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Spinal Tumors: Viewpoint—Surgery

  • Chapter
Principles and Practice of Stereotactic Radiosurgery

Abstract

The majority of spine tumors encountered by clinicians are metastatic, accounting for approximately 70 % of all spine tumors. Currently a number of treatment modalities are available for treating spinal tumors, including medical therapy, chemotherapy, surgery, radiation therapy, and radiosurgery. This chapter will describe the current role of surgery in the treatment of spinal tumors and the specific factors that make surgery the preferred treatment in a given situation. As with any type of surgery, patient’s age, performance status, life expectancy, and comorbidities must be taken into account when considering operative management for metastatic spine disease. The goals of surgery are neural decompression, making a diagnosis, pain control, stabilization of spine, and/or cure/locoregional tumor control. The surgical approach depends on location of the tumor, patient’s health status and symptoms, and could be anterior, posterior, lateral, or a combination of these. Cement augmentation is also a good option in many cases. Careful patient selection is the key factor for maximizing the potential benefits and avoiding the associated risks of any treatment modality, be it surgery or radiotherapy.

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References

  1. Posner JB. Back pain and epidural spinal cord compression. Med Clin North Am. 1987;71(2):185–205.

    CAS  PubMed  Google Scholar 

  2. Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15(4):365–73.

    Article  PubMed  Google Scholar 

  3. Wu AS, Fourney DR. Evolution of treatment for metastatic spine disease. Neurosurg Clin N Am. 2004;15(4):401–11.

    Article  PubMed  Google Scholar 

  4. Jaffe W. Tumors and tumorous conditions of the bones and joints. Philadelphia: Lea and Febiger; 1958. p. 589–618.

    Google Scholar 

  5. Cobb 3rd CA, Leavens ME, Eckles N. Indications for nonoperative treatment of spinal cord compression due to breast cancer. J Neurosurg. 1977;47(5):653–8.

    Article  PubMed  Google Scholar 

  6. Wong DA, Fornasier VL, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine. 1990;15(1):1–4.

    Article  CAS  PubMed  Google Scholar 

  7. Bohm P, Huber J. The surgical treatment of bony metastases of the spine and limbs. J Bone Joint Surg Br. 2002;84(4):521–9.

    Article  CAS  PubMed  Google Scholar 

  8. Jacobs WB, Perrin RG. Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus. 2001;11(6):e10.

    Article  CAS  PubMed  Google Scholar 

  9. Bailar 3rd JC, Gornik HL. Cancer undefeated. N Engl J Med. 1997;336(22):1569–74.

    Article  PubMed  Google Scholar 

  10. Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam Jr JB, et al. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg. 1998;89(4):599–609.

    Article  CAS  PubMed  Google Scholar 

  11. Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A. Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery. 1991;29(5):645–50.

    Article  CAS  PubMed  Google Scholar 

  12. Sundaresan N, Steinberger AA, Moore F, Sachdev VP, Krol G, Hough L, et al. Indications and results of combined anterior-posterior approaches for spine tumor surgery. J Neurosurg. 1996;85(3):438–46.

    Article  CAS  PubMed  Google Scholar 

  13. Vrionis FD, Small J. Surgical management of metastatic spinal neoplasms. Neurosurg Focus. 2003;15(5):E12.

    Article  PubMed  Google Scholar 

  14. Fourney DR, Abi-Said D, Lang FF, McCutcheon IE, Gokaslan ZL. Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures. J Neurosurg. 2001;94(1 Suppl):25–37.

    CAS  PubMed  Google Scholar 

  15. Sundaresan N, Rothman A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine. 2002;27(16):1802–6.

    Article  PubMed  Google Scholar 

  16. Sorensen S, Borgesen SE, Rohde K, Rasmusson B, Bach F, Boge-Rasmussen T, et al. Metastatic epidural spinal cord compression. Results of treatment and survival. Cancer. 1990;65(7):1502–8.

    Article  CAS  PubMed  Google Scholar 

  17. Wai EK, Finkelstein JA, Tangente RP, Holden L, Chow E, Ford M, et al. Quality of life in surgical treatment of metastatic spine disease. Spine. 2003;28(5):508–12.

