From OT Europe

Tumors of the thoracolumbar spine: Convergence of orthopaedic expertise

EFORT

The percentage of patients with terminal cancer developing bone metastasis is set between 50% and 70% when considering all primary tumor types and increases to 85% for breast cancer. However, from all bone and soft-tissue sarcomas, only 10% are related to the spine.

Primary malignant tumors of the spine are also rare in orthopaedic oncology but still, once symptomatic spine metastases are detected in the patient, treatment by surgery can lead to good outcome in a significant number of cases. The most common sites for spine metastasis are thoracic and thoracolumbar spine with lumbar spine and sacrum having more than 20% of the metastatic lesions. Treatment of spine tumors requires extensive knowledge and expertise both in spine orthopaedic surgery and in tumor removal procedures, raising the degree of skills to be acquired by the practitioner. Furthermore, a multi-disciplinary approach with experts from various fields (plastic surgeons, radiotherapists, etc.) before, during and after the operation is key in the success of the treatment and challenges the team spirit of the purely spine orthopaedic surgeon.

During our upcoming 2018 Barcelona Congress, the EFORT Science Committee has scheduled an Interactive Expert Exchange (IEE) session, offering the state-of-the-art in treatment of thoracolumbar spine tumors to address all the concerns of the experts in both, spinal and oncologic fields.

Thursday 31 May 2018 | 10:15 to 12:30
Tumors of the Thoracolumbar Spine

Introduction & Conclusions
Ufuk Aydinli (Turkey)

Questions & Presentations

  • Treatment of Metastatic Spine Disease | Ufuk Aydinli (Turkey)
  • Treatment of Primary Malign Spine Tumors | Aaron Lazary (Hungary)
  • Team Work for Spine Tumors | Jeremy Reynolds (United Kingdom)
  • MIS Concept for Treatment of Spine Metastasis | Alexander Disch (Germany)
  • Stability at The Cervicothoracic and Lumbosacral Junction | Alessandro Luzzati (Italy)

Clinical Cases - Discussion
Provocateurs: Cordula Netzer (Switzerland) & Patrick Tropiano (France)

Spinal tumors are a wide group of diverse lesions ranging from benign to malignant, and primary to metastatic. Aneurysmal bone cyst (benign osteolytic bone neoplasm - ABC), osteoid osteoma (benign bone tumor from osteoblasts - OO), osteochondroma (benign cartilage overgrowth - OC), osteoblastoma (rare primary benign bone neoplasm - OB), Ewing’s sarcoma (primary malignant tumor) and osteogenic sarcoma (malignant neoplasm of mesenchymal origin) are spine tumors more commonly seen during childhood and adolescence. The onset of all other types of spinal tumors is more likely to happen between 30 years and 50 years of age. Some patients with impaired immune systems also develop spinal cord tumors like non-Hodgkin lymphoma. Moreover, inherited conditions like multiple hereditary exostoses, neurofibromatosis Type 2 (NF2) and Von Hippel-Lindau disease are associated with tumors of the spine and paraspinal region. It is also the case when the genetic disorder McCune-Albright syndrome affects the bones, skin and endocrine system.

Some benign spine tumors (OO, ABC, OC) can be treated only with intralesional surgery, whereas aggressive benign tumors and primary malignant spine tumors should be treated in priority with wide marginal resections. Supplementary plastic surgical reconstruction may require further interventions. In practice, several types of spinal tumors that required extensive surgery until recently are now treated with a combination of minimally invasive surgery and physical therapy, simplifying the postoperative handling and shortening the hospitalization stay. Even malignant spine tumors previously thought to be radio-resistant are managed today with advanced radiotherapy techniques. In fact, the increase in the survival rate of the primary tumor organ by the recent advances in both radiotherapy and chemotherapy increases the possibility of coping with spine metastasis. Ultimately, the combination of treatments leads to a better prognosis for the patient.

The malignancies that more often spread to the spine include breast, lung, prostate, thyroid and renal cancers, as well as multiple myeloma. In addition, exposure to radiation or industrial chemicals may increase the likelihood of developing spinal cancers. As the origin and nature of spinal tumors are diverse, surgical treatment of metastatic lesions should be individualized depending on the patient’s general condition, neurologic status, spinal stability and, most importantly, the histological analysis, including genetic markers, and tumor staging.

This Interactive Expert Exchange will guide attendees through all the considerations for spine tumor removal and will help the audience to better plan any necessary surgical procedure, in particular in primary malign spine tumors and spinal metastasis handling. This session includes lectures, open debates and case presentations leading to deep discussion of all current treatments and presenting the pros and cons of each approach. Pain management, availability of new devices, like carbon spine instrumentation, as well as the general considerations to secure long-term functionality and mobility will be addressed to enlighten decision-making in the daily practice.

IEE banner

The IEEs are paying sessions and pre-registration is mandatory (up to a maximum of 200 participants) on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the Congress. All details to sign-up will be available on our registration platform.

