Publications by authors named "Justin E Bird"

25 Publications

  • Page 1 of 1

Surgical drainage after limb salvage surgery and endoprosthetic reconstruction: is 30 mL/day critical?

J Orthop Surg Res 2021 Feb 15;16(1):137. Epub 2021 Feb 15.

Department of Orthopedic Oncology, MD Anderson Cancer Center, Houston, TX, USA.

Background: Periprosthetic infection is a major cause of failure after segmental endoprosthetic reconstruction. The purpose of this study is to determine whether certain aspects of drain output affect infection risk, particularly the 30 mL/day criterion for removal.

Methods: Two hundred and ninety-five patients underwent segmental bone resection and lower limb endoprosthetic reconstruction at one institution. Data on surgical drain management and occurrence of infection were obtained from a retrospective review of patients' charts and radiographs. Univariate and multivariate Cox regression analyses were performed to identify factors associated with infection.

Results: Thirty-one of 295 patients (10.5%) developed infection at a median time of 13 months (range 1-108 months). Staphylococcus aureus was the most common organism and was responsible for the majority of cases developing within 1 year of surgery. Mean output at the time of drain removal was 72 mL/day. Ten of 88 patients (11.3%) with ≤ 30 mL/day drainage and 21 of 207 patients (10.1%) with > 30 mL/day drainage developed infection (p = 0.84). In multivariate analysis, independent predictive factors for infection included sarcoma diagnosis (HR 4.13, 95% CI 1.4-12.2, p = 0.01) and preoperative chemotherapy (HR 3.29, 95% CI 1.1-9.6, p = 0.03).

Conclusion: Waiting until drain output is < 30 mL/day before drain removal is not associated with decreased risk of infection for segmental endoprostheses of the lower limb after tumor resection. Sarcoma diagnosis and preoperative chemotherapy were independent predictors of infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13018-021-02276-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883436PMC
February 2021

Free Vascularized Fibula Flap Reconstruction of Total and Near-total Destabilizing Resections of the Sacrum.

Ann Plast Surg 2020 Oct 1. Epub 2020 Oct 1.

Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.

Background: Vascularized bone grafts (VBGs) are associated with improved union and fewer instrumentation complications in the mobile spine. It is not known if VBGs are similarly efficacious after sacrectomy.

Methods: We conducted a retrospective chart review of all patients who underwent total sacrectomy and immediate reconstruction with VBG between 2005 and 2019. Patient and surgical characteristics in addition to union and functional outcomes were analyzed.

Results: We identified 10 patients (6 women and 4 men) with a mean age of 42 years (range, 12-71 years). All patients received iliolumbar instrumentation as well as a free fibula flap as a VBG. There were no complications at the fibula flap donor site or specifically related to the VBG. Bony union was achieved in 7 (88%) of 8 patients with an average union time of 6.3 months (range, 2-10 months). Surgical complications occurred in 5 patients, 4 patients required reoperation for wound dehiscence, and 1 patient required conversion to a 4-rod construct and bone grafting for instrumentation loosening and partial nonunion. Instrumentation failure developed in 1 patient, but no surgical intervention was required. One patient was able to walk independently without any limitation, 5 patients required a walker, 2 were wheelchair-bound except for short (<15 ft) distances, and 2 were lost to follow-up.

Conclusions: The free vascularized fibula flap is a safe and effective option for supplementing spinal reconstruction after destabilizing sacrectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0000000000002562DOI Listing
October 2020

Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience.

Ann Surg 2020 08;272(2):e106-e111

Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Objective: To summarize the multi-specialty strategy and initial guidelines of a Case Review Committee in triaging oncologic surgery procedures in a large Comprehensive Cancer Center and to outline current steps moving forward after the initial wave.

Summary Of Background Data: The impetus for strategic rescheduling of operations is multifactorial and includes our societal responsibility to minimize COVID-19 exposure risk and propagation among patients, the healthcare workforce, and our community at large. Strategic rescheduling is also driven by the need to preserve limited resources. As many states have already or are considering to re-open and relax stay-at-home orders, there remains a continued need for careful surgical scheduling because we must face the reality that we will need to co-exist with COVID-19 for months, if not years.

Methods: The quality officers, chairs, and leadership of the 9 surgical departments in our Division of Surgery provide specialty-specific approaches to appropriately triage patients.

Results: We present the strategic approach for surgical rescheduling during and immediately after the COVID-19 first wave for the 9 departments in the Division of Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas.

Conclusions: Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLA.0000000000004092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373457PMC
August 2020

Computer-Aided Design and Computer-Aided Manufacturing for Pelvic Tumor Resection and Free Fibula Flap Reconstruction.

