IVb tumors (20/20, 100%) and some with type V tumors (3/13, 23.1%). The mean follow-up duration was 93.6±2.6 months. A recurrence was observed in 19 (6.4%) patients., Conclusion: The authors describe a novel classification system that is of practical use for planning the complete resection of cervical dumbbell tumors., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Most patients with spinal tumors suffer no symptoms or have mild symptoms, but about 14% of patients have refractory pain caused by mechanical instability, or symptoms of spinal cord damage caused by epidural spinal cord compression. The Spinal Instability Neoplastic Score (SINS) and Kostuik classification are commonly used to evaluate spinal stability, and help to make a more detailed operation plan. The objectives of this study are to evaluate the reliability and reproducibility of the SINS and Kostuik classification, and to explore their clinical application value., Methods: All 80 patients with spinal tumors were enrolled. Six spine surgeons who have certain clinical experience were selected. Patients were scored according to the SINS scoring system and classification was determined according to the Kostuik system. We used Fleiss and Cohen κ values to check the coefficient consistency for multifactors. We used Cohen κ value to check the interobserver reliability and intraobserver reproducibility. After 12 weeks, we repeated the analysis., Results: The interobserver reliability and intraobserver reproducibility of the SINS scoring system were near perfect with values of 0.831 and 0.874, respectively. The interobserver reliability and intraobserver reproducibility of the Kostuik classification system were moderate with values of 0.505 and 0.595, respectively., Conclusions: Compared with the Kostuik classification system, the SINS scoring system has better interobserver reliability and intraobserver reproducibility, which can be widely used in clinical practice and has great significance in the decision-making of spinal tumor treatment. Although the Kostuik classification system is often used in clinical practice, it shows inferior reliability and reproducibility in our study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose To evaluate the use of susceptibility-weighted MRI for the differentiation of predominantly osteoblastic and osteolytic spine metastases. Materials and Methods For this prospective study, 53 study participants (mean age, 54.5 years ± 14.3 [range, 22-88 years]; 27 men with a mean age of 55.3 years ± 12.7 [range, 22-72 years] and 26 women with a mean age of 53.8 years ± 15.7 [range, 23-88 years]) with clinically suspected spine metastases underwent imaging with standard MRI sequences, susceptibility-weighted MRI, and CT. Sensitivities and specificities of MRI sequences for the detection of predominantly osteoblastic and osteolytic metastases were determined by using CT as the reference standard. The metastases-to-vertebral body signal intensity ratio (MVR) was calculated to compare modalities. Phantom measurements were obtained to correlate bone densities between MRI sequences and CT. Results A total of 64 metastases (38 predominantly osteoblastic, 26 predominantly osteolytic) were detected. Susceptibility-weighted MRI achieved a sensitivity of 100% (38 of 38) and specificity of 96% (25 of 26) for predominantly osteoblastic metastases and a sensitivity of 96% (25 of 26) and specificity of 100% (38 of 38) for predominantly osteolytic metastases. Standard MRI sequences achieved a sensitivity of 89% (34 of 38) and specificity of 73% (19 of 26) for predominantly osteoblastic metastases and a sensitivity of 73% (19 of 26) and specificity of 92% (35 of 38) for predominantly osteolytic metastases. MVR measurements obtained with susceptibility-weighted MRI demonstrated a strong correlation with those obtained with CT (R 2 = 0.75), whereas those obtained with T1-weighted MRI, T2-weighted MRI, and turbo inversion-recovery magnitude MRI showed a weak to moderate correlation (R 2 = 0.00, R 2 = 0.35, and R 2 = 0.39, respectively). Susceptibility-weighted MRI showed a strong correlation with CT with regard to metastases size (R 2 = 0.91). In phantom measurements, susceptibility-weighted MRI enabled the reliable differentiation of different degrees of mineralization (R 2 = 0.92 compared with CT). Conclusion Susceptibility-weighted MRI enables the reliable differentiation between predominantly osteoblastic and osteolytic spine metastases with a higher accuracy than standard MRI sequences. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Schweitzer in this issue.

OBJECTIVE Osteoblastoma is a rare primary benign bone tumor with a predilection for the spinal column. Although of benign origin, osteoblastomas tend to behave more aggressively clinically than other benign tumors. Because of the low incidence of osteoblastomas, evidence-based treatment guidelines and high-quality research are lacking, which has resulted in inconsistent treatment. The goal of this study was to determine whether application of the Enneking classification in the management of spinal osteoblastomas influences local recurrence and survival time. METHODS A multicenter database of patients who underwent surgical intervention for spinal osteoblastoma was developed by the AOSpine Knowledge Forum Tumor. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Patients in 2 cohorts, based on the Enneking classification of the tumor (Enneking appropriate [EA] and Enneking inappropriate [EI]), were analyzed. If the final pathology margin matched the Enneking-recommended surgical margin, the tumor was classified as EA; if not, it was classified as EI. RESULTS A total of 102 patients diagnosed with a spinal osteoblastoma were identified between November 1991 and June 2012. Twenty-nine patients were omitted from the analysis because of short follow-up time, incomplete survival data, or invalid staging, which left 73 patients for the final analysis. Thirteen (18%) patients suffered a local recurrence, and 6 (8%) patients died during the study period. Local recurrence was strongly associated with mortality (relative risk 9.2; p = 0.008). When adjusted for Enneking appropriateness, this result was not altered significantly. No significant differences were found between the EA and EI groups in regard to local recurrence and mortality. CONCLUSIONS In this evaluation of the largest multicenter cohort of spinal osteoblastomas, local recurrence was found to be strongly associated with mortality. Application of the Enneking classification as a treatment guide for preventing local recurrence was not validated.

Study Design: One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification., Objective: To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach., Summary of Background Data: Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters., Methods: The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures., Result: Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient., Conclusion: The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach., Level of Evidence: 4.

