Search Results (58)

Background/Objectives: Although the Spinal Instability Neoplastic Score (SINS) is widely used to estimate spinal metastases fracture risk and guide decisions on stabilisation procedures, prior studies have demonstrated mixed results. Patients with the same score exhibit clinically heterogeneous outcomes, with some SINS criteria correlating less well with the estimated fracture risk than others. There are also barriers to implementation such as the time burden required for manual calculation and interobserver variability associated with qualitative morphological criteria. SINS also lacks sensitivity for detecting latent structural compromise in treatment-naive patients and those susceptible to the iatrogenic effects of stereotactic body radiation therapy. This review aims to evaluate emerging imaging, biomechanical, and microstructural markers with the potential to improve fracture risk stratification and prognostication for spinal oncology patients. Methods: We synthesise evidence across three innovative frontiers: (1) biomechanical modelling, including CT-derived finite element analysis and failure-load pattern models; (2) radiomics, utilizing radiomics features from radiological imaging to develop a predictive model; and (3) microstructural MRI biomarkers, exploring the translatability of the Vertebral Bone Quality score, fat fraction, and paraspinal muscle atrophy from osteoporosis to the metastatic spine. Results: Emerging biomechanical, radiomic and microstructural imaging markers show potential in addressing some limitations of traditional SINS criteria for fracture risk stratification across the spinal oncology treatment continuum, from initial diagnosis to post-radiation surveillance, thereby facilitating more precise risk assessment. However, current evidence remains largely retrospective and heterogeneous, and further validation is required before clinical adoption. Conclusions: We propose a framework that shifts the paradigm from conventional morphological scoring toward a multiparametric assessment of spinal stability. Full article

Background/Objectives: Stereotactic body radiation therapy (SBRT) provides improved pain response and local control for spinal metastases. However, management of local failure after initial SBRT is challenging. We report institutional outcomes, dosimetry, and toxicity for reSBRT following SBRT. Methods: We retrospectively reviewed 61 lesions (55 patients) treated with reSBRT after prior SBRT. Both SBRT courses delivered a median dose of 27 Gy. Patients underwent clinical and radiological evaluation every three months. Toxicity was graded using CTCAE v5.0. Dosimetric parameters for the spinal cord (SC), cauda equina (CE), planning organ-at-risk volumes (PRV), and thecal sac were converted to equivalent dose in 2 Gy fractions (EQD₂) using the linear–quadratic model (α/β = 2). Results: Median follow-up was 10.3 months. Forty lesions (65%) were cervicothoracic and 21 (35%) were lumbosacral. One- and two-year overall survival (OS) were 45% and 29%, respectively, and one- and two-year local control (LC) were 89% and 88%, respectively. Gastrointestinal primary tumors were associated with inferior LC (HR 2.41, 95% CI 1.11–5.23, p = 0.026). Fifteen patients (27%) reported myelitis/neuropathic symptoms during follow-up; four (7%) developed new post-radiation myelitis or neuropathy (RMN) without radiologic progression. Five patients (9%) developed vertebral compression fractures (VCF). Cumulative EQD₂ was not significantly associated with RMN (p = 0.344); all affected patients had thecal sac EQD₂ > 95.5 Gy and relevant nerve roots EQD₂ > 108 Gy. Conclusions: ReSBRT provided a favorable LC with acceptable toxicity. High cumulative dose to the thecal sac and nerve roots may contribute to neurologic toxicity as peripheral nerve injury. Full article

Background: Hidden blood loss (HBL) following surgery for spinal metastases constitutes a major portion of total blood loss (TBL), yet its predictors and impact on early recovery remain unclear. This study aimed to identify independent predictors of HBL in patients with Tomita type 1–5 lesions and to assess its association with early clinical outcomes. Methods: In this retrospective study of 230 patients undergoing posterior tumor resection with cement augmentation and fixation, HBL was calculated using the Gross equation. Predictors were identified via univariate and multivariate linear regression. The impact of HBL on postoperative length of stay, change in Karnofsky Performance Status (ΔKPS), moderate-to-severe anemia, and complications was evaluated using adjusted regression models. Additionally, receiver operating characteristic curve analysis was performed to explore the predictive value of HBL for adverse events. Results: Mean HBL was 449.87 ± 284.86 mL (37.1% of total loss). Independent predictors included higher body mass index (BMI), longer surgery, extensive vertebral involvement (Tomita 4–5), and preoperative hypertension (all p < 0.05). Higher HBL independently predicted longer hospital stay (β = 0.023, p < 0.001), worse ΔKPS (β = −0.012, p < 0.001), increased anemia risk (OR = 1.002, p < 0.001), and more complications (OR = 1.003, p < 0.001). Receiver operating characteristic curve analysis suggested that a HBL >382.5 mL was associated with an increased risk of complications requiring intervention, and a HBL >344.0 mL was associated with an increased risk of postoperative moderate-to-severe anemia. Conclusions: HBL is influenced by both patient-related and surgery-related factors. Greater HBL negatively affects early recovery by prolonging hospitalization, impeding functional recovery, and increasing complication risks. The findings provide a preliminary basis for integrating HBL monitoring into Enhanced Recovery After Surgery (ERAS) pathways. Proactive perioperative blood management is recommended for high-risk patients to improve prognosis. Full article