Plast Reconstr Surg 2020 04;145(4):889e-890e

Division of Plastic Surgery, Department of General Surgery, Baylor College of Medicine, Houston, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0000000000006689DOI Listing
April 2020

Extraskeletal Myxoid Chondrosarcomas: Combined Modality Therapy With Both Radiation and Surgery Improves Local Control.

Am J Clin Oncol 2019 10;42(10):744-748

Departments of Radiation Oncology.

Objective: We evaluated our experience treating patients with localized extraskeletal myxoid chondrosarcomas (EMCs) to evaluate outcomes and relapse rates in order to better inform treatment decisions for these rare soft tissue sarcomas.

Materials And Methods: We reviewed the records of 41 consecutive patients with localized EMC treated at our institution from 1990 to 2016. Most patients (n=33, 80%) received combined modality therapy with surgery and radiation therapy, whereas only 8 (20%) underwent surgery alone. The Kaplan-Meier method was used to estimate rates of overall survival, disease-specific survival, local control (LC), and distant metastatic-free survival (DMFS).

Results: Median follow-up time was 94 months (range, 8 to 316). The 10-year LC, DMFS, disease-specific survival, and overall survival rates were 90%, 69%, 85%, and 66%, respectively. There were 5 patients (12%) with local relapse at a median time of 75 months (range, 13 to 176). On univariate analysis, the only significant factor associated with poorer LC was the use of surgery alone (10 y LC, 63% vs. 100% for combined modality therapy, P=0.004), which remained the only factor also significant on the multivariable analysis (P=0.02; hazard ratio [HR], 12.7; 95% confidence interval [CI], 1.4-115.3). In total, 13 patients (32%) developed distant metastatic at a median time of 28 months (range, 3 to 154). Interestingly, local recurrence was the only factor associated with poorer DMFS on multivariate analysis (P=0.04; HR, 3.9; 95% CI, 1.1-14.7).

Conclusions: For patients with EMC, surgery alone was associated with a higher risk of local recurrence. Therefore, we recommend optimal local therapeutic strategies upfront with both surgery and radiation therapy to reduce the risk of local and ultimately distant recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/COC.0000000000000590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771031PMC
October 2019

Surgical Management of Enneking Stage 3 Aggressive Vertebral Hemangiomas With Neurological Deficit by One-stage Posterior Total En Bloc Spondylectomy: A Review of 23 Cases.

Spine (Phila Pa 1976) 2020 Jan;45(2):E67-E75

Department of Orthopedics, Chinese PLA General Hospital, Beijing, PR China.

Study Design: Clinical case series.

Objective: The aim of this study was to describe the treatment of aggressive vertebral hemangiomas (VHs) with neurological deficit treated with total en bloc spondylectomy (TES) in a single institute.

Summary Of Background Data: Despite increasing utilization of surgery to treat aggressive VHs, owing to the rarity, the diagnosis and treatment protocols of aggressive VHs are still questionable and disputable.

Methods: All patients with Enneking stage 3 aggressive thoracic or lumbar VHs with neurological deficit and treated with TES from January 2005 to January 2013 were included. Clinical characteristics and surgery outcomes of patients, including Tomita classification, operation time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) impairment scale, visual analogue score (VAS), and Spinal Instability Neoplastic Score (SINS), were retrospectively reviewed.

Results: A total of 23 VHs patients were enrolled in this study, including 17 in the thoracic spine and six in the lumbar spine. All patients suffered neurological deficits caused by direct spinal cord compression with or without associated mechanical instability. The average SINS score was 9.78 ± 1.51. The mean operation time of patients with preoperative embolization was 426.6 ± 104.3 minutes and the mean blood loss was 1883.3 ± 932.1 mL. There were no technical difficulties or serious complications. After surgery, all patients recovered to ASIA-E levels. The VAS pain score decreased from 8.0 ± 0.9 to 2.8 ± 0.8 (P < .05).

Conclusion: TES is a good treatment option for patients with aggressive VHs with bony destruction and neurological deficit.

Level Of Evidence: 4.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BRS.0000000000003192DOI Listing
January 2020

The future of free vascularized fibular grafts in oncologic spinal and pelvic reconstruction.

J Spine Surg 2019 Jun;5(2):291-295

Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jss.2019.04.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626738PMC
June 2019

Postoperative Radiotherapy for Multiple Myeloma of Long Bones: Should the Entire Rod Be Treated?

Clin Lymphoma Myeloma Leuk 2019 08 2;19(8):e465-e469. Epub 2019 May 2.

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address:

Purpose: To characterize local relapse after surgical fixation and postoperative radiotherapy (RT) for multiple myeloma (MM) with cortical involvement of long bones.

Patients And Methods: We retrospectively identified patients with MM involving cortical long bones treated with surgical fixation followed by postoperative RT at our institution. Local failures, defined as radiographic recurrence along the surgical hardware, were documented, and potential associations of independent variables (RT dose, fractionation, and extent of hardware coverage) with local failure were assessed by univariate Cox regression.