Benign tumors of the spine are rare and may lead to unspecific back pain. The classification of the lesion is typically achieved with a combination of imaging techniques (MRI and CT scans) and, in some cases, a histological sampling to allow differentiation from malignant processes. Both open and interventional (CT guided) biopsies are possible, depending on the localization of the tumor. Treatment strategies are diverse, require an interdisciplinary approach, and include operative and interventional procedures. The following article gives an overview of the most important benign tumors of the spine, the typical features in imaging, and treatment strategies.

Background: Malignant tumours particularly often metastasise to the spine, causing considerable pain and limiting the patient's physical function. Standard therapy consists in surgical treatment with adjuvant radiotherapy. The qualification for surgery is a multifaceted process and detailed analysis of the morphology of the metastasis is a key factor. Numerous types of classification of metastatic lesions exist, among which the Tomita system, based on MRI findings, appears to be the most practical. The aim of this paper is to present the current incidence of different morphological types of metastases as classified by the Tomita system., Materials and Methods: This work was based on cases treated at the Department of Oncological Orthopaedics of the Specialist Hospital in Brzozów - Podkarpacie Oncological Centre from 2010-2015. A total of 854 patients with spinal metastases were hospitalised at the department. All patients underwent a CT and MRI of the spine and their metastatic lesions were classified as one of the 7 types described by Tomita. The incidence of different morphological types of metastases per type of the primary tumour was also determined., Results: Most patients treated at the department had advanced disease as a result of diagnostic delays. Types T3-T7 were found in 91% of the patients and T7 in 44%. The highest incidence of advanced disease was seen among patients with breast cancer and myeloma. Higher pain severity and incidence of neurological complications were noted in patients with multisite lesions. Neurological deficits were diagnosed in 228 patients, of whom 68% were classified as Type T6 or T7. Most of the T6/T7 patients were unable to walk unassisted and required constant help from their family or medical staff., Conclusions: The Tomita system allows for easy and clear classification of the morphology of malignant metastases. 66% of patients treated at our department had multisite T6 or T7 metastases.

Dumbbell tumors can not only cause the compression of cervical cord and nerve root, but also invade the important structures and the surrounding organs, causing great harm to the patient. Toyama classification that is commonly used has not been evaluated and still requires independent validation.The objectives of this study were to evaluate and analyze the interobserver reliability and intraobserver reproducibility of Toyama classification system, explore the differences, discover the shortages, and evaluate the clinical value for diagnosis.One hundred sixty-five consecutive patients of a cervical dumbbell tumor with complete clinical and radiologic data were enrolled. Six surgeons determined the classification according to Toyama system. The classification was repeated 12 weeks later. Correlation coefficient (ICC) and kappa coefficient (κ) test were used to determine interobserver reliability and intraobserver reproducibility.The interobserver reliability for Toyama classification was moderate with a value of 0.432. The interobserver reproducibility for Toyama classification was moderate with a value of 0.608.The Toyama classification has landmark value in clinical practice, but it is a relatively cumbersome system. This study shows that it has low reliability and reproducibility. Accordingly, surgical management of the resection of dumbbell cervical tumors raises several problems, including preservation of the cervical nerve root, control of the vertebral artery, and maintenance of spine. There is a need to optimize the classification in the future.

Aim: To characterise and evaluate magnetic resonance imaging (MRI) images for their clinical value in diagnosing and assessing intraspinal mature teratoma., Materials and Methods: MRI images obtained from eight patients with a histopathologically verified intraspinal mature teratoma were analysed retrospectively regarding tumour location, size, and margins. Additionally, the signal intensity and enhancement pattern on MRI and other associated malformations were also assessed., Results: Three cases that contained fatty tissue showed markedly heterogeneous hyperintense signalling on T1-weighted images, and mixed hyperintense and hypointense signalling on T2-weighted images and fat-suppression sequences. All three of those cases showed an irregular peripheral fatty tissue signal, and one case showed additional patches of an interspersed calcification signal. The remaining five cases without fatty tissue displayed heterogeneous hyperintense signalling on T1-weighted images and T2-weighted images, and also on fat-suppression sequences. Four of the five cases showed additional patches of interspersed nodular calcification signals. Contrast-enhanced MRI images showed only slight enhancement (n=3)., Conclusions: MRI is regarded as the reference standard diagnostic technique to reveal the location of teratomas and the degree of spinal cord involvement. In most cases, MRI provides accurate anatomical and histological information, which is necessary for patients with suspected intraspinal mature teratoma., (Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Background Context: Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature., Purpose: This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management., Study Design: Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out., Patient Sample: Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included., Outcome Measures: Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board., Methods: Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation., Results: Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category., Conclusions: Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Vascular anomalies included hemangiomas and vascular malformations (VMs). VMs are mediated by mutations in the endothelial cell-specific receptor tyrosine kinase Tie2 (TEK),which is essential for angiogenesis and vascular stabilization. We identified five types of Tie2 mutations in 80 patients with soft tissue or spinal VMs by PCR including the previously detected missense mutations 2690A>G (Y897C), 2740C>T (L914F), 2743C>T (R915C), and two nonsense mutations 2763G>A, 2688C>T, we identified Tie2 mutation in primary spinal VMs for the first time. Tie2 mutations were found to be absent in 33 patients with hemangiomas and DNA samples of VMs. In addition, we showed that Tie2 mRNA expression in spinal VMs was similar to soft tissue VMs, but obviously lower than infant hemangiomas (P<0.01). This study provides new insights into spinal VMs, the association of Tie2 and vascular anomalies needs to be further discussed., (Copyright © 2015. Published by Elsevier B.V.)