EFORT

The percentage of patients with terminal cancer developing bone metastasis is set between 50% and 70% when considering all primary tumor types and increases to 85% for breast cancer. However, from all bone and soft-tissue sarcomas, only 10% are related to the spine.

Primary malignant tumors of the spine are also rare in orthopaedic oncology but still, once symptomatic spine metastases are detected in the patient, treatment by surgery can lead to good outcome in a significant number of cases. The most common sites for spine metastasis are thoracic and thoracolumbar spine with lumbar spine and sacrum having more than 20% of the metastatic lesions. Treatment of spine tumors requires extensive knowledge and expertise both in spine orthopaedic surgery and in tumor removal procedures, raising the degree of skills to be acquired by the practitioner. Furthermore, a multi-disciplinary approach with experts from various fields (plastic surgeons, radiotherapists, etc.) before, during and after the operation is key in the success of the treatment and challenges the team spirit of the purely spine orthopaedic surgeon.

During our upcoming 2018 Barcelona Congress, the EFORT Science Committee has scheduled an Interactive Expert Exchange (IEE) session, offering the state-of-the-art in treatment of thoracolumbar spine tumors to address all the concerns of the experts in both, spinal and oncologic fields.

Thursday 31 May 2018 | 10:15 to 12:30
Tumors of the Thoracolumbar Spine

Introduction & Conclusions
Ufuk Aydinli (Turkey)

Questions & Presentations

  • Treatment of Metastatic Spine Disease | Ufuk Aydinli (Turkey)
  • Treatment of Primary Malign Spine Tumors | Aaron Lazary (Hungary)
  • Team Work for Spine Tumors | Jeremy Reynolds (United Kingdom)
  • MIS Concept for Treatment of Spine Metastasis | Alexander Disch (Germany)
  • Stability at The Cervicothoracic and Lumbosacral Junction | Alessandro Luzzati (Italy)

Clinical Cases - Discussion
Provocateurs: Cordula Netzer (Switzerland) & Patrick Tropiano (France)

Spinal tumors are a wide group of diverse lesions ranging from benign to malignant, and primary to metastatic. Aneurysmal bone cyst (benign osteolytic bone neoplasm - ABC), osteoid osteoma (benign bone tumor from osteoblasts - OO), osteochondroma (benign cartilage overgrowth - OC), osteoblastoma (rare primary benign bone neoplasm - OB), Ewing’s sarcoma (primary malignant tumor) and osteogenic sarcoma (malignant neoplasm of mesenchymal origin) are spine tumors more commonly seen during childhood and adolescence. The onset of all other types of spinal tumors is more likely to happen between 30 years and 50 years of age. Some patients with impaired immune systems also develop spinal cord tumors like non-Hodgkin lymphoma. Moreover, inherited conditions like multiple hereditary exostoses, neurofibromatosis Type 2 (NF2) and Von Hippel-Lindau disease are associated with tumors of the spine and paraspinal region. It is also the case when the genetic disorder McCune-Albright syndrome affects the bones, skin and endocrine system.

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Some benign spine tumors (OO, ABC, OC) can be treated only with intralesional surgery, whereas aggressive benign tumors and primary malignant spine tumors should be treated in priority with wide marginal resections. Supplementary plastic surgical reconstruction may require further interventions. In practice, several types of spinal tumors that required extensive surgery until recently are now treated with a combination of minimally invasive surgery and physical therapy, simplifying the postoperative handling and shortening the hospitalization stay. Even malignant spine tumors previously thought to be radio-resistant are managed today with advanced radiotherapy techniques. In fact, the increase in the survival rate of the primary tumor organ by the recent advances in both radiotherapy and chemotherapy increases the possibility of coping with spine metastasis. Ultimately, the combination of treatments leads to a better prognosis for the patient.

The malignancies that more often spread to the spine include breast, lung, prostate, thyroid and renal cancers, as well as multiple myeloma. In addition, exposure to radiation or industrial chemicals may increase the likelihood of developing spinal cancers. As the origin and nature of spinal tumors are diverse, surgical treatment of metastatic lesions should be individualized depending on the patient’s general condition, neurologic status, spinal stability and, most importantly, the histological analysis, including genetic markers, and tumor staging.

This Interactive Expert Exchange will guide attendees through all the considerations for spine tumor removal and will help the audience to better plan any necessary surgical procedure, in particular in primary malign spine tumors and spinal metastasis handling. This session includes lectures, open debates and case presentations leading to deep discussion of all current treatments and presenting the pros and cons of each approach. Pain management, availability of new devices, like carbon spine instrumentation, as well as the general considerations to secure long-term functionality and mobility will be addressed to enlighten decision-making in the daily practice.

IEE banner

The IEEs are paying sessions and pre-registration is mandatory (up to a maximum of 200 participants) on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the Congress. All details to sign-up will be available on our registration platform.