    PubMed  Google Scholar 

  18. Perrin RG, Livingston KE, Aarabi B. Intradural extramedullary spinal metastasis. A report of 10 cases. J Neurosurg. 1982;56(6):835–7.

    Article  CAS  PubMed  Google Scholar 

  19. Posner JB, Howieson J, Cvitkovic E. "Disappearing" spinal cord compression: oncolytic effect of glucocorticoids (and other chemotherapeutic agents) on epidural metastases. Ann Neurol. 1977;2(5):409–13.

    Article  CAS  PubMed  Google Scholar 

  20. Byrne TN. Spinal cord compression from epidural metastases. N Engl J Med. 1992;327(9):614–9.

    Article  CAS  PubMed  Google Scholar 

  21. Grant R, Papadopoulos SM, Greenberg HS. Metastatic epidural spinal cord compression. Neurol Clin. 1991;9(4):825–41.

    CAS  PubMed  Google Scholar 

  22. Nottebaert M, von Hochstetter AR, Exner GU, Schreiber A. Metastatic carcinoma of the spine. A study of 92 cases. Int Orthop. 1987;11(4):345–8.

    Article  CAS  PubMed  Google Scholar 

  23. Livingston KE, Perrin RG. The neurosurgical management of spinal metastases causing cord and cauda equina compression. J Neurosurg. 1978;49(6):839–43.

    Article  CAS  PubMed  Google Scholar 

  24. Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40–51.

    Article  CAS  PubMed  Google Scholar 

  25. O’Rourke T, George CB, Redmond 3rd J, Davidson H, Cornett P, Fill WL, et al. Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease. J Clin Oncol. 1986;4(4):576–83.

    PubMed  Google Scholar 

  26. Ruff RL, Lanska DJ. Epidural metastases in prospectively evaluated veterans with cancer and back pain. Cancer. 1989;63(11):2234–41.

    Article  CAS  PubMed  Google Scholar 

  27. Ippolito V, Micheletti E, Saccalani M, Barbera F, Tonoli S, Motta C. Radiotherapy and spinal brace: still first-choice treatment for vertebral metastases from breast cancer. Chir Organi Mov. 1998;83(1–2):177–83.

    CAS  PubMed  Google Scholar 

  28. Katagiri H, Takahashi M, Inagaki J, Kobayashi H, Sugiura H, Yamamura S, et al. Clinical results of nonsurgical treatment for spinal metastases. Int J Radiat Oncol Biol Phys. 1998;42(5):1127–32.

    Article  CAS  PubMed  Google Scholar 

  29. Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg. 1983;59(1):111–8.

    Article  CAS  PubMed  Google Scholar 

  30. Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53(6):741–8.

    Article  CAS  PubMed  Google Scholar 

  31. Weinstein SM, Walton O. Management of pain associated with spinal tumor. Neurosurg Clin N Am. 2004;15(4):511–27.

    Article  PubMed  Google Scholar 

  32. Fourney DR, Abi-Said D, Rhines LD, Walsh GL, Lang FF, McCutcheon IE, et al. Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. J Neurosurg. 2001;94(2 Suppl):232–44.

    CAS  PubMed  Google Scholar 

  33. Patchell RTP, Regine W, Payne R, Saris S, Kryscio R, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366:643–8.

    Article  PubMed  Google Scholar 

  34. Klimo Jr P, Thompson CJ, Kestle JR, Schmidt MH. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol. 2005;7(1):64–76.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Yao KC, Boriani S, Gokaslan ZL, Sundaresan N. En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus. 2003;15(5):E6.

    Article  PubMed  Google Scholar 

  36. Ryken TC, Eichholz KM, Gerszten PC, Welch WC, Gokaslan ZL, Resnick DK. Evidence-based review of the surgical management of vertebral column metastatic disease. Neurosurg Focus. 2003;15(5):E11.

    Article  PubMed  Google Scholar 

  37. Harrington KD. Metastatic disease of the spine. J Bone Joint Surg Am. 1986;68(7):1110–5.

    CAS  PubMed  Google Scholar 

  38. Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S. Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine. 1990;15(11):1110–3.

    Article  CAS  PubMed  Google Scholar 

  39. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine. 2001;26(3):298–306.

    Article  CAS  PubMed  Google Scholar 

  40. Fourney DR, Gokaslan ZL. Use of “MAPs” for determining the optimal surgical approach to metastatic disease of the thoracolumbar spine: anterior, posterior, or combined. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2005;2(1):40–9.