Objective: To explore the clinical classification and selection of surgical approaches for cervical spinal dumbbell tumors., Methods: The clinical data of 87 patients with cervical spinal dumbbell tumors undergoing surgical operations from January 2005 to December 2012 at our hospital were analyzed retrospectively. According to the size of inner and outer parts of tumors and the presence or absence of spinal bone damage, the cervical spinal dumbbell tumors were divided into 4 types of intraspinal predominant (I, n = 48), extraspinal predominant (II, n = 1), intrapinal and extraspinal without damage of spinal bone (III, n = 15) and intrapinal and extraspinal type with damage of spinal bone (IV, n = 7). Different surgical approaches were selected on the basis of tumor classification: posterior median-hemilamina approaches for type I tumors, lateral-muscle gap approaches for type II tumors, ateral-muscle gap-hemilamina or lateral-muscle gap-posterior median-hemilamina approaches for type III tumors, posterior far lateral-muscle gap-hemilamina or posterior median-muscle gap-hemilamina approaches plus posterior occipital cervical or cervical spinal bone graft fusion and internal fixation for type IV tumors., Results: Among them, 83 cases underwent total resection and another 4 subtotal resection in one-stage operation. The postoperative follow-up period had a range of 9 months to 6 years (mean, 3.2 years). There was no recurrence of tumors for total resection and 1 case of tumor recurrence for subtotal resection. During the follow-up period, the clinical manifestations of 85 patients improved while another 2 deteriorated. And there was no occurrence of spinal deformity., Conclusion: Clinical classification of cervical spinal dumbbell tumor plays an important guiding role in the selection of surgical approaches. Adopting appropriate surgical approaches based on tumor type can not only improve the rate of total resection of tumor but also reduce the incidence of postoperative spinal deformity.

Purpose: To summarise our experience treating patients with spinal angiolipomas (SAs) and to evaluate factors relating to its prognosis., Methods: We retrospectively reviewed the records of patients diagnosed with SAs who received surgical treatment from January 2001 to February 2013., Results: Twenty-one patients were described. We divide SAs into two types: "intraspinal" and "dumbbell-shaped". The former were further subclassified as "with lipomatosis" and "without lipomatosis". Overweight people are more likely to get the "with lipomatosis" type which needs different surgical strategy and/or a diet therapy to get better outcomes., Conclusion: Diagnosis of SAs should be made with reference to clinical, radiological, and pathological findings. Application of different methods is needed to treat SAs.

Background: Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options. We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimal therapy for patients with spine metastases., Methods: We provide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of the NOMS-guided treatment., Results: The NOMS decision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional external beam radiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for the NOMS decision framework. Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population., Conclusion: NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention.

Introduction: Diffuse infiltrative gliomas, the most common primary brain tumours, account for almost 80% of malignant brain tumours. 60-70% of gliomas are astrocytic and over 80% of these tumours is considered high grade malignancy (grade III and IV) according to current World Health Organization classification. Infiltrating gliomas include diffuse astrocytomas, oligodendrogliomas and oligoastrocytomas., Aim: To review the clinical and histological features of cerebral gliomas, and molecular alterations that add relevant information for novel approaches in diagnosis, prognosis and treatment., Development: The current gold standard diagnosis of these tumours relies on histopathological classification, which provides a grading of malignancy as a predictor of biological behaviour. However emerging molecular abnormalities have been discovered in the last years and these molecular changes are playing an increasingly prominent role as predictive biomarkers or in the development of diagnostic and prognostic. Now the neuropathologist is in crossroads between pathology and molecular biology and he plays a significant role in implementation of treatments and/or clinical trials., Conclusions: The study of proteomics and molecular biomarkers should complement the histopathological analysis and sometimes allows to determine direct or indirect predictive factors as well as the study of affected pathways which may become selective therapeutic targets.

Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency., Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions., Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V(4Gy)) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by ∼20%: an effect independent of prior planning experience., Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning., (Copyright © 2012. Published by Elsevier Inc.)

Background and Objectives: To summarise our experience treating patients with spinal malignant peripheral nerve sheath tumours (MPNSTs)., Methods: We retrospectively reviewed the records of patients diagnosed with spinal MPNSTs who received surgical treatment from January 1998 to December 2009., Results: Postoperative follow-up data were available for 14/16 patients with spinal MPNSTs (7 men, 7 women; median age = 44 years [range: 23-68 years]). Eight of 14 (57.1%) patients had primary and 6/14 (42.9%) recurrent MPNSTs. A total of 12/14 (85.7%) patients underwent total tumour resection, whereas 2/14 (14.3%) patients underwent subtotal tumour resection. Malignancies were graded low in 4 (28.6%) and high in 10 (71.1%) cases. A total of 12/14 (85.7%) patients experienced tumour recurrence and 10/14 (71.4%) patients died during the course of follow-up. The 0.5- 1-, 3-, and 5-year survival rates were 64.3, 48.2, 32.1, and 21.4%, respectively. Overall survival was significantly associated with tumour malignant degree (P = 0.012)., Conclusion: Diagnosis of spinal MPNSTs should be made with reference to clinical, radiological, and pathological findings. Surgical resection is the best available option for treating spinal MPNST; however, postoperative prognosis is poor.

Background: Hemangiopericytomas (HPs) of the central nervous system are rare tumors and afflicted with a high propensity of recurrences and metastases. Histopathologically, HPs correspond to differentiated (WHO grade II) and anaplastic (WHO grade III) tumors. With respect to the available literature and our own experiences, the aggressiveness, especially of differentiated grade II HPs, seems to be underestimated., Methods: Thus, in this retrospective study, we describe tumor behavior and examined the effect of radio- and chemotherapy on tumor control with respect to the WHO classification of grade II and III neoplasms. This study consists of 15 patients with cerebral (n = 10) and spinal (n = 5) HPs., Results: Seven HPs were histopathologically classified as grade II and eight as anaplastic grade III tumors. Complete surgical resection could be achieved in 60% of cerebral and in 25% of spinal HPs. In total, local recurrences occurred in 20% of patients within 17.3 months after the primary operation. Recurrences occurred both from differentiated (n = 1) and anaplastic (n = 2) neoplasms. Treatment comprised re-operation followed by radio- and chemotherapy. Pointing out the importance of the extent of surgical resection, in this study, we could not detect a single patient showing any recurrences or systemic metastases after complete surgical resection of grade II HPs. During primary diagnostics, four patients showed systemic metastases. Although these tumors could be controlled via surgery, systemic metastases appeared in further four patients within 60.4 months. Interestingly, two of them were classified as differentiated tumors (WHO grade II). To control tumor progress, radiotherapy seemed to be partially effective. On the other hand, however, chemotherapy did not show any effect on tumor control. With respect to these results, screening investigations seem to be indispensable and are highly recommended during primary diagnostics and after the appearance of recurrences or metastases, independent of the histopathological staging of the tumor., Conclusion: With respect to our results, radical surgical resection offers the best treatment option to control tumor progress. In case of subtotal resection or histopathologically diagnosed anaplasia (WHO III), radiotherapy seems to be indicated; however, chemotherapy did not show effectiveness to control tumor progress.

