The spine journal : official journal of the North American Spine Society
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Recent advances in image guidance and stereotactic body radiotherapy (SBRT) have resulted in unprecedented local control for spinal metastases of all histologies. However, little is known about early imaging biomarkers of local control. ⋯ We report the first analysis on the utility of DCE-MRI for metastatic sarcoma spine metastases treated with SBRT. We demonstrate that early assessment at 2 months post-SBRT using size and subjective neuroradiology impressions is insufficient to judge ultimate disease progression, and that a combination of perfusion parameters provides excellent correlation to local control.
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Observational Study
Percutaneous vertebroplasty for patients with metastatic compression fractures of the thoracolumbar spine: clinical and radiological factors affecting functional outcomes.
Vertebroplasty (VP), including balloon kyphoplasty (BKP), has long been accepted as a minimally invasive surgical intervention for the stabilization of painful vertebral compression fractures. In metastatic compression fracture (MCF), cancer often invades the paravertebral structure and involves the posterior column of the vertebrae. ⋯ Paravertebral extension and posterior column involvement of MCF did not preclude pain improvement after VP. Balloon kyphoplasty for MCF failed to show enhanced pain improvement relative to SVP. Metastatic compression fracture patients with other bone metastases or rapidly growing tumors had a lower chance of performance improvement and reduced drug requirements, respectively.
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The ideal timing of surgical decompression or stabilization following combat-related spine injury remains unclear. ⋯ Our study found that instability or progressive kyphosis and incomplete decompression were the most common indications for reoperation after evacuation to the United States. Our data provide additional understanding of the potential etiologies of failure and reoperation following in-theater combat spine surgery, and may help avoid such complications.