Diagnostic accuracy of dual-layer spectral CT for osteolytic vertebral metastases.

Objectives: To evaluate whether dual-layer spectral computed tomography, compared with conventional CT, improves diagnostic accuracy for osteolytic vertebral metastases. Furthermore, to investigate the influence of dual-layer CT on the subjective visibility of metastases.

Materials And Methods: In this single-center retrospective study, consecutive patients with an untreated primary tumor who underwent dual-layer CT and either MRI or PET-CT as reference standard within 14 days were included.

Preclinical safety and feasibility of a bupivacaine-loaded hydrogel for pain relief after spinal surgery.

Pain and side effects of analgesics hinder postoperative recovery after instrumented spine surgery. Current locoregional blocks and sustained-release formulations are limited by rapid systemic absorption. We evaluated the local and systemic safety of a bupivacaine-loaded hydrogel, co-implanted with pedicle screws, in a sheep spine surgery model.

An International Delphi Consensus on Defining the Optimal Surgical Composite Outcome in Metastatic Spine Disease (OSCO-M).

Study Design: Delphi Consensus.

Objective: To define an optimal surgical composite outcome measure in patients with metastatic spine disease (OSCO-M) through international consensus among key opinion leaders.

Methods: Members of the AO Spine Knowledge Forum Tumor, an international group of dedicated spine oncology surgeons and oncologists, participated in a modified Delphi process between March 2023 and November 2024.

The influence of social determinants of health on clinical presentation in patients surgically treated for metastatic spinal disease.

Background Context: Spinal metastases can result in compression of the spinal cord with neurological symptoms in an acute setting. Surgical intervention is often necessary to mitigate the risk of irreversible neurological impairment. Therefore, an enhanced risk assessment for acute presentation in patients with spinal metastases could be highly valuable.

A multicenter analysis of registry data on postoperative orthopedic pain: a retrospective cohort study.

Background: Postoperative pain can lead to complications, prolonged hospital stays, and increased healthcare costs. Orthopedic surgeries are particularly associated with severe pain. This study aimed to identify orthopedic procedures that cause severe pain in hospitalized patients within 72 h post-surgery.

AO Spine Clinical Practice Recommendations: Reducing the Surgical Footprint of Surgery for Spinal Metastases.

Study DesignLiterature review with clinical recommendations.ObjectiveSpinal metastases represent a late complication of cancer and a major factor in decreased quality of life. The role of surgery for specific indications for spinal metastases is well established.

Evaluation of Adverse Events and the Impact on Health-Related Outcomes in Patients Undergoing Surgery for Metastatic Spine Tumors: Analysis of the Metastatic Tumor Research and Outcomes Network (MTRON) Registry Dataset.

Study DesignThis study is part of the AO Spine Metastatic Tumor Research and Outcomes Network [MTRON], an international multicenter prospective observational registry including patients with spinal metastases.ObjectivesThis study aims to elucidate the incidence of surgical complications, their risk factors and consequent effects on survival outcomes, hospital length of stay, and overall health-related quality of life (HRQOL) parameters in a large cohort of patients affected by spinal metastases who were surgically treated.MethodsAvailable data from February 2017 to July 2023 were analyzed.

Diffuse idiopathic skeletal hyperostosis as a marker for incident diabetes mellitus in cardiovascular disease patients.

Objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is a common incidental finding in medical imaging characterized by continuous vertebral ossification, which is associated with prevalent type 2 diabetes mellitus (T2DM). We hypothesized that incidental screen-detected DISH may be an actionable marker for incident diabetes screening and aimed to assess the absolute incidence rate (ratio) for T2DM in cardiovascular patients with and without DISH.

Methods: Cardiovascular disease patients without diabetes (n = 3395) were included via the prospective Second Manifestation of ARTerial disease cohort.

Testing a new sustained-release local anesthetic formulation specifically designed for spine surgery in a sheep model.

Instrumented spinal surgery is a frequently performed and painful intervention, with severe pain often lasting for three days. Opioids are the cornerstone of treatment of postoperative pain, but can induce severe side effects, dependence, and addiction. Novel local anesthetic applications, such as erector spinae plane blocks, and sustained release formulations have the potential to decrease opioid consumption without analgesic compromise but have limited efficacy beyond 24 h.

Automated vertebrae identification and segmentation with structural uncertainty analysis in longitudinal CT scans of patients with multiple myeloma.

Objectives: Optimize deep learning-based vertebrae segmentation in longitudinal CT scans of multiple myeloma patients using structural uncertainty analysis.

Materials & Methods: Retrospective CT scans from 474 multiple myeloma patients were divided into train (179 patients, 349 scans, 2005-2011) and test cohort (295 patients, 671 scans, 2012-2020). An enhanced segmentation pipeline was developed on the train cohort.

Surgical management of spinal metastases: A cross-continental study in the United States and the Netherlands.

Background: There is currently no consensus on the optimal surgical treatment for patients with spinal metastases. Investigating regional variations in surgical management could provide valuable insights to optimize care and refine surgical practices globally.

Objective: To investigate differences in patient populations, surgical management, and perioperative outcomes among patients who underwent surgery for spinal metastases in either Boston (United States) or Utrecht (Netherlands).

External validation of a machine learning prediction model for massive blood loss during surgery for spinal metastases: a multi-institutional study using 880 patients.