Objectives: Spinal canal tumours constitute a minor part of CNS invading neoplasm. However, due to their damaging influence on the spinal cord and the spinal roots, they cause serious clinical problems and can lead to severe disability. The aim of this study is to review material collected on tumours of the spine and the spinal canal at the Department of Neuropathology over the past ten years., Material and Methods: One hundred and eighty five histopathological examinations of spinal tumours were evaluated between August 1997 and August 2007. The group of patients included 94 females and 91 males between the age of 18 and 79 years with a mean age of 53., Results: Apart from typical intraspinal tumours (i.e. astrocytomas and ependymomas), and extraspinal tumours, (i.e. meningiomas, schwannomas, neurofibromas), rare neoplastic and non-neoplastic tumour-like changes occur in the same localizations. These rare conditions include: capillary haemangioma, paraganglioma of filum terminale, meningeal gliomatosis, different variants of cysts such as the dermoid cyst, synovial cyst and aneurysmatic bone cyst, neoplastic and non-neoplastic bone tumours like the giant cell tumour, chordomas, and intramedullary metastatic carcinomas., Conclusions: This paper presents and discusses spinal lesions from collected data with special attention paid to the rare conditions, which are reviewed in more detail.

Object: The authors propose a new surgical classification method for sacral tumors that improves the guidance for specific surgical decisions and approaches., Methods: The authors retrospectively studied the clinical courses of 92 patients with sacral tumors treated at the Changhai Hospital; all patients underwent tumor resection between January 2000 and August 2005. The clinical characteristics, imaging features, and pathological classifications were carefully assessed in each case. The tumors were classified according to the imaging features and intraoperative findings. The surgical approach and the resection area were determined according to the tumor classification., Results: The proposed surgical classification system divided the sacral tumors into 2 major types according to the lesion's anatomical position in the sagittal plane. The tumors were further divided into 4 subtypes according to the length of the tumor's anterior protrusion into the pelvic cavity. Finally, each tumor subtype was classified into 16 areas according to the anatomical position in the cross-sectional plane. This classification method was used to categorize the sacral tumors, all of which were totally resected under the naked eye. Postoperatively symptoms were improved to varying degrees., Conclusions: The appropriate classification of sacral tumors and the selection of a corresponding surgical approach can improve the rate of total resection and the surgical safety, as well as decrease the recurrence rate.

Study Design: A systematic review of Health Related-Quality of Life Outcomes (HRQOL) in metastatic disease of the spine and content validation of a new Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ)., Objective: To identify HRQOL questionnaires previously reported for spinal metastases and to validate the content of the new SOSGOQ based on the International Classification of Function and Disability (ICF)., Summary of Background Data: Literature on metastatic tumors of the spine and clinical outcomes is limited and generally of poor quality. The SOSG has developed a "quality of life" outcome tool specific for patients with metastatic of the spine. The ICF is a universal framework allowing content exploration, comparison, and validation of all questionnaires relating to HRQOL., Methods: A systematic review identified 141 studies. Reported outcome tools were enumerated. The most commonly used (ESAS, Karnofsky Scale, and Oswestry Disability Index) and the SOSGOQ were linked to the ICF. Descriptive statistics examined the frequency and specificity of the ICF linkage. Linkage reliability was evaluated by interinvestigator percentage agreement., Results: The SOSGOQ contains 56 concepts, with all 4 domains of the ICF represented. Four concepts could not be linked. There was 100% interobserver agreement (IOA) for total number of concepts and for those "not covered." Hundred percent of concepts had "First and Second" level linkage. Hundred percent IOA exists at both "Component" and "First Level" linkage. There was 96.1% IOA at "Second Level". Thirty-three concepts linked to Third Level with 96.9% IOA. Ten concepts linked at the Fourth Level with 100% IOA., Conclusion: The SOSGOQ includes all domains relevant for measurement of function and disability and its content validity is confirmed by linkage with the ICF. This new questionnaire has superior content capacity to measure disease burden of patients with metastatic disease of the spine than any instruments previously identified in the literature.

Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours.

Objective: To investigate the surgical treatment for cervical dumbbell tumors., Methods: Clinical manifestation, surgical type and stage, and surgical method of 36 consecutive patients with cervical dumbbell tumor were retrospectively studied., Results: The tumors in 35 patients were completely resected once, and the other one patient underwent subtotal resection. Signs and symptoms of all patients were recovered to different degrees, without significant complications and tumor recurrence., Conclusion: According to the type and stage of dumbbell tumors, we could adopt surgical methods through posterior or posterior combined with anterior approach, together with instruments and fusion, which could completely resect tumors and prevent complications.

Sacral tumors pose significant challenges to the managing physician from diagnostic and therapeutic perspectives. Although these tumors are often diagnosed at an advanced stage, patients may benefit from good clinical outcomes if an aggressive multidisciplinary approach is used. In this review, the epidemiology, clinical presentation, imaging characteristics, treatment options, and published outcomes are discussed. Special attention is given to the specific anatomical constraints that make tumors in this region of the spine more difficult to effectively manage than those in the mobile portions of the spine.

