Separation Surgery Followed by Conformal Postoperative Spine Stereotactic Body Radiation Therapy Does Not Increase Risk of Adjacent Spine Level Progression in the Management of Spine Metastases.

Objectives: To determine if piecemeal separation surgery, in conjunction with smaller treatment volumes utilized with spine stereotactic radiation therapy (S-SBRT), increased the risk of adjacent level progression (ALP).

Methods: We performed a retrospective analysis of a prospectively maintained database of adult spine oncologic patients who underwent SBRT to the spine at University of Michigan from 2010 to 2021. We compared ALP in patients undergoing SBRT who had pretreatment surgery with those who did not.

Role of epidural disease in local control of spinal metastases treated with stereotactic body radiation therapy.

Spinal metastases can be contained in the bone or have epidural spread. Whether the extent of epidural involvement changes tumor response to therapy is unknown. The decision of when to treat disease progression with focal radiation therapy with or without surgery vs.

Stereotactic body radiotherapy for treatment of spinal metastasis: A systematic review of the literature.

Background: Advances in local and systemic therapies continue to improve overall survival for patients with cancer, increasing the incidence of spine metastases. Up to 15% of patients with solid tumors develop spinal metastases. Spinal metastases can be particularly devastating for quality of life given the potential pain, neurological deficits from spinal cord compression or cauda equina syndrome, spinal instability, and pathological fractures that may result.

Patients with progression of spinal metastases who present to the clinic have better outcomes compared to those who present to the emergency department.

Background: As cancer therapies have improved, spinal metastases are increasingly common. Resulting complications have a significant impact on patient's quality of life. Optimal methods of surveillance and avoidance of neurologic deficits are understudied.

Local Control in Patients with Metastatic Renal Cell Carcinoma to the Spine: The Experience of an Institution with a Multidisciplinary Spine Oncology Program.

Background: The outcomes for patients with metastatic renal cell carcinoma (RCC) to the spine who underwent stereotactic body radiotherapy (SBRT) through a multidisciplinary spine oncology program are not well described. We sought to describe the clinical course and local control rates at 1 and 2 years for these patients.

Methods: A retrospective analysis of a prospectively maintained database of adult oncologic patients receiving SBRT to the spine through a multidisciplinary spine oncology program at a single institution from 2010 to 2021 was performed.

Bone metastasis from glioblastoma: a systematic review.

Introduction: Glioblastoma (GBM) is a devastating disease with poor overall survival. Despite the common occurrence of GBM among primary brain tumors, metastatic disease is rare. Our goal was to perform a systematic literature review on GBM with osseous metastases and understand the rate of metastasis to the vertebral column as compared to the remainder of the skeleton, and how this histology would fit into our current paradigm of treatment for bone metastases.

Differential immune landscapes in appendicular versus axial skeleton.

Roughly 400,000 people in the U.S. are living with bone metastases, the vast majority occurring in the spine.

Dura promotes metastatic potential in prostate cancer through the CXCR2 pathway.

Purpose: Spinal metastases are common in cancer. This preferential migration/growth in the spine is not fully understood. Dura has been shown to affect the surrounding microenvironment and promote cancer growth.

Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video.

Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors.

Hybrid Therapy for Metastatic Disease.

Metastatic spine disease represents a complex clinical entity, requiring a multidisciplinary treatment team to formulate treatment plans that treat disease, palliate symptoms, and give patients the greatest quality-of-life. With the improvement in focused radiation technologies, the role of surgery has changed from a standalone treatment to an adjuvant supporting other treatment modalities. As patients within this population are often exceptionally frail, there has been increased emphasis on the smallest possible surgery to achieve the team's treatment goals.

Survival, fusion, and hardware failure after surgery for spinal metastatic disease.

Objective: Decompression with instrumented fusion is commonly employed for spinal metastatic disease. Arthrodesis is typically sought despite limited knowledge of fusion outcomes, high procedural morbidity, and poor prognosis. This study aimed to describe survival, fusion, and hardware failure after decompression and fusion for spinal metastatic disease.

Impact of Michigan's new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative.

Objective: In 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.

Methods: Patient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database.

The feasibility of computer-assisted 3D navigation in multiple-level lateral lumbar interbody fusion in combination with posterior instrumentation for adult spinal deformity.