Early and reliable identification of vertebral metastases on computed tomography remains a major challenge in oncologic imaging due to the morphological complexity of metastatic lesions and the high inter-patient variability of spinal anatomy. In this study, an end-to-end interpretable radiomic-based framework was developed to automatically distinguish healthy from metastatic vertebrae using segmented DICOM data, coupled with an interactive virtual reality (VR) visualization module implemented in Unity 3D. The proposed framework integrates radiomic feature extraction and selection, informed undersampling to address class imbalance, and automatic machine learning-based classification. To facilitate interpretation, patient-specific 3D models with overlapped classifier outputs were integrated into a VR desktop application, enabling advanced exploration of patient-specific spinal models, with color-coded visualization of algorithmic predictions and expert-defined suspicious lesions. The final classification model, trained using a Random Forest algorithm and optimized via stratified 5-fold cross-validation, achieved an overall accuracy of 0.86, an Area Under the Receiver Operating Characteristic Curve of 0.91, and an F1-score of 0.81 for the metastatic class on the independent test set, achieving competitive diagnostic performance while preserving transparency and clinical interpretability. This study represents a foundational step toward intelligent, interactive, and clinically interpretable tools for the diagnosis and follow-up of spinal metastatic disease. Full article

Experimental characterisation of ex vivo specimens is limited by specimen availability and high costs, whereas 3D printing provides a cost-effective alternative for producing multiple replicas. This study aimed to develop a methodology for evaluating the individual and combined effects of material composition and geometry on the biomechanical performance of 3D-printed vertebrae. CT scans of healthy human vertebrae and with lytic metastases were segmented to fabricate synthetic models through Digital Anatomy Printing. Three types of 3D-printed models were produced: Healthy vertebrae, Metastatic vertebrae, and Healed vertebrae (metastatic geometry filled with healthy material). All models were tested under axial compression to measure the strength, stiffness, and strain. Repeatability across replicas was assessed as well as comparison of mechanical properties among the different vertebral types. Results showed excellent repeatability, with coefficients of variation below 5% for strength and stiffness-related parameters. The Metastatic models exhibited significant reductions in strength compared to Healthy ones, while stiffness remained similar, consistent with ex vivo data trends. Healed models highlighted the role of material composition in driving mechanical behaviour, independently of geometry. This work provides the first quantitative assessment of 3D-printed vertebrae with metastatic lesions, supporting their future potential as standardised alternatives to cadaveric testing. Full article

A butterfly vertebra is an uncommon but clinically and radiologically significant pathology. The etiological factor of this pathology is a congenital defect in the formation of the vertebral body during embryogenesis, resulting in a cleft within the vertebral body that, in an X-ray, resembles the shape of a butterfly. Butterfly vertebrae are most often found in the thoracic and lumbar spine and more rarely in the sacral region. The clinical manifestations of this condition do not differ from the symptoms of other diseases, and it may also be asymptomatic. Only the recognition of its characteristic radiologic signs allows for accurate and timely diagnosis, as well as differentiation from other pathological processes such as fractures, metastases, and inflammation. In these cases, magnetic resonance imaging is the first-choice method. An important aspect in recognizing this pathology is its correlation with other congenital syndromes, even in cases of a single vertebral defect. We present 2 cases with an isolated S1 butterfly vertebra. The first is a 47-year-old male who presented to the hospital with complaints of chronic pain in the lower back and sacral region, more pronounced on the right side. The second is of a 39-year-old male who also presented to the hospital with chronic pain. All diagnostic modalities for this pathology have been used to demonstrate high-quality pictures, including X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Full article