Study Design: Reliability analysis based on expert panel case series review and grading per the Enneking and Weinstein-Boriani-Biagini classification systems., Objective: To assess the reliability of the Enneking and Weinstein-Boriani-Biagini classification systems., Summary of Background Data: The Enneking and Weinstein-Boriani-Biagini (WBB) classifications were developed to stage and facilitate treatment planning in patients with primary spine tumors. To date, their interobserver and intraobserver reliability has not been assessed-a fundamental step in facilitating broader clinical and research use., Methods: Clinical information, imaging studies, and biopsy results were compiled from 15 selected patients with primary spinal tumors. Eighteen spine surgeons independently estimated and scored the cases for Enneking grade, tumor and metastasis categories, Enneking stage, Enneking-recommended surgical margin, WBB zones and layers, and WBB-recommended surgical procedures, with a second assessment performed after random resorting of cases. Interobserver and intraobserver reliability of each category were assessed by percent agreement or proportional overlap. The Fleiss, Cohen, and Mezzich kappa statistics (kappa) were then applied, determined by the type of variable analyzed., Results: The kappa statistics for interobserver reliability were 0.82, 0.22, 0.00, 0.57, 0.47, 0.31, 0.58, and 0.54 for the fields of Enneking grade, tumor and metastasis categories, Enneking stage, Enneking-recommended surgical margin, WBB zones and layers, and WBB-recommended surgical procedures, respectively. The kappa statistics for intraobserver reliability were 0.97, 0.53, 0.47, 0.82, 0.67, 0.63, 0.79, and 0.79 for the same respective fields. According to Landis and Koch, the ranges of kappa values of 0.00 to 0.20, 0.21 to 0.40, 0.41 to 0.60, 0.61 to 0.80, and >0.80 imply slight, fair, moderate, substantial, and near-perfect agreement, respectively., Conclusion: Results indicate moderate interobserver reliability and substantial and near-perfect intraobserver reliability for both the Enneking and WBB classification in terms of staging and guidance for treatment, despite a less than moderate interobserver reliability in interpreting the Enneking local tumor extension and WBB sector. Before incorporating the classifications in the clinical practice and research studies, further work is required to investigate the validity of the classifications.

Introduction: The skeletal system is the third most frequent (after lungs and liver) seat of metastases, and metastatic tumours are the most common type of bone malignancies. The aim of the study was to evaluate the influence of the type of neoplasm and method of treatment on the survival of patients with malignant spinal tumours., Materials and Methods: A retrospective analysis of 452 patients operated on between 2000 and 2004 in the Orthopaedic Surgery Hospital in Piekary Slaskie revealed a group of 203 patients whose histopathologic examination confirmed the presence of neoplastic foci in the spine. Data concerning the type of surgery and tumour location in 139 patients with the most frequent malignant spinal tumors were analyzed. The other information concerning subsequent treatment was analyzed in the Maria Skłodowska-Curie Oncology Centre and Institute in Gliwice. Patient deaths were verified in the Regional Administrative Office in Katowice., Results: The most common types of neoplasms producing spinal metastases (in patients who underwent surgery) were: breast cancer, prostatic adenocarcinoma and kidney cancer. Multiple myeloma was the most frequent diagnosis among primary bone neoplasms. The survival of patients with multiple myeloma was statistically longer than the survival of patients with renal, breast and prostatic cancer metastases. It appears that, in the absence of contraindications, the best treatment for patients with spinal metastases is locally radical surgery combined with radiation therapy (a single teleradiotherapy session of 8 Gy). This treatment resulted in a statistically significant prolongation of life of the patients., Conclusions: The length of survival of patients with malignant spinal metastases is influenced by the type of neoplasm and locally radical surgery combined with palliative radiation therapy.

Object: This study is a retrospective analysis of 60 surgically treated patients with 64 peripheral nerve sheath tumors (PNSTs) at the second cervical (C-2) nerve root. The anatomical subtleties of these tumors and their implications for surgical strategy when compared with other spinal PNSTs and other tumors in the foramen magnum region are reviewed., Methods: Sixty patients with C-2 PNSTs treated surgically in the Department of Neurosurgery at King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College between 1992 and 2006 were studied. All patients underwent magnetic resonance imaging. Tumors were divided into 3 groups depending on their anatomical location identified during surgery. Those tumors located within or extending into the spinal dural tube were called Type A, those located within the dural tube of the C-2 ganglion were labeled as Type B, and tumors extending laterally into the paraspinal region were labeled as Type C. Follow-up durations ranged from 6 months to 15 years (mean 64 months)., Results: There were 38 male and 22 female patients in the study, who ranged in age from 6 to 62 years (mean 28 years). Nine patients had clinical features indicative of neurofibromatosis (NF). The mean duration of symptoms at the time of presentation was 27 months (range 4 days-5 years). Two patients had no specific symptoms related to the C-2 PNST, 6 patients had only local symptoms such as neck pain or stiffness, and 52 patients had symptoms of varying degrees of myelopathy. There were 5 solely Type A tumors, 7 Type A + B tumors, 31 Type B tumors, and 21 Type B + C tumors. All Type A, A + B, and B tumors were totally resected. Seven of 21 Type B + C tumors were partially resected, and the remainder were completely resected. All patients postoperatively reported varying improvement in their preoperative symptoms. Except for patients with NF who were disabled by other tumors, the rest of the patients resumed their normal life style. There have been no cases of symptomatic tumor recurrence., Conclusions: The majority of PNSTs located at the C-2 level in these patients probably arose from the large C-2 ganglion and are limited within the dural confines or are interdural in location. In contrast to other spinal PNSTs, the location of C-2 PNSTs is in most cases posterior to the lateral mass of the atlas and axis and the atlantoaxial joint and is exposed to the posterior without any bone cover. Radical tumor resection is safe, resolution of clinical symptoms is rapid, and recurrence rates are extremely low. In a selected number of cases, bone work for tumor exposure and resection can be entirely avoided.