Results: We identified 33 patients with 40 treated sites with a median follow-up of 25.7 months; 68% of treatments were for pathologic fracture, and 32% were for impending fracture. The most common dose and fractionation were 20 to 25 Gy in 8 to 12 fractions. On average, 76% of the surgical hardware was covered by the postoperative RT field (median, 80%; range, 28%-100%). Local failure was observed in 5 cases (12.5%), 2 within the RT field and 3 out of field. None of the relapses resulted in hardware failure, and 2 were retreated with RT. The extent of hardware coverage predicted disease relapse along the hardware (hazard ratio = 6.44; 95% confidence interval, 1.09-37.97; P = .04); however, total RT dose, biologically effective dose, and number of fractions did not.

Conclusion: After internal fixation of long bones with MM, full hardware coverage with the RT field could reduce the risk, though small, of disease developing in the future in the proximate hardware. Postoperative RT doses of 20 to 25 Gy in 8 to 10 fractions can achieve excellent local control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clml.2019.04.015DOI Listing
August 2019

Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases: A Randomized Phase 2 Trial.

JAMA Oncol 2019 Jun;5(6):872-878

Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston.

Importance: Consensus is lacking as to the optimal radiotherapy dose and fractionation schedule for treating bone metastases.

Objective: To assess the relative efficacy of high-dose, single-fraction stereotactic body radiotherapy (SBRT) vs standard multifraction radiotherapy (MFRT) for alleviation of pain in patients with mostly nonspine bone metastases.

Design, Setting, And Participants: This prospective, randomized, single-institution phase 2 noninferiority trial conducted at a tertiary cancer care center enrolled 160 patients with radiologically confirmed painful bone metastases from September 19, 2014, through June 19, 2018. Patients were randomly assigned in a 1:1 ratio to receive either single-fraction SBRT (12 Gy for ≥4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in 10 fractions.

Main Outcomes And Measures: The primary end point was pain response, defined by international consensus criteria as a combination of pain score and analgesic use (daily morphine-equivalent dose). Pain failure (ie, lack of response) was defined as worsening pain score (≥2 points on a 0-to-10 scale), an increase in morphine-equivalent opioid dose of 50% or more, reirradiation, or pathologic fracture. We hypothesized that SBRT was noninferior to MFRT.

Results: In this phase 2 noninferiority trial of 96 men and 64 women (mean [SD] age, 62.4 [10.4] years), 81 patients received SBRT and 79 received MFRT. Among evaluable patients who received treatment per protocol, the single-fraction group had more pain responders than the MFRT group (complete response + partial response) at 2 weeks (34 of 55 [62%] vs 19 of 52 [36%]) (P = .01), 3 months (31 of 43 [72%] vs 17 of 35 [49%]) (P = .03), and 9 months (17 of 22 [77%] vs 12 of 26 [46%]) (P = .03). No differences were found in treatment-related toxic effects or quality-of-life scores after SBRT vs MFRT; local control rates at 1 and 2 years were higher in patients receiving single-fraction SBRT.

Conclusions And Relevance: Delivering high-dose, single-fraction SBRT seems to be an effective treatment option for patients with painful bone metastases. Among evaluable patients, SBRT had higher rates of pain response (complete response + partial response) than did MFRT and thus should be considered for patients expected to have relatively long survival.

Trial Registration: ClinicalTrials.gov identifier: NCT02163226.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaoncol.2019.0192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487911PMC
June 2019

The Accuracy and Clinical Utility of Intraoperative Frozen Section Analysis in Open Biopsy of Bone.

J Am Acad Orthop Surg 2019 Jun;27(11):410-417

From the Department of Orthopaedic Oncology, MedStar Georgetown Cancer Institute, Washington, DC (Dr. Wallace), and the Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX (Dr. Lin, Dr. Bird, Dr. Moon, Dr. Satcher, and Dr. Lewis).

Background: Open biopsy of bone is the diagnostic benchmark for the diagnosis of skeletal lesions. Intraoperative pathology consultation with frozen section analysis is commonly performed to confirm adequacy of lesional tissue and guide intraoperative decision making. The purpose of this study was to determine the accuracy and clinical utility of intraoperative frozen section during open bone biopsy.

Methods: A retrospective review of 485 open biopsies of osseous lesions from 474 patients between 1997 and 2014 was performed. Pathology reports, operative notes, and prebiopsy imaging were assessed to determine the accuracy rates of frozen section analysis compared with final pathology. Pearson chi-squared and Fisher exact tests were performed to compare the accuracy and clinical utility rates based on soft-tissue extension, previous biopsy, lesional consistency, disease, and location.