Objectives: This study aimed to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for spinal metastases, focusing on pain control, local tumor control, and the incidence of vertebral compression fractures (VCF). Materials and Methods: We retrospectively analyzed 179 patients with 217 spinal metastatic lesions who underwent SBRT between July 2020 and April 2022. The prescribed doses for SBRT were 18 or 20 Gy for one fraction, ≥24 Gy for three fractions, ≥20 Gy for four fractions, and ≥25 Gy for five fractions. Patient-reported treatment response was evaluated 1–3 months after SBRT completion. Local recurrence was defined as failure within the radiotherapy field. Pain response, local progression-free survival (LPFS), and the incidence of painful VCF were assessed. Prognostic factors for LPFS and VCF risk factors were evaluated. Results: The overall pain response rate was 80.8%. LPFS rates were 90.6% at 1 year and 83.0% at 2 years. Lytic/mixed lesions and involvement of multiple segments were significant prognostic factors for reduced LPFS. The cumulative incidence of painful VCF was 8.7% at 1 year and 12.8% at 2 years. A biologically effective dose (BED₃) ≥104 Gy was the only significant risk factor for painful VCF. Conclusions: SBRT demonstrated high efficacy for pain and local tumor control in spinal metastases, with an acceptable VCF risk. Full article

With continued improvements in systemic cancer therapies, there has been an increase in the survivorship of patients with spinal metastases. However, many patients with spinal metastases are frail and may not be able to tolerate the morbidity of open surgery. For these patients, percutaneous ablation techniques offer a minimally invasive approach that can facilitate local tumor control and pain relief. Here we describe the currently employed modalities—radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, and laser interstitial thermal therapy (LITT)—summarize the clinical support for their use, and overview the relative risks and benefits for each. All these technologies offer to help improve local tumor control and improve oncologic pain associated with vertebral metastases, and they have become a staple of multidisciplinary spine metastasis care at many centers. As clinical experience with these technologies continues to grow, their use will likely become more widely adopted, and so understanding of their indications, risks, and benefits will become increasingly important to the practicing spine oncologist. Full article

Background/Objectives: Vertebroplasty (VP) and kyphoplasty (KP) are widely performed minimally invasive procedures for osteoporotic vertebral compression fractures and vertebral metastases. Although generally safe, postoperative surgical site infections (SSIs) can lead to severe complications. The true incidence of SSIs and optimal prophylactic antibiotic strategies remains unclear. This study evaluated SSI incidence and the impact of antibiotic timing and type using a nationwide quality assessment (QA) database in South Korea. Methods: We analyzed data from the 7th to 9th QA waves of the Health Insurance Review and Assessment (HIRA) Service, including 23,868 patients who underwent VP or KP. SSI incidence was compared across antibiotic timing groups (preoperative-only, postoperative-only, and combined) and antibiotic types. Multivariate logistic regression identified independent risk factors for SSIs. Results: SSI occurred in 47 patients (0.20% of 23,868 procedures). No infections were observed in the preoperative-only group, compared with 0.36% in the postoperative-only group and 0.19% in the pre- and postoperative group. The lowest incidence (0.16%) was seen with first- or second-generation cephalosporins. Multivariate analysis found no significant difference between the preoperative-only and the combined regimens, nor between first-/second-generation cephalosporins and broad-spectrum antibiotics. However, surgery at a tertiary hospital (aOR: 3.566) and malnutrition (aOR: 2.915) were independently associated with increased SSI risk. Conclusions: This nationwide study, the largest to date on VP and KP, demonstrated that SSIs are rare (0.2%). A single preoperative dose of first- or second-generation cephalosporins was as effective as combined or broader-spectrum regimens. Targeted preventive measures may be warranted for high-risk groups such as patients with malnutrition or those treated in tertiary hospitals. Full article

Objectives: Spinal diseases are commonly encountered health problems with a wide spectrum. In addition to degenerative changes, other common spinal pathologies include metastases and compression fractures. Benign tumors like hemangiomas and infections such as spondylodiscitis are also frequently observed. Although magnetic resonance imaging (MRI) is considered the gold standard in diagnostic imaging, the morphological similarities of lesions can pose significant challenges in differential diagnoses. In recent years, the use of artificial intelligence applications in medical imaging has become increasingly widespread. In this study, we aim to detect and classify vertebral body lesions using the YOLO-v8 (You Only Look Once, version 8) deep learning architecture. Materials and Methods: This study included MRI data from 235 patients with vertebral body lesions. The dataset comprised sagittal T1- and T2-weighted sequences. The diagnostic categories consisted of acute compression fractures, metastases, hemangiomas, atypical hemangiomas, and spondylodiscitis. For automated detection and classification of vertebral lesions, the YOLOv8 deep learning model was employed. Following image standardization and data augmentation, a total of 4179 images were generated. The dataset was randomly split into training (80%) and validation (20%) subsets. Additionally, an independent test set was constructed using MRI images from 54 patients who were not included in the training or validation phases to evaluate the model’s performance. Results: In the test, the YOLOv8 model achieved classification accuracies of 0.84 and 0.85 for T1- and T2-weighted MRI sequences, respectively. Among the diagnostic categories, spondylodiscitis had the highest accuracy in the T1 dataset (0.94), while acute compression fractures were most accurately detected in the T2 dataset (0.93). Hemangiomas exhibited the lowest classification accuracy in both modalities (0.73). The F1 scores were calculated as 0.83 for T1-weighted and 0.82 for T2-weighted sequences at optimal confidence thresholds. The model’s mean average precision (mAP) 0.5 values were 0.82 for T1 and 0.86 for T2 datasets, indicating high precision in lesion detection. Conclusions: The YOLO-v8 deep learning model we used demonstrates effective performance in distinguishing vertebral body metastases from different groups of benign pathologies. Full article