Primary pediatric spinal column tumors are rare lesions, but they can lead to serious morbidity if left untreated. Progressive pain, deformity, and neurologic decline may result from destructive and compressive insults on neighboring structures. In addition, histologic diagnosis is paramount in determining overall survival and management options. Evolution of spinal instrumentation has allowed safe and effective application of spinal reconstruction to the developing spine. As a result, aggressive surgical decompression, deformity correction, fusion, and gross total tumor resections may improve functional and oncologic outcomes without sacrifice of spinal stability.

The decision to select en bloc resection or intralesional resection needs to be tailored to each individual patient and circumstance. Though complete resection with long-term progression-free survival is the goal, it is not always feasible, nor advisable, depending on what the patient's expectations are and what the risk of complications may be. However, in cases with favorable circumstances and consensus agreement between physicians, surgeons, and patients, aggressive en bloc removal of spinal tumors can be extremely valuable and may offer the only chance at cure for otherwise devastating malignancies.

Spinal lipomas, particularly lipomas of the conus medullaris and terminal filum, are the most common form of occult spinal dysraphism and represent a wide spectrum of disease with regard to anatomy, clinical presentation, and treatment options. These lesions, however, are united by a similar embryology and pathological mechanism by which symptoms arise. Recently, the treatment of these lesions has generated much controversy, with some physicians advocating surgical treatment for all patients regardless of symptoms and others proposing that surgery be withheld until symptoms develop. The authors discuss lumbosacral spinal lipomas, with particular attention to the theories of their origin, anatomical and pathological features, and treatment options, including a review of current controversies.

Background: Neuroblastic tumors cause spinal cord compression when they arise primarily in the spinal canal or invade it through the radicular foramen. Whereas neuroblastomas (NB) are relatively common and are generally treated with chemotherapy, mature neuroblastic tumors (MNT), which include intermixed ganglioneuroblastomas (iGNB) and ganglioneuromas (GN), are less common and the role of surgery is more prominent. Because MNT are rare and have been separated only recently from NB, their clinical and radiological features as well as the role of surgery are poorly defined., Materials and Methods: In order to increase our knowledge on MNT, we reviewed our database for cases operated for spinal cord compression in our department since the introduction of magnetic resonance imaging (MRI). We treated four cases of NB and one case of iGNB presenting primarily with spinal cord compression., Report of Cases: MNT represented 10% of spinal tumors and 1.6% of all tumors of the nervous system in our pediatric neurosurgical practice. The neurological and oncological outcomes were generally favorable after surgical resection, followed by orthotic treatment. In one case with neurofibromatosis type 1, the tumor was inoperable and the child died of tumor progression several years later., Conclusion: GN, and some iGNB, are chemo-insensitive and can only be cured by surgical removal. Surgery is an emergency in case of rapidly progressing paraplegia and can be challenging because the tumor is often hard and hemorrhagic. In case of subtotal removal, tumor remnants can stay stable without oncological treatment.

The authors investigated the postoperative quality of life in 89 patients with metastatic spinal tumors. As the results of our study, it was found that spinal surgery could maintain or improve the quality of life, and then most of patients with poor quality of life had multiple spine/bone metastasis or brain/spinal cord metastasis.

Magnetic resonance imaging (MRI) is the best imaging modality for evaluating most spinal tumors. In this review, we describe the MRI appearance of extradural, intradural-extramedullary, and intradural-intramedullary tumors as well as the image interpretation techniques that permit identification of the compartment in which a lesion is located. In addition, we review the literature and our experience in using an anatomic classification system to narrow the differential diagnosis for patients with spine tumors. This method permits successful identification of a narrow differential diagnosis, which can be used to guide additional evaluation and treatment.

Unlabelled: Nine patients had sacrectomy with ilio-lumbar arthrodesis for treatment of sacral malignancies at our institution between 2000 and 2004. Five patients had total sacrectomy, three had a sagittal hemisacrectomy, and one had an extended internal hemipelvectomy Type I-S. The average patient age was 39 years. Tumors were Stage IIB in seven patients and Stage IB in two patients. A combined anteroposterior approach was used and a wide surgical margin was attained in all seven patients. A new form of reconstruction using structural fibular grafts and pedicle screw-rod instrumentation was used to create a triangular construct along the anatomic force transmission vectors from the femoral heads to the lumbar spine. The average followup was 18 months. At latest followup, seven patients were alive with no evidence of disease, and two had died from disease. One patient suffered postoperative infection. Independent ambulation was noted in seven patients at last followup. Eight patients had stable reconstructions at latest followup (one patient, who died in December 2004, had a stable reconstruction and was walking with braces and a walker before her death). One patient had instrumentation failure twice and had additional revision instrumentation and bone grafting procedures. She eventually obtained a solid lumbopelvic fusion and walks with Canadian crutches and ankle-foot orthoses. The technique of reconstruction reported here offers promise in dealing with the challenges of reestablishing spinopelvic stability in this difficult anatomic location., Level of Evidence: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

The aim of this study was to assess the time to diagnosis in patients with intraspinal tumors and to assess factors contributing to a long delay in some patients. Patients who were admitted at our hospital over a 15-year period (1986-2000) with an intraspinal (either intradural or extradural) tumor were included. Records of patients were studied for variables such as sex, age, diagnosis, date of diagnosis, initial symptoms, symptoms at diagnosis, level of tumor, original diagnosis and diagnostic technique [CT-myelography, CT-caudography or magnetic resonance imaging (MRI)]. The median time to diagnosis of 108 patients with an intraspinal tumor was 12.3 months (range: 4 days-14.4 years). Most common initial symptoms were back and/or neck pain, pain radiating to one extremity and walking disturbances. There was no distinctive clinical pattern between intramedullary and extramedullary tumors regarding initial symptoms. At the time of diagnosis, patients presented with moderate to severe neurological deficits: weakness in one extremity in 26%, sphincter disturbance (20%) and paraparesis (12%). Improved imaging of the spinal cord by MRI did not result in earlier detection of the intraspinal tumor. The time to diagnosis is explained by non-specific and slowly progressing signs and symptoms. A high rate of clinical suspicion should be present to diagnose an intraspinal tumor at an early stage.