Results: Overall diagnostic yield of open bone biopsy was 95.3%. Frozen section analysis was accurate in 54.2%, equivocal positive in 21.2%, equivocal negative in 21.0%, and incorrect in 3.5% of cases. Previous nondiagnostic biopsy and the type of disease were found to have statistically significant effects on the accuracy of frozen section analysis.

Conclusion: Frozen section analysis was diagnostic in approximately one half of open biopsy cases. Additional information in equivocal positive results suggests that frozen section analysis is helpful for intraoperative decision making (clinical utility) in 75.4% of cases.

Level Of Evidence: Retrospective review level IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-18-00071DOI Listing
June 2019

Implementation of an Enhanced Recovery After Spine Surgery program at a large cancer center: a preliminary analysis.

J Neurosurg Spine 2018 Nov;29(5):588-598

Departments of1Anesthesiology and Perioperative Medicine.

This study describes the implementation of a multimodal, multidisciplinary, evidence-based ERAS program in oncologic spine surgery, identifies and measures several relevant postoperative recovery outcomes, and demonstrates the feasibility and potential benefit of the program in improving analgesia and decreasing opioid consumption. The study underscores the importance of defining and capturing meaningful, patient-specific, and patient-reported outcomes, and constant evaluation and monitoring of a group's compliance with the program. The study represents the steppingstone for evaluation and improvement of a young ERAS program for spine surgery and serves as a roadmap for further initiatives and larger-scale studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2018.4.SPINE171317DOI Listing
November 2018

BIGH3 Promotes Osteolytic Lesions in Renal Cell Carcinoma Bone Metastasis by Inhibiting Osteoblast Differentiation.

Neoplasia 2018 01 27;20(1):32-43. Epub 2017 Nov 27.

Department of Orthopedic Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address:

Background: Bone metastasis is common in renal cell carcinoma (RCC), and the lesions are mainly osteolytic. The mechanism of bone destruction in RCC bone metastasis is unknown.

Methods: We used a direct intrafemur injection of mice with bone-derived 786-O RCC cells (Bo-786) as an in vivo model to study if inhibition of osteoblast differentiation is involved in osteolytic bone lesions in RCC bone metastasis.

Results: We showed that bone-derived Bo-786 cells induced osteolytic bone lesions in the femur of mice. We examined the effect of conditioned medium of Bo-786 cells (Bo-786 CM) on both primary mouse osteoblasts and MC3T3-E1 preosteoblasts and found that Bo-786 CM inhibited osteoblast differentiation. Secretome analysis of Bo-786 CM revealed that BIGH3 (Beta ig h3 protein), also known as TGFBI (transforming growth factor beta-induced protein), is highly expressed. We generated recombinant BIGH3 and found that BIGH3 inhibited osteoblast differentiation in vitro. In addition, CM from Bo-786 BIGH3 knockdown cells (786-BIGH3 KD) reduced the inhibition of osteoblast differentiation compared to CM from vector control. Intrafemural injection of mice with 786-BIGH3 KD cells showed a reduction in osteolytic bone lesions compared to vector control. Immunohistochemical staining of 18 bone metastasis specimens from human RCC showed strong BIGH3 expression in 11/18 (61%) and moderate BIGH3 expression in 7/18 (39%) of the specimens.

Conclusions: These results suggest that suppression of osteoblast differentiation by BIGH3 is one of the mechanisms that enhance osteolytic lesions in RCC bone metastasis, and raise the possibilty that treatments that increase bone formation may improve therapy outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neo.2017.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711998PMC
January 2018

Glomangiomatosis of the sciatic nerve: a case report and review of the literature.

Skeletal Radiol 2017 Jun 17;46(6):807-815. Epub 2017 Mar 17.

Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1448, Houston, TX, 77030, USA.

Glomus tumors are hamartomas, which tend to occur in sites rich in glomus bodies, such as the subungual regions of digits or the deep dermis of the palm, wrist, forearm, and foot. Very rarely, they may involve peripheral nerves. We describe a patient, who, following surgical resection of a solitary glomus tumor of the left distal sciatic nerve in his teens, had recurrence with development of multiple tumors in the course of the nerve over several years. To our knowledge, this is the only known case of glomangiomatosis involving a major peripheral nerve.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-017-2594-9DOI Listing
June 2017

Is It Appropriate to Treat Sarcoma Metastases With Intramedullary Nailing?

Clin Orthop Relat Res 2017 Jan 1;475(1):212-217. Epub 2016 Nov 1.

Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.

Background: Patients with primary bone and soft tissue sarcoma are at risk for skeletal metastases. Although uncommon, these metastases can result in impending or pathologic fractures. Intramedullary nailing traditionally has been an accepted form of palliative treatment for patients with metastatic carcinoma, but we could find no studies that report specifically on intramedullary nailing of metastatic sarcoma lesions.

