Artikel
Primary bone tumours of the spine – proposal for treatment based on a single-centre experience
Primäre Knochentumore der Wirbelsäule – Behandlungsempfehlung basierend auf einer Kohortenstudie
Suche in Medline nach
Autoren
Veröffentlicht: | 26. Juni 2020 |
---|
Gliederung
Text
Objective: Primary bone tumours (PBTs) of the spine are considered to be a rare disease. They represent less than 0.2% of all newly diagnosed tumours. The aim of this study was to report a large contemporary single-center series of PBTs of the spine and review the concepts of management.
Methods: We identified 92 patients (59 male, 33 female) receiving surgery for PBTS from January 2007 to August 2019. We analysed the patients’ clinical characteristics, comorbidities, surgical management, and adjuvant/neoadjuvant strategies. Overall survival and outcome were measured using the Karnofsky performance index (KPI) at intervals of three months and six months, and then one-, three-, and five years postoperatively.
Results: The< edian patient age was 46 (ranging from 7 to 80). About 14.6% were younger than 18 years. A total of 50 patients suffered from benign lesions (18 haemangiomas, 14 osteoidosteomas, 9 aneurysmatic bone cysts, 4 osteoblastomas, 3 fibrous bone cell dysplasias, 1 enchondroma, 1 fibroma), 40 had malignant lesions (15 chordomas, 8 chondrosarcomas, 8 osteosarcomas, 7 ewing-sarcomas, 2 fibrosarcomas), and two were semi-malignant lesions (giant cell tumours).
The following symptoms were observed: local pain (97%), pareses (19%), dysesthesia (25%), and myelopathy (13%). Overall 73% showed improvement of symptoms directly after surgery. We performed 145 surgical procedures (50 in the cervical spine, 46 thoracic, 28 lumbar, and 21 sacral). In 65%, complete resection of the tumour was achieved. Of these, 22% suffered a recurrence of the tumour during the follow-up period (mean 417 days, 10–3172 days’ range). The five-year mortality rate was 12% (3% after complete resection vs 25% after subtotal resection). Instrumented spinal fusion was needed in 51%.
Conclusion: PBTS mostly lead to local pain, dysesthesia, and pareses. Complete resections are often possible and result in better survival rates. Nevertheless, overall recurrence and mortality rates are high. Decision making strategies based on 92 cases were reported.