Background: The third edition of the International Classification of Diseases for Oncology (ICD-O-3), which was published in 2000, introduced major changes in coding and classification of neoplasms, notably for leukemias and lymphomas, which are important groups of cancer types that occur in childhood. This necessitated a third revision of the 1996 International Classification of Childhood Cancer (ICCC-3)., Methods: The tumor categories for the ICCC-3 were designed to respect several principles: agreement with current international standards, integration of the entities defined by newly developed diagnostic techniques, continuity with previous childhood classifications, and exhaustiveness., Results: The ICCC-3 classifies tumors coded according to the ICD-O-3 into 12 main groups, which are split further into 47 subgroups. These 2 levels of the ICCC-3 allow standardized comparisons of the broad categories of childhood neoplasms in continuity with the previous classifications. The 16 most heterogeneous subgroups are broken down further into 2-11 divisions to allow study of important entities or homogeneous collections of tumors characterized at the cytogenetic or molecular level. Some divisions may be combined across the higher-level categories, such as the B-cell neoplasms within leukemias and lymphomas., Conclusions: The ICCC-3 respects currently existing international standards and was designed for use in international, population-based, epidemiological studies and cancer registries. The use of an international classification system is especially important in the field of pediatric oncology, in which the low frequency of cases requires rigorous procedures to ensure data comparability., (Copyright 2005 American Cancer Society.)

Purpose: To evaluate patient age and sex and location and imaging appearances of primary vertebral osteosarcoma (PVOS) compared with histologic subtypes., Materials and Methods: Retrospective review (1915-2001) of imaging findings in patients with histologically proved primary osteosarcoma of vertebral column was performed. Two radiologists in consensus reviewed findings for location, origin site, matrix pattern, and spinal canal invasion and compared them with histologic subtypes. Radiation-induced, Paget, metastatic, and multifocal osteosarcoma were excluded., Results: Of 4,887 osteosarcoma cases, 198 (4%) were PVOS arising from vertebral column. There were 103 female and 95 male patients (age range, 8-80 years; median age, 34.5 years). Involvement included cervical (27 patients), thoracic (66 patients), lumbar (64 patients), and sacral (41 patients) spine. Adequate imaging findings were available in 69 patients, and involvement of two levels was seen in 12 (17%). In nonsacral spine, most tumors (44 cases) arose from posterior elements, with partial involvement of vertebral body. Lesions confined to vertebral body were less frequent (12 cases). Sacral tumors involved body and sacral ala. The most common histologic subtypes were osteoblastic (47 patients), chondroblastic (12 patients), telangiectatic (four patients), fibroblastic (four patients), small cell (one patient), and epithelioid (one patient). The majority (55 cases) demonstrated osteoid matrix mineralization; 17 showed marked mineralization. Five cases with marked mineralization were confined to vertebral body, with "ivory vertebra" appearance. Purely lytic pattern was seen in 14 (20%) cases. Lytic pattern was seen in four (100%) telangiectatic, three (75%) fibroblastic, three (25%) chondroblastic, three (6%) conventional osteoblastic, and one (100%) small-cell subtypes. Invasion of spinal canal was common (84% of cases). Appearance simulating osteoblastoma without soft-tissue mass was present (seven cases). Pathologic compression fractures were identified (seven patients)., Conclusion: This study provides age and sex distribution and location and imaging features in a large series of PVOS., (Copyright RSNA, 2004)

Hypothesis: An anatomic classification system for paraspinal tumors that identifies complexity of regional anatomy, morbidity in complete or partial resection of anatomic structures, and potential complications may assist surgeons in preoperative planning., Design: Application of a 6-level anatomic classification system for paraspinal tumors by retrospective medical record analysis. The classification system is defined by the following divisions of the vertebral column: I (C3-T3), II (T3-T10), III (T10-L2), IV (L1-L5, anterior to spine), V (L2-L5, lateral to spine), and VI (S1-S5)., Patients: All patients seen by us who underwent paraspinal tumor resection between 1997 and 2002., Setting: Tertiary referral facility., Main Outcome Measures: Level-specific preoperative and surgical procedures and expected and unexpected vascular and neurologic morbidity caused by surgical intervention., Results: Twenty-six patients met the inclusion criteria, and each of the levels (I through VI) of the classification system was represented by at least 2 patients. Expected morbidity that occurred because of surgical intervention included laryngeal paralysis in 1 patient with a level I tumor, femoral nerve palsy in 1 patient with a level V tumor, and neurogenic bladder and rectal dysfunction in 2 patients with level VI tumors. No unexpected neurologic deficit developed in any patient. Unanticipated intestinal ischemia and infarction occurred in 1 patient, who died after undergoing level IV surgery. Follow-up period ranged from 3 months to more than 5 years., Conclusion: Application of this 6-level anatomic classification system based on paraspinal tumor location may allow surgeons to anticipate specific surgical problems and to evaluate risks of resection and potential complications on the basis of regional anatomy.

Study Design: Forty-two patients with cervical dumbbell tumors were analyzed retrospectively using a new three-dimensional classification., Objectives: To establish optimal surgical strategies, we considered shapes and three-dimensional locations of cervical dumbbell tumors based on diagnostic images and intraoperative findings., Summary of Background Data: Eden's classification for dumbbell tumors of the spine, long considered a "gold standard," no longer is sufficient to determine surgical strategy in view of recent advances in computed tomography and magnetic resonance imaging., Methods: Forty-two cervical dumbbell tumors were characterized according to transverse-section images (Toyama classification; nine types) and craniocaudal extent of intervertebral and transverse foraminal involvement (IF and TF staging; three stages each)., Results: Type IIIa tumors, involving dura plus an intervertebral foramen, accounted for 50% of cases. A posterior approach was used in 35 patients; 7 others underwent a combined anterior and posterior approach. A posterior approach was used for all type IIa and IIIa tumors, and for some type IIIb (upper cervical), IV, and VI tumors; a combined posterior and anterior approach was used for type IIb and the remainder of type IV and VI. Reconstruction was performed using spinal instrumentation in 4 patients (9.5%). Resection was subtotal in 6 patients (14.3%) and total in 36 (85.7%)., Conclusions: Systematic, imaging-based three-dimensional characterization of shape and location of cervical dumbbell tumors is essential for planning optimal surgery. The classification used here fulfills this need.