Questions/purposes: We asked: (1) What is the survival of patients with an impending or pathologic fracture from a sarcoma metastasis? (2) What proportion of patients treated with intramedullary nailing subsequently underwent a revision procedure or nail removal during their lifetimes?

Methods: Between 1996 and 2014, we performed 40 intramedullary nailing procedures in 34 patients with multifocal metastases from sarcomas who showed signs or symptoms of impending fracture or who presented with a pathologic fracture. All of these patients are accounted for, either through the time of death or to the present, and all are included at a mean of 13 months (range, 0.3-86 months) in this retrospective study. During the study period, we generally applied the same surgical indications for patients with nailing of metastatic sarcoma lesions as we did for patients with metastatic carcinoma; in general, we used intramedullary nailing (with or without cement) rather than resection for diaphyseal lesions with less cortical destruction and no substantial soft tissue mass or metadiaphyseal lesions that could be adequately supplemented with cementation. The goal was to use this approach when it would allow immediate weightbearing, or in patients whose medical conditions were such that a more-extensive procedure seemed unsafe. During the same period, an additional 58 patients underwent resection procedures for metastatic sarcomas to long bones because they either did not meet the above indications, had a solitary resectable metastasis, or because of surgeon preference; these patients were excluded from this study. The median age of the patients was 52 years (range, 27-81 years). Eleven patients with 11 impending or pathologic fractures were documented to have received either preoperative or postoperative radiation therapy and 29 patients received some form of chemotherapy.

Results: Thirty (88%) patients died during the period of observation, at a median of 5 months (range, 0.3-80 months) after surgery. Twenty-nine patients (85%) underwent no additional surgery and retained their original intramedullary nail. One patient (3%) underwent nail removal for infection, and four patients (12%) underwent further surgical revision secondary to local progression.

Conclusions: Patients with an impending or pathologic fracture from multifocal metastatic sarcoma to a long bone have a dismal prognosis, but they may gain short-term benefit from surgical fixation with the goal of reducing pain and maintaining mobility. Although we have no group for comparison, such as treating with radiotherapy alone or resection and an endoprosthesis, our findings suggest that use of intramedullary nails is helpful for providing fixation that in most instances lasts for the lifetime of patients with multifocal bone metastases from sarcomas.

Level Of Evidence: Level IV, therapeutic study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11999-016-5069-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174050PMC
January 2017

Optimizing the Adverse Event and HRQOL Profiles in the Management of Primary Spine Tumors.

Spine (Phila Pa 1976) 2016 Oct;41 Suppl 20:S212-S217

Department of Neurosurgery, University of California-San Francisco Medical Center, San Francisco, CA.

Study Design: Systematic literature review.

Objective: To investigate if evidence-based principles of oncologic resection for primary spinal tumors are correlated with an acceptable morbidity and mortality profile and satisfactory health-related quality of life (HRQOL) measures.

Summary Of Background Data: Respecting oncologic principles for primary spinal tumor surgery is correlated with lower recurrence rates. These interventions are, however, often highly morbid.

Methods: A systematic literature review was performed to address the objectives by searching MEDLINE and EBMR databases. Articles that met our inclusion criteria were reviewed. GRADE guidelines were used for recommendation formulation.

Results: A total of 25 articles addressing the morbidity and mortality profile of primary spinal tumor surgery were identified. For sacral tumors, complication rates of up to 100% have been reported and complication-related death ranged from 0% to 27%. Mobile spine tumor complication rates varied from 13% to 73.7% and complication-related death ranged from 0% to 7.7%. Seven articles examining HRQOL for this patient population were identified. The limited literature showed comparable patient HRQOL profiles to those with benign conditions such as degenerative disc disease.

Conclusion: Respecting oncologic principles for primary spinal tumors are correlated with high adverse event rates. We recommend that primary spinal tumor surgeries be performed in experienced centers with multidisciplinary support teams and that prospective adverse event collection be promoted (strong recommendation/very low certainty of the evidence). Oncologic resection of primary tumors of the spine is associated with HRQOL that more closely approximates normative values with increasing duration of follow-up, but decreases with disease recurrence. We recommend primary spinal tumor surgery be performed with a curative intent whenever possible, even at the expense of greater initial morbidity to optimize long-term HRQOL (strong recommendation/very low certainty of the evidence).

Level Of Evidence: N/A.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BRS.0000000000001821DOI Listing
October 2016

Changing the Adverse Event Profile in Metastatic Spine Surgery: An Evidence-Based Approach to Target Wound Complications and Instrumentation Failure.

Spine (Phila Pa 1976) 2016 Oct;41 Suppl 20:S262-S270

Department of Neurosurgery, Mayo Clinic, Rochester, MN.

Study Design: Systematic review.