    Article  PubMed  Google Scholar 

  41. Fourney DR, Gokaslan ZL. Anterior approaches for thoracolumbar metastatic spine tumors. Neurosurg Clin N Am. 2004;15(4):443–51.

    Article  PubMed  Google Scholar 

  42. Patchell R RW, Payne R, Saris S, Kryscio R, et al. A randomized clinical trial of direct decompressive surgical resection in the treatment of spinal cord compression caused by metastasis [abstract]. Presented at the Annual ASCO Meeting, Chicago,. May/June. 2003.

    Google Scholar 

  43. Regine WFYA, Payne R, Saris S, Kryscio RJ, et al. Metastatic spinal cord compression: a randomized trial of direct decompressive surgical resection plus radiotherapy vs radiotherapy alone. Int J Radiat Oncol Biol Phys. 2003;57(2 Suppl):S125.

    Article  Google Scholar 

  44. Panjabi MM, Thibodeau LL, Crisco 3rd JJ, White 3rd AA. What constitutes spinal instability? Clin Neurosurg. 1988;34:313–39.

    CAS  PubMed  Google Scholar 

  45. Kostuik JP, Errico TJ, Gleason TF, Errico CC. Spinal stabilization of vertebral column tumors. Spine. 1988;13(3):250–6.

    Article  CAS  PubMed  Google Scholar 

  46. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8(8):817–31.

    Article  CAS  PubMed  Google Scholar 

  47. Emery SE, Hughes SS, Junglas WA, Herrington SJ, Pathria MN. The fate of anterior vertebral bone grafts in patients irradiated for neoplasm. Clin Orthop Relat Res. 1994;300:207–12.

    PubMed  Google Scholar 

  48. Steinmetz MP, Mekhail A, Benzel EC. Management of metastatic tumors of the spine: strategies and operative indications. Neurosurg Focus. 2001;11(6):e2.

    Article  CAS  PubMed  Google Scholar 

  49. Errico TJ, Cooper PR. A new method of thoracic and lumbar body replacement for spinal tumors: technical note. Neurosurgery. 1993;32(4):678–80; discussion 80–1.

    Article  CAS  PubMed  Google Scholar 

  50. Murray JA, Bruels MC, Lindberg RD. Irradiation of polymethylmethacrylate. In vitro gamma radiation effect. J Bone Joint Surg Am. 1974;56(2):311–2.

    CAS  PubMed  Google Scholar 

  51. Liu JK, Apfelbaum RI, Chiles 3rd BW, Schmidt MH. Cervical spinal metastasis: anterior reconstruction and stabilization techniques after tumor resection. Neurosurg Focus. 2003;15(5):E2.

    PubMed  Google Scholar 

  52. Singletary SE, Walsh G, Vauthey JN, Curley S, Sawaya R, Weber KL, et al. A role for curative surgery in the treatment of selected patients with metastatic breast cancer. Oncologist. 2003;8(3):241–51.

    Article  PubMed  Google Scholar 

  53. Hortobagyi GN. Can we cure limited metastatic breast cancer? J Clin Oncol. 2002;20(3):620–3.

    PubMed  Google Scholar 

  54. Boriani S, Biagini R, De Iure F, Bertoni F, Malaguti MC, Di Fiore M, et al. En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients. Spine. 1996;21(16):1927–31.

    Article  CAS  PubMed  Google Scholar 

  55. Gilbert HA, Kagan AR, Nussbaum H, Rao AR, Satzman J, Chan P, et al. Evaluation of radiation therapy for bone metastases: pain relief and quality of life. AJR Am J Roentgenol. 1977;129(6):1095–6.

    Article  CAS  PubMed  Google Scholar 

  56. Hosono N, Yonenobu K, Fuji T, Ebara S, Yamashita K, Ono K. Vertebral body replacement with a ceramic prosthesis for metastatic spinal tumors. Spine. 1995;20(22):2454–62.

    Article  CAS  PubMed  Google Scholar 

  57. Cortet B, Cotten A, Boutry N, Dewatre F, Flipo RM, Duquesnoy B, et al. Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma. Rev Rhum Engl Ed. 1997;64(3):177–83.