Background/Objectives: The image guidance of choice for the combination therapy of radiofrequency ablation (RFA) and vertebral augmentation (VA) in the context of vertebral disease from spinal metastases are fluoroscopy and computer tomography (CT). Here, we aimed to assess the roles of both imaging modalities and if adoption of either would influence clinical outcomes of pain, physical function, and quality of life (QoL). RFA has been favored as a minimally invasive option for managing painful spinal metastases, and it is often coupled with VA to treat underlying osseous structural instability. This combination therapy of RFA with VA, which could be performed under CT or fluoroscopy, has in recent years been recognized as highly successful for pain control and functional restoration of metastatic spine lesions. Methods: Our scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The databases accessed were Medline and Embase, and the time frame of the search was set from database inception to 2 January 2025. The inclusion eligibility included primary research studies utilizing clearly defined imaging modalities of interest with measurable clinical end points of pain, quality of life (QoL), analgesic use, or complications. Results: Twenty-two articles were identified after screening fifty-eight papers using the databases. Fluoroscopy alone was the more frequently adopted imaging modality (n = 17/22, 77.3%). Almost all of the papers, regardless of the imaging modality used, consistently demonstrated reduction in pain, improvement in QoL, as well as a decrease in analgesia use. Complications were present but had minimal clinical implications, aside from a single article which appeared to demonstrate significantly higher cement leak rates with a singular case of resultant paraplegia. Conclusions: Fluoroscopy- and CT-guided RFA with VA have both proven to be efficacious in reducing patient discomfort and improving functionality while keeping risks of permanent neurological injuries to a minimum. Full article

Introduction: Metastatic spinal cord compression (MSCC) is a life-threatening complication caused by the involvement of the spinal cord or nerve roots. It can result in severe neurological deficits, including paralysis, sensory loss, and bladder or bowel dysfunction, significantly affecting patients’ quality of life. Prompt diagnosis and intervention are critical to minimizing these outcomes and improving neurological recovery. This study evaluates the efficacy of a diagnostic and therapeutic protocol introduced at our institution in 2022, designed to enhance early detection, optimize management, and improve outcomes for patients with MSCC. Materials and Methods: The protocol was developed through a multidisciplinary collaboration involving emergency physicians, oncologists, spine surgeons, neuroradiologists, and radiation oncologists. Each specialty contributed its expertise to create a streamlined approach emphasizing early symptom recognition, rapid diagnostic imaging, and timely therapeutic interventions, such as surgical decompression and radiotherapy. To assess the protocol’s effectiveness, a retrospective analysis was conducted. Clinical data from the pre-implementation period (years 2019–2021) were compared to the post-implementation period (2022–2024). Results: The implementation of the algorithm significantly improved MSCC management, increasing outpatient consultations from 671 to 828 (+23%). Comparing the pre- to post-implementation periods, emergency consultations rose from 14% to 23%, while intrahospital consultations decreased from 20% to 16%. Surgical procedures increased slightly, from 60 to 66 (+10%), including 26 emergency surgeries (+4%) and 40 elective delayed surgeries (+14%). Conclusions: The introduction of a multidisciplinary diagnostic and therapeutic protocol significantly improved outpatient management of patients with metastatic spine disease, demonstrated by a significant increase in urgent outpatient consultations and a reduction in intrahospital consultations. The number of surgical interventions for metastatic spinal cord compression slightly increased after the protocol’s adoption, although the proportion of elective surgeries remained unchanged. Neurological presentation at the time of surgery did not show a statistically significant difference between the pre- and post-implementation periods. These findings highlight the protocol’s effectiveness in optimizing patient flow and triaging, while further research is needed to evaluate its long-term clinical impact. Full article