Objective: To identify risk factors and preventive methods for wound complications and instrumentation failure after metastatic spine surgery.

Summary Of Background Data: We focused on two postoperative complications of metastatic spine tumor surgery: wound complications and instrumentation failure and preventive measures.

Methods: We performed a systematic review of the literature from 1980 to 2015. The articles were analyzed for the presence of documented infection and/or wound complications and instrumentation failure.

Results: Forty articles met our inclusion criteria for wound complications and prevention. There is very low level of evidence that preoperative radiation, preoperative neurological deficit, revision procedures, and posterior approaches can contribute to wound complications (infections, wound dehiscence). There is very low level of evidence that plastic surgery soft tissue reconstruction, intrawound vancomycin powder, and percutaneous pedicle screws may prevent postoperative wound complications. Fourteen articles met our inclusion criteria for instrumentation failure. There is very low level of evidence that constructs greater than six levels, positive sagittal balance, preoperative radiation, and history of chest wall resection can contribute to implant failures.

Conclusion: • For patients undergoing revision metastatic spine tumor surgery, plastic surgery should perform the soft tissue reconstruction (strong recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, plastic surgery may perform immediate soft tissue reconstruction (weak recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, intrawound vancomycin can be applied to decrease the risk of postoperative wound infections (weak recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, percutaneous pedicle screws can be placed to decrease the risk of postoperative wound complications (weak recommendation/very low quality of evidence).• Instrumentation failure risk factors include constructs greater than six levels, positive sagittal balance, preoperative radiation, and history of chest wall resections (weak recommendation/very low quality of evidence).

Level Of Evidence: N/A.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BRS.0000000000001817DOI Listing
October 2016

Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC: Systematic Review.

Spine (Phila Pa 1976) 2016 Oct;41 Suppl 20:S224-S230

Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.

Study Design: Systematic literature review and expert survey OBJECTIVE.: The aim of this study was to determine factors associated with neurologic improvement in patients with neurologic deficits secondary to metastatic epidural spinal cord compression (MESCC). Clear understanding of these factors will guide surgical decision-making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration.

Summary Of Background Data: Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, owing to sparse data and complexity of these patients.

Methods: PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation.

Results: Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and previous irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation.

Conclusions: Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made to improve the probability of neurologic recovery.

Level Of Evidence: 2.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BRS.0000000000001827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581189PMC
October 2016

Non-Radiographic Risk Factors Differentiating Atypical Lipomatous Tumors from Lipomas.

Front Oncol 2016 22;6:197. Epub 2016 Sep 22.

Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA; Sarcoma Research Center, Houston, TX, USA; MD Anderson Cancer Center, Houston, TX, USA.

Purpose: To determine non-radiographic risk factors differentiating atypical lipomatous tumors (ALTs) from lipomas.

Methods: All patients with deep-seated lipomatous tumors of the extremities treated from January 2000 to October 2010 were retrospectively reviewed. Factors reviewed included age, gender, tumor location, size, histology, local recurrence, dedifferentiation, and metastasis. Multivariate logistic regression models were used to evaluate the effects of patient characteristics on ALT status.

Results: Ninety-four lipomas and 46 ALTs were included. Patients with an ALT were older (median: 60.5 vs. 55 years). Lipomas were evenly distributed between upper (48.9%) and lower extremities (51.1%), whereas ALTs predominately involved the lower extremities (91.3%). Median ALT size (22 cm) was greater than lipomas (10 cm),  < 0.0001. One lipoma (1.04%) recurred at 77 months and five ALTs (10.9%) recurred at an average of 39 months (19-64 months). Two ALTs originally treated with wide resection recurred with a dedifferentiated component and were treated with wide re-excision and chemotherapy. No metastases or tumor-related deaths occurred in either group at the time of last follow-up. Patients older than 60 years, tumors greater than 10 cm, or thigh location, were more likely to be diagnosed with an ALT ( < 0.05).

Conclusion: Lipomatous tumors were more likely to be ALTs when the tumor was at least 10 cm in size, located in the thigh, or found in patients that were 60 years of age or older. These risk factors may be used to guide management and surveillance strategies, when lipomatous tumors do not display characteristic radiographic features.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fonc.2016.00197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031604PMC
September 2016

Malignant Peripheral Nerve Sheath Tumors: A Single Institution's Experience Using Combined Surgery and Radiation Therapy.

Am J Clin Oncol 2018 05;41(5):465-470

Departments of Radiation Oncology.

Purpose: The purpose of this study is to investigate local control (LC), survival outcomes, and associated prognostic factors for patients with malignant peripheral nerve sheath tumors (MPNSTs) treated with combined surgery and radiation therapy (RT).