Objective: The lateral lumbar interbody fusion (LLIF) technique is used to treat many common spinal degenerative pathologies including kyphoscoliosis. The use of spinal navigation for LLIF has not been broadly adopted, especially in adult spinal deformity. The purpose of this study was to evaluate the feasibility as well as the intraoperative and navigation-related complications of computer-assisted 3D navigation (CaN) during multiple-level LLIF for spinal deformity.

Effect of Fenestrated Pedicle Screws with Cement Augmentation in Osteoporotic Patients Undergoing Spinal Fusion.

Objective: Osteoporosis is a well-known risk factor for instrumentation failure and subsequent pseudoarthrosis after spinal fusion. In the present systematic review, we analyzed the biomechanical properties, clinical efficacy, and complications of cement augmentation via fenestrated pedicle screws in spinal fusion.

Methods: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Utilization of a Resuscitative Care Unit for Initial Triage, Management, and Disposition of Minor Intracranial Hemorrhage.

Unlabelled: Management of minor intracranial hemorrhage typically involves ICU admission. ICU capacity is increasingly strained, resulting in increased emergency department boarding of critically ill patients. Our objectives were to implement a novel protocol using our emergency department-based resuscitative care unit for management of management of minor intracranial hemorrhage patients in the emergency department setting, to provide timely and appropriate critical care, and to decrease inpatient ICU utilization.

Hybrid Therapy for Spinal Metastases.

The combination of separation surgery and stereotactic body radiotherapy optimizes the treatment of metastatic spine tumors. The integration of SBRT into treatment paradigms produces superb local control rates and consequently has diminished the role of surgery from principle treatment to one of adjuvant therapy. Under this paradigm, hybrid therapy for the treatment of metastatic spine tumors employs separation surgery to decompress the spinal cord and stabilize the spine while creating a safe target for ablative SBRT.

Pupillary changes after clinically asymptomatic high-acceleration head impacts in high school football athletes.

Objective: Previous studies have shown that clinically asymptomatic high-acceleration head impacts (HHIs) may be associated with neuronal and axonal injury, as measured by advanced imaging and biomarkers. Unfortunately, these methods of measurement are time-consuming, invasive, and costly. A quick noninvasive measurement tool is needed to aid studies of head injury and its biological impact.

Local Control and Toxicity of Multilevel Spine Stereotactic Body Radiotherapy.

Background: Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated.

Objective: To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes.

Methods: We analyzed consecutive cases of sSBRT treated from 2013 to 2017.

Analysis of Outcomes Between Traditional Open versus Mini-Open Approach in Surgical Treatment of Spinal Metastasis.

Objective: The treatment of spinal metastasis carries significant surgical morbidity, and decompression and stabilization are often necessary. Less invasive techniques may reduce risks and postoperative pain. This study describes the differences between a mini-open (MO) procedure and a traditional open surgery (OS) for symptomatic spinal metastasis, and reports differences in outcome for similar patients undergoing each procedure.

Computed Tomography Myelosimulation Versus Magnetic Resonance Imaging Registration to Delineate the Spinal Cord During Spine Stereotactic Radiosurgery.

Background: Underestimation of the spinal cord's volume or position during spine stereotactic radiosurgery can lead to severe myelopathy, whereas overestimation can lead to tumor underdosage. Spinal cord delineation is commonly achieved by registering a magnetic resonance imaging (MRI) study with a computed tomography (CT) simulation scan or by performing myelography during CT simulation (myelosim). We compared treatment planning outcomes for these 2 techniques.

Predominance of Spinal Metastases Involving the Posterior Vertebral Body.

Background: Spinal metastases pose significant morbidity. For many histologies, the spine is a frequent site for bone metastases. This predilection is not fully understood, and there are conflicting reports regarding the distribution within the vertebral body itself.

Elevated markers of brain injury as a result of clinically asymptomatic high-acceleration head impacts in high-school football athletes.

Objective: This prospective observational cohort study of high-school football athletes was performed to determine if high-acceleration head impacts (HHIs) that do not result in clinically diagnosed concussion still lead to increases in serum levels of biomarkers indicating traumatic brain injury (TBI) in asymptomatic athletes and to determine the longitudinal profile of these biomarkers over the course of the football season.

Methods: Sixteen varsity high-school football athletes underwent baseline neurocognitive testing and blood sampling for the biomarkers tau, ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), and spectrin breakdown products (SBDPs). All athletes wore helmet-based accelerometers to measure and record head impact data during all practices and games.