    CAS  PubMed  Google Scholar 

  58. Deramond H, Depriester C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am. 1998;36(3):533–46.

    Article  CAS  PubMed  Google Scholar 

  59. Kaemmerlen P, Thiesse P, Bouvard H, Biron P, Mornex F, Jonas P. [Percutaneous vertebroplasty in the treatment of metastases. Technic and results]. J Radiol. 1989;70(10):557–62. Vertebroplastie percutanee dans le traitement des metastases. Technique et resultats.

    CAS  PubMed  Google Scholar 

  60. Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003;98(1 Suppl):21–30.

    PubMed  Google Scholar 

  61. Ghelman B, Lospinuso MF, Levine DB, O’Leary PF, Burke SW. Percutaneous computed-tomography-guided biopsy of the thoracic and lumbar spine. Spine. 1991;16(7):736–9.

    Article  CAS  PubMed  Google Scholar 

  62. Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine. 2001;26(7):818–24.

    Article  CAS  PubMed  Google Scholar 

  63. Kim RY, Smith JW, Spencer SA, Meredith RF, Salter MM. Malignant epidural spinal cord compression associated with a paravertebral mass: its radiotherapeutic outcome on radiosensitivity. Int J Radiat Oncol Biol Phys. 1993;27(5):1079–83.

    Article  CAS  PubMed  Google Scholar 

  64. Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine. 1997;22(9):1036–44.

    Article  CAS  PubMed  Google Scholar 

  65. Black P. Spinal metastasis: current status and recommended guidelines for management. Neurosurgery. 1979;5(6):726–46.

    Article  CAS  PubMed  Google Scholar 

  66. Olerud C, Jonsson B. Surgical palliation of symptomatic spinal metastases. Acta Orthop Scand. 1996;67(5):513–22.

    Article  CAS  PubMed  Google Scholar 

  67. Klimo Jr P, Schmidt MH. Surgical management of spinal metastases. Oncologist. 2004;9(2):188–96.

    Article  PubMed  Google Scholar 

  68. Harrington KD. Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. Clin Orthop Relat Res. 1988;233:177–97.

    PubMed  Google Scholar 

  69. Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine. 2000;25(17):2240–9; discussion 250.

    Article  CAS  PubMed  Google Scholar 

  70. Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine. 1999;24(18):1943–51.

    Article  CAS  PubMed  Google Scholar 

  71. Klimo Jr P, Kestle JR, Schmidt MH. Treatment of metastatic spinal epidural disease: a review of the literature. Neurosurg Focus. 2003;15(5):E1.

    Article  PubMed  Google Scholar 

  72. Liu JK, Apfelbaum RI, Schmidt MH. Surgical management of cervical spinal metastasis: anterior reconstruction and stabilization techniques. Neurosurg Clin N Am. 2004;15(4):413–24.

    Article  PubMed  Google Scholar 

  73. Le H, Balabhadra R, Park J, Kim D. Surgical treatment of tumors involving the cervicothoracic junction. Neurosurg Focus. 2003;15(5):E3.

    Article  PubMed  Google Scholar 

  74. Kraus DH, Huo J, Burt M. Surgical access to tumors of the cervicothoracic junction. Head Neck. 1995;17(2):131–6.

    Article  CAS  PubMed  Google Scholar 

  75. Cahill DW, Kumar R. Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach. J Neurosurg. 1999;90(1 Suppl):42–7.

    CAS  PubMed  Google Scholar 

  76. Schmidt MH, Larson SJ, Maiman DJ. The lateral extracavitary approach to the thoracic and lumbar spine. Neurosurg Clin N Am. 2004;15(4):437–41.

    Article  PubMed  Google Scholar 

  77. Thongtrangan I, Balabhadra RS, Le H, Park J, Kim DH. Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection. Neurosurg Focus. 2003;15(5):E8.

    Article  PubMed  Google Scholar 

  78. Pilitsis JG, Rengachary SS. The role of vertebroplaty inmetastatic spinal disease. Neurosurg Focus. 2001;11(6):e9.

    Article  CAS  PubMed  Google Scholar 

  79. Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology. 1996;200(2):525–30.

    Article  CAS  PubMed  Google Scholar 

  80. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine. 2001;26(14):1547–54.