Spinal tumors are classified in intradural and extradural tumors. Most extradural spinal tumors are metastasis. The other spinal tumors are rare and mostly benign. Only about 5% of tumors of the nervous system are spinal tumors. Their symptomatology is often insidious and the diagnosis can be difficult. Magnetic resonance imaging has revolutionized their diagnosis. The lesions within the spinal cord can now be directly visualized. The treatment of these tumors mostly require surgery. It has been proven that surgical results are better if these tumors are operated as soon as neurological symptoms have appeared. In our series of 39 operated intradural tumors we noted a functional improvement in 46.5% of the cases, a stabilisation in 43.5% and a deterioration in 10%.

Treatment of patients with metastatic disease of the spine continues to be a challenging problem. Advances in imaging studies and surgical techniques have improved patient outcomes with operative intervention. However, the lack of a validated set of criteria to determine spinal instability makes patient selection for surgical intervention difficult. Multiple classification systems that assist surgeons in determining appropriate operative candidates have been proposed. We will review current information on the evaluation and treatment of metastatic disease of the spine and discuss classification systems that assist in determining appropriate operative candidates.

Study Design: A case of myopericytoma of the thoracic spine is reported., Objective: To report a recently described and extremely rare soft tissue neoplasm in the previously unreported location of the thoracic spine., Summary of Background Data: Myopericytoma is a recently described soft tissue neoplasm with perivascular myoid differentiation. All cases have been reported in the subcutaneous and superficial soft tissues of the extremities. This represents the first reported case of this unusual lesion in the spine., Methods: A patient with a 3-month history of progressive weakness of the arms and legs was found to have a lytic lesion of T3. The lesion was surgically treated by curettage followed by a course of radiation. Presenting symptoms, imaging studies, histologic findings, and related literature are reviewed in this study., Results: Histologic evaluation of sections of the surgically removed lesion revealed a concentric, periluminal proliferation of cells with prominent positive smooth muscle actin immunoreactivity. These findings are consistent with the diagnosis of a myopericytoma, a lesion not previously reported in the spine., Conclusions: This study shows the presence of a lesion in the thoracic spine only previously described in the soft tissue of the extremities. The diagnosis of myopericytoma should be included, along with hemangiopericytoma, in the differential diagnosis of lytic lesions of the spine.

The results of treatment of 136 patients with primary and metastatic tumors, affecting the vertebra and compressing the spinal cord or its roots were analyzed. The kind and adequacy of access, method of excision of the vertebral column tumor, volume of the tumoral resection, type of used system of the vertebral column stabilization were evaluated. Histological peculiarities of the vertebral column tumors were studied and classified.

Study Design: The authors report on the clinical course of 27 consecutive patients surgically treated for solitary or multiple myeloma of the spine., Objectives: To evaluate the complications, neurologic function, life quality, and survival after decompression of the spinal cord and stabilization of the spinal column in cases of conventionally untreatable pain, neurologic impairment, or spinal instability., Summary of Background Data: The clinical outcome in patients surgically treated for multiple myeloma of the spine has not been intensively studied. Because patients with myeloma often live longer than patients with bone metastases from other malignancies, it is important that these patients be examined and treated with methods specific to their needs and not only with those typically used for patients with metastatic disease., Methods: The 27 patients had undergone the following surgical procedures: two dorsal decompressions, seven dorsal decompressions and stabilizations, 15 ventral decompressions and stabilizations, and three ventral and dorsal decompressions and stabilizations. Quality of life was measured by the Karnofsky Index, neurologic impairment according to Frankel, and survival by the Kaplan-Meier method., Results: Life quality improved from 48% before surgery to 59% 1 month after surgery and 73% in 24 survivors after the first year. Comparison of their presurgical scores with the scores obtained 1 month after surgery revealed that 18 patients had improved, five patients stayed the same, and four patients declined. After 1 year the scores of all 24 surviving patients had improved from their presurgical levels. In the 21 patients with unimpaired preoperative neurologic function, one patient developed a paraparesis as a complication of surgery, while 20 remained unimpaired until death or 1 year after treatment. All six patients with neurologic deficits improved, two of them to normal function. Pain relief was evident in 26 cases. The mean length of postoperative survival was 49.7 months. Local tumor recurrence occurred in three of 27 patients (11.1%)., Conclusion: The surgical treatment of myeloma of the spine seems to be an effective method of treatment with respect to neurologic function and life quality in selected cases.

Metastases to the spine are a common and somber manifestation of systemic neoplasia. The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. Historically, surgery for spinal metastases has consisted of simple decompressive laminectomy. Results obtained in retrospective case series, however, have shown that this treatment provides little benefit to the patient. With the advent of better patient-related selection practices, in conjunction with new surgical techniques and improved postoperative care, the ability of surgical therapy to play an important and beneficial role in the multidisciplinary care of cancer patients with spinal disease has improved significantly. Controversy remains, however, with respect to the relative merits of surgery, radiotherapy, chemotherapy, or a combination of these treatments. In this topic review, the literature on spinal column and spinal cord metastases is collated to provide a description of the presentation, investigations, indications for surgical therapy, and the role of adjuvant cancer therapies for patients with spinal metastases. In addition, the authors discuss the different surgical strategies available in the armamentarium of the neurosurgeon treating patients with spinal metastasis.

Brain tumours should be considered when patients present with headache with diurnal variation, seizures, or progressive neurological symptoms. Spinal cord compression by tumour is a medical emergency. Prognosis for patients with glioma is better in those with tumours of low grade, and in patients younger than 50 years and with higher functional levels. Surgery, radiotherapy and chemotherapy can improve survival for patients. Anticancer therapies can have neurotoxic side effects.