Background and Objectives: Vertebral metastases often lead to pathological fractures and spinal cord compression, thus impacting patient quality of life. This study aimed to quantify the poroelastic mechanical properties of vertebral metastatic tissue explanted during spine surgery and correlate it with clinical data. Methods: Nine patients (61.7 ± 13.1 years) were prospectively recruited from April 2021 to February 2022, where 78% had a vertebral fracture. Demographic and metastases data, including primary origin, spinal level, lesion volume, and SINS score, were collected, and tissue specimens were explanted during surgery. Using a newly developed portable experimental setup, confined compression creep tests were conducted to measure the aggregate modulus and permeability of each sample. Dealing with limited samples, the results were expressed as the median (min; max). Results: Specimens from the unfractured vertebrae had higher aggregate modulus (200.35 (149.80; 250.90) kPa vs. 14.47 (8.27; 35.89) kPa) and higher permeability (0.02 (0.01; 0.03) mm⁴/N·s vs. 0.41 (0.10; 4.68) mm⁴/N·s) compared with the specimens from the fractured vertebrae. Histology revealed prominent levels of neoplastic cell infiltration and disruption of typical bone matrix architecture. Specimens with low neoplastic cellularity had comparable or slightly higher poroelastic properties compared to high cellularity. No clear trend was observed between the mechanical properties and SINS score, nor between the mechanical properties, percentage lesion volume, and fractures. Conclusions: Despite the limited sample size, the poroelastic characterization revealed relevant insights to investigate in future research. A transdisciplinary assessment of vertebral metastases, incorporating poroelastic testing, deserves further attention and could enhance the treatment options. Full article

Background: Patients with vertebral metastases often experience spinal instability, chronic pain, and psychological distress, all of which can significantly reduce quality of life. Spinal instability, measured by the Spinal Instability Neoplastic Score (SINS), may exacerbate functional impairment and emotional distress, underscoring the potential benefit of personalized recovery interventions. Material and methods: This prospective, observational study investigated the impact of personalized recovery interventions on spinal instability, psychological distress, and quality of life in oncological patients with vertebral metastases. Results: The experimental group received tailored rehabilitation strategies, while the control group underwent standard oncological care. Spinal instability was assessed using the Spinal Instability Neoplastic Score (SINS), psychological distress was measured with the Hopelessness Depression Symptom Questionnaire (HDSQ), and quality of life was evaluated using the European Quality of Life-5 Dimensions (EQ-5D). The experimental group demonstrated significantly lower mean SINS scores, indicating reduced spinal instability, and lower HDSQ scores, suggesting decreased psychological distress. They also exhibited improvements in mobility, self-care, usual activities, and anxiety/depression dimensions of the EQ-5D. Furthermore, the experimental group had longer survival times, lower fracture rates, and reduced prevalence of osteoporosis, anemia, and vomiting. These findings underscore the potential benefits of integrating physical and psychological rehabilitation into routine oncological management. Conclusions: Personalized recovery interventions appear to enhance functional independence, emotional well-being, and overall quality of life in patients with vertebral metastases. Future research should focus on longitudinal, multicenter, randomized controlled trials to confirm these findings and further elucidate the complex interplay between spinal instability, psychological distress, and functional recovery. Full article

Background: Spinal metastases affect approximately 40% of patients with systemic cancers; metastatic epidural spinal cord compression (MESCC) occurs in up to 20% of cases and leads to potential significant morbidity. Recent advancements in high-dose conformal radiation techniques, such as Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiosurgery (SRS), enable histology-independent ablative treatments, yet optimal dose fractionation remains undetermined. Methods and Results: This case of vertebral metastases with high-grade ESCC exemplifies the model of a comprehensive treatment workflow that emphasizes interdisciplinary collaboration, within the framework of a personalized medicine. The “Hybrid Therapy” combines Separation Surgery, aimed at achieving circumferential spinal cord decompression, with SBRT/SRS. The oncologic resection has been performed in a navigation-assisted technique that is tailored to the SBRT target, pre-operatively defined on the neuronavigation station. Conclusions: This seamless integration during initial planning of surgery with the ideal radio-oncological target is aimed at avoiding delays in referral and limitations in subsequent treatment options. This integrative holistic strategy not only prioritizes functional preservation, minimizing surgical invasiveness, but also promotes tumor control, thus offering potential promising new avenues for patient-centered oncologic care. Future high-quality studies are warranted to validate the widespread potential utility and safety of this approach. Full article