Background Context: A machine learning (ML) model was recently developed to predict massive intraoperative blood loss (>2,500 mL) during posterior decompressive surgery for spinal metastasis that performed well on external validation within the same region in China.

Purpose: We sought to externally validate this model across new geographic regions (North America and Europe) and patient cohorts.

Study Design: Multiinstitutional retrospective cohort study.

Predicting quality of life of patients after treatment for spinal metastatic disease: development and internal evaluation.

Background Context: When treating spinal metastases in a palliative setting, maintaining or enhancing quality of life (QoL) is the primary therapeutic objective. Clinicians tailor their treatment strategy by weighing the QoL benefits against expected survival. To date, no available model exists that predicts QoL in patients after treatment for spinal metastases.

AO Spine Clinical Practice Recommendations: Current Systemic Oncological Treatments with the Largest Impact on Patients with Metastatic Spinal Disease.

Study DesignLiterature review with clinical recommendation.ObjectiveTo provide the readers with a concise curation of the latest literature in recent advances in systemic oncological therapies and their implications for decision-making in patients with metastatic spinal disease. This review aims to enhance spine specialist's understanding of modern oncological treatments to facilitate optimal timing and planning of local interventions.

Does sagittal alignment after spinal reconstruction following en bloc tumor resection impact revision rate? A preliminary long-term retrospective study.

Objective: To investigate if postoperative sagittal alignment in long spinal fusions after lumbar enbloc resections can affect mechanical failure rates in a long-term follow-up study.

Methods: Retrospective study. All patients with more than 2-years follow-up, with complete demographic and oncological data, and with a set of standing x-rays that allowed the measure of sagittal spinopelvic parameters, the difference between the ideal and actual postoperative lumbar lordosis (LLM) and the Pelvic Incidence - Lumbar Lordosis mismatch (PI-LL) were included.

Frontline Voice: AO Spine Member Survey Regarding Spine Oncology Knowledge Generation and Translation Needs.

Study Designcross-sectional survey.ObjectivesTo evaluate AO Spine members' practices and comfort in managing metastatic and primary spine tumors, explore the use of decision-support and patient assessment tools, and identify knowledge gaps and future needs in spine oncology.MethodsAn online survey was distributed to AO Spine members to query comfort levels with key decisions in spinal oncology management, utilization of decision frameworks and spine oncology-specific instruments, and educational material preferences.

Radiotherapy and surgery: can this combination be further optimized for patients with metastatic spine disease?

This narrative review provides a comprehensive overview of the current status, recent advancements, and future directions in the management of metastatic spine disease using both radiotherapy and surgery. Emphasis has been put on the integrated use of radiotherapy and surgery, incorporating recent developments such as separation surgery, active dose sparing of the surgical field, and the implementation of carbon fiber-reinforced polymer implants. Future studies should explore the effects of minimizing the time between radiotherapy and surgery and investigate the potential of vertebral re-ossification after radiotherapy to obviate the need for stabilization surgery.

Overview of Molecular Prognostication for Common Solid Tumor Histologies - What the Surgeon Should Know.

Study Design: Narrative Literature review.

Objective: To provide a general overview of important molecular markers and targeted therapies for the most common neoplasms (lung, breast, prostate and melanoma) that metastasize to the spine and offer guidance on how to best incorporate them in the clinical setting.

Methods: A narrative review of the literature was performed using PubMed, Google Scholar, Medline databases, as well as the histology-specific National Comprehensive Cancer Network guidelines to identify relevant articles limited to the English language.

Risk Factors for the Development of Neurological Deficits in Metastatic Spinal Disease: An International, Multicenter Delphi Study.

Study Design: Delphi study.

Objective: The objective of this study was to identify risk factors associated with the development and/or progression of neurological deficits in patients with metastatic spinal disease.

Methods: A three-round Delphi study was conducted between January-May 2023 including AO Spine members, comprising mainly neurosurgeons and orthopedic surgeons.

Advanced Radiotherapy Technologies in Spine Tumors: What the Surgeon Needs to Know.

Study Design: Narrative review of existing literature.

Objectives: Significant technological advancements in radiotherapy planning and delivery have enabled new radiotherapy techniques for the management of spine tumors. The objective of this study was to provide a comprehensive summary of these treatment techniques for practicing spine surgeons.

Prevention and Management of Posterior Wound Complications Following Oncologic Spine Surgery: Narrative Review of Available Evidence and Proposed Clinical Decision-Making Algorithm.

Study Design: Narrative Review.

Objective: Contextualized by a narrative review of recent literature, we propose a wound complication prevention and management algorithm for spinal oncology patients. We highlight available strategies and motivate future research to identify optimal and individualized wound management for this population.

Defining Spine Cancer Pain Syndromes: A Systematic Review and Proposed Terminology.

Study Design: Systematic Review.

Objectives: Formalized terminology for pain experienced by spine cancer patients is lacking. The common descriptors of spine cancer pain as mechanical or non-mechanical is not exhaustive.

Latest Developments in Targeted Biological Therapies in the Management of Chordoma and Chondrosarcoma.

Study Design: Systematic review.

Objectives: The objective of this review paper was to summarize targeted molecular therapy options for spinal chordoma and chondrosarcoma, and to provide an update on the relevant clinical trials open for recruitment.

Methods: A systematic review of the current literature was performed, according to PRISMA guidelines, to summarize the latest developments in non-surgical molecular treatment options for low grade malignant primary spinal tumours.