spine tumors
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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Spine TumorsWaleed Awwad, MD, FRCSC
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HistoryRed Flags:
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HistoryRed 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
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Physical examFull Spine examGeneral exam if unknown primary.What are the primary tumor that most
likely to metastasize to spine?
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InvestigationLocal.Systemic.Blood and Urine.Tissue diagnosis.
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Investigation
.Enneking classification
.Tomita classification
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Investigation Weinstein Boriani
Biagini (WBB) Staging system
The more extensive the less likely a surgical cure
Most useful staging system for spineEasy to
rememberCentred on
what's important
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InvestigationSign of instability:
1.Loss of Hight.
2.Focal angular deformity.
3. Kostuik Stability Classification6 columns (2 anterior,2 middle and 2
posterior)Unstable if 3 or more columns involved.
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Spine TumorsPrimary benign.Primary malignant.Metastatic lesion.
What is the mode of spread?
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Spine TumorsPrimary benign.
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Spine TumorsPrimary benign. Aneurysmal Bone Cyst
Giant Cell Tumor
Hemangioma
Osteoblastoma
Osteoid Osteoma
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Spine TumorsPrimary malignant
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Spine TumorsPrimary malignant
Chondrosarcoma
Chordoma
Ewing’s Sarcoma
Multiple Myeloma
Osteosarcoma
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Spine TumorBody Neural element
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MM.ChordomaGCTHemangiomaEGOsteosarcoma
Spine TumorBody Neural element
ABCOsteoid osteomaOsteoblastomaOsteochondroma
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What is this sign?
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What is the diagnosis?
What is this radiologic feature called?
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What is your diagnosis?
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What this radiologic feature called?What is your
DDx?
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What is this radiologic feature?What is your DDx?
MELT.What is the most
cause?
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What is this radiologic sign?
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What is your diagnosis?
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Treatment of spinal tumorsNon-Surgical Treatment
Surgical Treatment
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Treatment of spinal tumorsPre-operative evaluation?
Solitary or multiple
Diagnosis (tissue) if solitary or unknown.
Life expectancy.
Medical fitness.
Patent wishes.
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Treatment of spinal tumorsWhat are the indication to operate for
spine tumor? A. For disease cure or control.
B. Other causes are:Intractable painNeurologic changes (unless long-standing)Instability – impending fractureNeed of open biopsy
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Treatment of spinal tumorsPre-operative embolization.Radiosensitive tumors.Chemo sensitive tumors.Hormone sensitive.Chemo and radio resisitant.
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Post operative?
What is your management?
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Cases41 Y/O MImmigrant from ChinaNo significant PMHx4 yr Hx of LBP2 yr Hx of LBP with Rt Leg painNeuro exam was N 4 yrs ago
Numbness X 1.5 yrsMild weaknes in EHL X .5 yrs
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What is your Diagnosis?How Would you manage this patient?
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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.
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Surgery: percutaneous, transpedicular, with currettes, cement, L3&4 followed by L5 w Rt L5 decomp 2 weeks later
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2nd Case
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45 yo Male6 mo History of LBP with radiation left
leg2 mo Hx of paraesthesias1 mo mild Lt Quad weakness requiring
a cane
Past History of enbloc resection of Lt buttock Liposarcoma 3 years earlier
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Bone Scan
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X-Ray
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MRI
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Other TestsCBC, ESR, CRP all NormalCT chest NormalWhole body MRI normal except for L3Needle Biopsy L3, Liposarcoma same
as in hip (myxomatous)
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What Would You Do?
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Two Stage En Bloc ResectionStage 1 Posterior
Stage 2 Anterior
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Surgical Plan, Stage 1-Posterior
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Surgical Plan, Stage 1-Posterior
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Surgical Plan, Stage 1-Posterior
Head
Screws
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Surgical Plan, Stage 1-Posterior
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Posterior Surgery:Laminectomy L2,3,4Facetectomy L2-3-4Pedicle instrumentation L2-4Transverse process resection L3 bilat.
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Surgical Plan, Stage 2 - Anterior
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Surgical Plan, Stage 2 - Anterior
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Surgical Plan, Stage 2 - Anterior
Vertebral Body L3
AnteriorEpiduralLiposarcoma
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Intra-operative Imaging
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Post-operative Imaging
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Thank you