Methods: We reviewed the medical records of 71 consecutive patients treated with surgery and RT for localized MPNST between 1965 and 2012. Preoperative RT was used to treat 23 patients (32%) to a median dose of 50 Gy (range, 50 to 60 Gy), whereas 48 (68%) received postoperative RT to a median dose of 64 Gy (range, 45 to 70 Gy).

Results: Median follow-up for living patients was 118 months (range, 21 to 512 mo). The 5-year LC, distant metastatic free survival, and disease-specific survival rates were 84%, 62%, and 66%, respectively. To identify predictors of outcome, several multivariate models were constructed: (1) positive/uncertain surgical margin status was the only factor adversely associated local relapse at 5 years (28% vs. 5% for negative margins; P=0.02; hazard ratios 5.92; 95% confidence interval, 1.3-27.4). (2) No factors were significantly associated with distant metastatic free survival. Of the 35 patients (49%) who sustained disease relapse, only 3 were ultimately salvaged. Only 2 patients had grade 2 late toxicities (necrosis, fibrosis) based on Common Terminology Criteria for Adverse Events version 4.03 criteria, and 1 patient had grade 1 edema.

Conclusions: Combination therapy with surgery and RT provides favorable LC. Distant recurrences, however, continue to be challenging with limited salvage success at the time of relapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/COC.0000000000000303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145780PMC
May 2018

Patellar Resurfacing: Does It Affect Outcomes of Distal Femoral Replacement After Distal Femoral Resection?

J Bone Joint Surg Am 2016 Apr;98(7):544-51

Departments of Orthopaedic Oncology (P.P.L., J.E.B., R.L.S., B.S.M., and V.O.L.) and Biostatistics (J.Y. and L.L.), The University of Texas MD Anderson Cancer Center, Houston, Texas

Background: Patellar resurfacing after routine arthroplasty remains controversial. Few studies have specifically examined the effect of patellar resurfacing on outcomes after resection of the distal part of the femur and reconstruction with a megaprosthesis. Our objective was to compare the outcomes of megaprosthesis reconstructions of the distal part of the femur with and without patellar resurfacing after resection of a distal femoral tumor.

Methods: We retrospectively reviewed the clinical records of patients with a femoral tumor who underwent resection of the distal part of the femur and endoprosthetic reconstruction between 1993 and 2013. We excluded patients who had had extra-articular knee resection, patellectomy, revision, reconstruction with an expandable prosthesis, or a proximal tibial replacement associated with the distal femoral replacement. We compared demographic characteristics, surgical variables, anterior knee pain, range of motion, extensor lag, Insall-Salvati ratio, Insall-Salvati patellar tendon insertion ratio, impingement, patellar degenerative disease, additional patellar procedures, complications, and Musculoskeletal Tumor Society (MSTS) score between the patellar resurfacing and nonresurfacing groups.

Results: One hundred and eight patients--sixty without patellar resurfacing and forty-eight with patellar resurfacing--were included in the study. The mean age was 33.9 years (range, twelve to seventy-five years). There were fifty-four men and fifty-four women. The mean duration of follow-up was 4.5 years (range, 0.7 to twenty years). There was no significant difference in anterior knee pain between the groups (p = 0.51). Anterior knee pain did not significantly affect the range of motion, extensor lag, or reoperation or complication rate. Patellar degenerative disease occurred in 48% of the nonresurfaced knees but was not associated with focal pain. Complication rates were similar in the two groups, although peripatellar calcifications were significantly more common in the resurfacing group (19% versus 2%; p = 0.005). There was no significant difference in the mean MSTS score between the nonresurfacing (81%) and resurfacing (71%) groups (p = 0.34).

Conclusions: There were no differences in anterior knee pain, range of motion, extensor lag, or MSTS score between the patients with and those without patellar resurfacing. There were no cases of patellar component loosening or revision. In light of the similar outcomes in the two groups, the decision to resurface should be left up to the individual surgeon, who should take into account preoperative peripatellar pain and the status of the patella at the time of resection.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.O.00633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948835PMC
April 2016

Tibial Growth Disturbance Following Distal Femoral Resection and Expandable Endoprosthetic Reconstruction.

J Bone Joint Surg Am 2015 Nov;97(22):e72

Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, P.O. Box 301402, Houston, Texas 77230. E-mail address for P.P. Lin:

Background: In growing children, an expandable endoprosthesis is commonly used after distal femoral resection to compensate for loss of the distal femoral physis. Our hypothesis was that such prostheses can affect proximal tibial growth, which would contribute to an overall leg-length discrepancy and cause angular deformity.

Methods: Twenty-three skeletally immature patients underwent the placement of a distal femoral expandable endoprosthesis between 1994 and 2012. Tibial length, femoral length, and mechanical axis were measured radiographically to determine the growth rate.