    Article  CAS  PubMed  Google Scholar 

  81. Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine. 1999;24(17):1772–6.

    Article  CAS  PubMed  Google Scholar 

  82. Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996;199(1):241–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Emory University, 80, Jesse Hill Dr SE, Atlanta, GA, 30303, USA

    Faiz U. Ahmad M.D., M.Ch.

  2. Department of Neurosurgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA, 90033, USA

    Gabriel Zada M.D.

  3. Department of Neurosurgery, Miller School of Medicine, University of Miami, 1095 NW 14Tr, Lois Pope Center, 2nd floor, Miami, FL, 33136, USA

    Michael Y. Wang M.D., F.A.C.S.

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  1. Faiz U. Ahmad M.D., M.Ch.
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  2. Gabriel Zada M.D.
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  3. Michael Y. Wang M.D., F.A.C.S.
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Correspondence to Michael Y. Wang M.D., F.A.C.S. .

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Editors and Affiliations

  1. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, USA

    Lawrence S. Chin

  2. Dept. of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, Maryland, USA

    William F. Regine

Appendices

Case 45.1

A 54-year-old female developed 1 week of progressive lower extremity weakness and attendant bowel and bladder dysfunction. She was wheelchair-bound at the time of presentation, and a CT scan showed a pathologic fracture at T7 (Fig. 45.1a). Her past medical history was significant for invasive ductal carcinoma treated 10 years prior and in remission. An MRI demonstrated this to be consistent with a metastatic lesion with a soft tissue component compressing upon the spinal cord (Fig. 45.1b), and SPECT studies showed no evidence of other lesions (Fig. 45.1c). The patient underwent an urgent T7 corpectomy via a transthoracic approach. The vertebral body was replaced by a PEEK vertebrectomy spacer packed with rib autograft and supplemental plating was utilized (Fig. 45.1d, e). She went on to have a complete neurologic recovery, ambulating without assistance 5 days after surgery.

Fig. 45.1
figure 1

(a–e) Plain CT scan showing a pathologic fracture at T7 (a). MRI thoracic spine T2WI revealed the cord compression (b), and SPECT studies showed no evidence of other lesions (c). The patient underwent an urgent T7 corpectomy via a transthoracic approach. The vertebral body was replaced by a PEEK vertebrectomy spacer packed with rib autograft and supplemental plating was utilized. Postoperative plain X-ray lateral (d) and AP view (e) showing the instrumentation

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Case 45.2

A 54-year-old male with prostate cancer presented with worsening upper back pain, progressive inability to walk, and signs of myelopathy for 10 days prior to presentation to the emergency room. He was found to have multiple spinal lesions but only the lesion at T3 was causing spinal cord compression. MRI demonstrated diffusely abnormal signal intensity in T3 body with extension to right pedicle and lamina and epidural enhancement with spinal cord compression (Fig. 45.2a–c). There was no signal change in the spinal cord itself. CT scan demonstrated multiple lytic and blastic lesions in the thoracic spine with loss of height of T3 body and epidural breakthrough of soft tissue mass into the spinal canal (Fig. 45.2d). He underwent T3 vertebrectomy with reconstruction of anterior spinal column with a carbon fiber cage, along with supplemental posterior fusion from T2–T6 without complications (Fig. 45.2e). Postoperatively his motor strength returned to normal and he was discharged home after a brief stay at the rehab center. He subsequently underwent spinal radiation and hormonal therapy and was doing well 1 year after the surgery.

Fig. 45.2
figure 2

(a–e) MRI demonstrating a diffusely abnormal signal intensity in T3 body with extension to right pedicle and lamina and epidural enhancement with spinal cord compression on axial (a) and sagittal (b–d) images. There was no signal change in the spinal cord itself. CT scan demonstrated multiple lytic and blastic lesions in the thoracic spine with loss of height of T3 body and epidural breakthrough of soft tissue mass into the spinal canal (e). The patient underwent T3 vertebrectomy with reconstruction of anterior spinal column with a carbon fiber cage, along with supplemental posterior fusion from T2–T6, as shown on postoperative AP X-ray (f)

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Ahmad, F.U., Zada, G., Wang, M.Y. (2015). Spinal Tumors: Viewpoint—Surgery. In: Chin, L., Regine, W. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8363-2_45

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