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Spine Tumors

Spine Tumors. Waleed Awwad, MD, FRCSC. History. Red Flags:. History. Red Flags: History of cancer Unexplained weight loss >10 kg within 6 months Age over 50 years or under 17 years old Failure to improve with therapy Pain persists for more than 4 to 6 weeks

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Spine Tumors

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  1. Spine Tumors Waleed Awwad, MD, FRCSC

  2. History Red Flags:

  3. History Red Flags: History of cancer Unexplained weight loss >10 kg within 6 months Age over 50 years or under 17 years old Failure to improve with therapy Pain persists for more than 4 to 6 weeks Night pain or pain at rest Fever

  4. Physical exam Full Spine exam General exam if unknown primary. What are the primary tumor that most likely to metastasize to spine?

  5. Investigation Local. Systemic. Blood and Urine. Tissue diagnosis.

  6. Investigation • Enneking classification • Tomita classification

  7. Investigation • Weinstein BorianiBiagini (WBB) Staging system • The more extensive the less likely a surgical cure • Most useful staging system for spine • Easy to remember • Centred on what's important

  8. Investigation • Sign of instability: 1.Loss of Hight. 2.Focal angular deformity. 3.Kostuik Stability Classification • 6 columns (2 anterior,2 middle and 2 posterior) • Unstable if 3 or more columns involved.

  9. Spine Tumors Primary benign. Primary malignant. Metastatic lesion. What is the mode of spread?

  10. Spine Tumors Primary benign.

  11. Spine Tumors Primary benign. Aneurysmal Bone Cyst Giant Cell Tumor Hemangioma Osteoblastoma OsteoidOsteoma

  12. Spine Tumors Primary malignant

  13. Spine Tumors Primary malignant Chondrosarcoma Chordoma Ewing’s Sarcoma Multiple Myeloma Osteosarcoma

  14. Spine Tumor Body Neural element

  15. Spine Tumor Body Neural element ABC Osteoidosteoma Osteoblastoma Osteochondroma • MM. • Chordoma • GCT • Hemangioma • EG • Osteosarcoma

  16. What is this sign?

  17. What is the diagnosis? What is this radiologic feature called?

  18. What is your diagnosis?

  19. What this radiologic feature called? What is your DDx?

  20. What is this radiologic feature? What is your DDx? MELT. What is the most cause?

  21. What is this radiologic sign?

  22. What is your diagnosis?

  23. Treatment of spinal tumors Non-Surgical Treatment Surgical Treatment

  24. Treatment of spinal tumors Pre-operative evaluation? Solitary or multiple Diagnosis (tissue) if solitary or unknown. Life expectancy. Medical fitness. Patent wishes.

  25. Treatment of spinal tumors • What are the indication to operate for spine tumor? A. For disease cure or control. B. Other causes are: • Intractable pain • Neurologic changes (unless long-standing) • Instability – impending fracture • Need of open biopsy

  26. Treatment of spinal tumors Pre-operative embolization. Radiosensitive tumors. Chemo sensitive tumors. Hormone sensitive. Chemo and radio resisitant.

  27. Post operative? What is your management?

  28. Cases • 41 Y/O M • Immigrant from China • No significant PMHx • 4 yr Hx of LBP • 2 yr Hx of LBP with Rt Leg pain • Neuro exam was N 4 yrs ago • Numbness X 1.5 yrs • Mild weaknes in EHL X .5 yrs

  29. What is your Diagnosis? How Would you manage this patient?

  30. Bone and Gallium Test hot bone scan, neg gallium, not infection. Biopsy, fibrous tissue with occ giant cells. Serology for parasites (echinococcus) neg. Patient now disabled by pain and cannot work.

  31. Surgery: percutaneous, transpedicular, with currettes, cement, L3&4 followed by L5 wRt L5 decomp 2 weeks later

  32. 2nd Case

  33. 45 yo Male • 6 mo History of LBP with radiation left leg • 2 mo Hx of paraesthesias • 1 mo mild Lt Quad weakness requiring a cane • Past History of enbloc resection of Lt buttock Liposarcoma 3 years earlier

  34. Bone Scan

  35. X-Ray

  36. MRI

  37. Other Tests • CBC, ESR, CRP all Normal • CT chest Normal • Whole body MRI normal except for L3 • Needle Biopsy L3, Liposarcoma same as in hip (myxomatous)

  38. What Would You Do?

  39. Two Stage En Bloc Resection • Stage 1 Posterior • Stage 2 Anterior

  40. Surgical Plan, Stage 1-Posterior

  41. Surgical Plan, Stage 1-Posterior

  42. Surgical Plan, Stage 1-Posterior Head Screws

  43. Surgical Plan, Stage 1-Posterior

  44. Posterior Surgery: • Laminectomy L2,3,4 • Facetectomy L2-3-4 • Pedicle instrumentation L2-4 • Transverse process resection L3 bilat.

  45. Surgical Plan, Stage 2 - Anterior

  46. Surgical Plan, Stage 2 - Anterior

  47. Surgical Plan, Stage 2 - Anterior Anterior Epidural Liposarcoma Vertebral Body L3

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