Results: No patient had radiographic evidence of injury to the proximal tibial physis at the time of surgery other than insertion of the tibial stem. Fifteen (65%) of the patients experienced less proximal tibial growth in the operative compared with the contralateral limb. In ten (43%) of the patients, the discrepancy progressively worsened, whereas in five (22%) of the patients, the discrepancy stabilized. Seven patients did not develop tibial length discrepancy, and one patient had overgrowth of the tibia. For the ten patients with progressive shortening, the proximal tibial physis grew an average of 4.0 mm less per year in the operative limb. Five (22%) of the patients had ≥ 20 mm of tibial length discrepancy at last follow-up. Three of these patients underwent contralateral tibial epiphysiodesis. Three patients required corrective surgery for angular deformity.

Conclusions: The tibial growth plate may not resume normal growth after implantation of a distal femoral prosthesis. Physeal bar resection, prosthesis revision, and contralateral tibial epiphysiodesis may be needed to address tibial growth abnormalities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.O.00060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642228PMC
November 2015

Management of metastatic cervical spine tumors.

J Am Acad Orthop Surg 2015 Jan;23(1):38-46

The skeletal system is the third most common site of metastases after the lung and liver. Within the skeletal system, the vertebral column is the most common site of metastases, and 8% to 15% of vertebral metastases are in the cervical spine, consisting, anatomically and biomechanically, of the occipitocervical junction, subaxial spine, and cervicothoracic junction. The vertebral body is more commonly affected than the posterior elements. Nonsurgical management techniques include radiation therapy (stereotactic and conventional), bracing, and chemotherapy. Surgical techniques include percutaneous methods, such as vertebroplasty, and palliative methods, such as decompression and stabilization. Surgical approach depends on the location of the tumor and the goals of the surgery. Appropriate patient selection can lead to successful surgical outcomes by restoring spinal stability and improving quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-23-01-38DOI Listing
January 2015

Intratumoral injection of Clostridium novyi-NT spores induces antitumor responses.

Sci Transl Med 2014 Aug;6(249):249ra111

The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA.

Species of Clostridium bacteria are notable for their ability to lyse tumor cells growing in hypoxic environments. We show that an attenuated strain of Clostridium novyi (C. novyi-NT) induces a microscopically precise, tumor-localized response in a rat orthotopic brain tumor model after intratumoral injection. It is well known, however, that experimental models often do not reliably predict the responses of human patients to therapeutic agents. We therefore used naturally occurring canine tumors as a translational bridge to human trials. Canine tumors are more like those of humans because they occur in animals with heterogeneous genetic backgrounds, are of host origin, and are due to spontaneous rather than engineered mutations. We found that intratumoral injection of C. novyi-NT spores was well tolerated in companion dogs bearing spontaneous solid tumors, with the most common toxicities being the expected symptoms associated with bacterial infections. Objective responses were observed in 6 of 16 dogs (37.5%), with three complete and three partial responses. On the basis of these encouraging results, we treated a human patient who had an advanced leiomyosarcoma with an intratumoral injection of C. novyi-NT spores. This treatment reduced the tumor within and surrounding the bone. Together, these results show that C. novyi-NT can precisely eradicate neoplastic tissues and suggest that further clinical trials of this agent in selected patients are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/scitranslmed.3008982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399712PMC
August 2014

"Advances in the surgical management of bone tumors".

Authors:
Justin E Bird

Curr Oncol Rep 2014 Jul;16(7):392

MD Anderson Cancer Center, 1400 Pressler St. Suite FCT 10.5054, Houston, TX, 77030, USA,

Bone tumor surgery is extremely challenging, particularly when tumors are located in tightly confined anatomical areas and abutting critical organs and neurovascular structures. Tumor resection requires good cutting accuracy to ensure safety, to achieve negative margins, and to preserve critical structures when possible. The purpose of this paper was to review the literature on the surgical advances for bone tumor surgery published within the last year. The majority of literature identified focused on computer-assisted surgical approaches. There is increasing evidence that 3D navigation plays an important role in the resection of bone tumors. Reconstruction materials that encourage healing and prevent infections are also in development. Optimal care includes execution of a well-developed pre-operative plan using a multidisciplinary approach led by the orthopaedic oncologist.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11912-014-0392-2DOI Listing
July 2014

Enchondroma with secondary aneurysmal bone cyst.

Skeletal Radiol 2012 Nov 26;41(11):1475-8. Epub 2012 May 26.

The University of Texas Health Science Center, 6410 Fannin St., Suite 1535, Houston, TX 77030, USA.

An enchondroma with complex cystic changes of the proximal femur is described in a 13-year-old male. The case illustrates a unique presentation of an enchondroma and reinforces the importance of considering the presence of secondary aneurysmal bone cysts in both benign and malignant lesions of bone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-012-1418-1DOI Listing
November 2012