Proceedings of the NASS 20th Annual Meeting / The Spine Journal 5 (2005) 1S–189S
of the right L4 and the left L3 superior articular process. In three other
patients, the lesion was located in close proximity to neural elements. It
was located in the right pedicle of the T9 vertebra in one patient, in the
posterior inferior portion of L3 vertebral body (end plate) close to the exiting
nerve root in the second patient, and in the inferior articular process of C5
in the third patient.
OUTCOME MEASURES: Postoperative computed tomography scan to
evaluate effectiveness of excision. Pain diagrams and Visual Analogue
Score for pain were used to evaluate clinical outcomes.
METHODS: The first to patients underwent radiofrequency coagulation
with the use of a radiofrequency generator at 90 degrees for 240 seconds,
under computed tomography guidance in the first patient, and fluoroscopy
in the second patient. In the three patients in whom the lesion was located in
close proximity to neural elements, it was cored out by means of a special
percutaneous instrument designed for percutaneous biopsy under fluoroscopic guidance.
RESULTS: All patients experienced immediate relief of pain, resumed
their regular activities, and remained free of symptoms at a mean time of
2.5 years follow-up.
CONCLUSIONS: When the nidus is not adjacent to the neural elements,
radiofrequency thermal ablation can be an effective and safe treatment
of osteoid osteoma of the spine. In close proximity to neural elements,
percutaneous nidus core out is an effective alternative.
DISCLOSURES: No disclosures.
CONFLICT OF INTEREST: No conflicts.
doi: 10.1016/j.spinee.2005.05.142
5:52
141. Tuberculosis spine presentation and management strategies
Dwarakanath Srinivas, Venkataramana Neelamkrishna, Swaroop Gopal,
Prasanna Krishna; Manipal Institute of Neurological Disorders,
Manipal Hospital, Bangalore, Bangalore, India
BACKGROUND CONTEXT: Tuberculosis is a major health problem in
developing countries. It has a myriad of presentations, among which spinal
tuberculosis is prominent. Spinal tuberculosis constitutes up to 50% of
all cases of skeletal tuberculosis and is a major cause of morbidity. The
spectrum of presentation varies as do the management techniques. These include different surgical approaches aiming at decompression of the spinal
cord, drainage of the abscess/granulation tissue, debridement of sequestral bone, and disc and stabilization of the spine for prevention and correction
of deformities.
PURPOSE: The purpose of this retrospective study was to analyze the
clinical features, management strategies, outcome, and long-term results
of patients with spinal tuberculosis.
STUDY DESIGN/SETTING: Retrospective study including all patients
treated for spinal tuberculosis.
PATIENT SAMPLE: The study group consisted of patients managed
for spinal tuberculosis in the department of Neurosurgery at our institute
(Manipal Institute of Neurological Disorders) between 1994 and 2004.
OUTCOME MEASURES: Clinical and radiological outcome.
METHODS: Preoperative and regular postoperative clinical and radiological assessment.
RESULTS: There were a total of 98 patients who were managed for spinal
tuberculosis during the past 10 years. The age group ranged from 11 to
68 years, commonest being the second and third decade. The most common
presentation was local pain in 92%, progressive weakness in 80%, bladder/
bowel disturbance in 28%, and spinal deformity in 16%. The majority of
the lesions occurred in the thoracic spine. The important surgical issues were
relief of compressive myelopathy, reduction or prevention of instability, and
histopathological diagnosis of the lesions. Cold abscess was seen in 28%
of the patients. About 22% of our patients had evidence of significant spinal
instability on radiology and all of them required instrumentation. Lumbar
spine tuberculosis had good outcome, whereas dorsal spinal tuberculosis
had high morbidity followed by cervical spine tuberculosis. Patients with
73S
predominant granulomatous lesions and who presented with significant
neurological deficits had a worse outcome when compared with those
patients who had an abscess or those who presented with minimal neurological involvement. About 19% of the patients had multidrug resistance
tuberculosis, which highlights a major concern in the management. All
the patients who underwent instrumentation were ambulated early without
any adverse outcome and had good bony fusion on subsequent radiological assessment.
CONCLUSIONS: Tuberculosis spine is a major health problem in developing countries. Surgical management whenever indicated along with antituberculosis drug therapy is the treatment of choice to prevent further
neurological detoriation. Spinal instrumentation whenever indicated results
in early ambulation, early recovery, and good bony fusion. Multidrug
resistance tuberculosis requiring second line antitubercular drugs emerged
as a major area of concern.
DISCLOSURES: No disclosures.
CONFLICT OF INTEREST: No conflicts.
doi: 10.1016/j.spinee.2005.05.143
5:58
142. Predictors for survival in metastases to the spine
Benjamin Tow, MBBS, Seang Beng Tan, Chong Tien Tan, John Chen;
Singapore General Hospital, Singapore
BACKGROUND CONTEXT: Spinal metastases occur in as many as one
third of patients with cancer. Surgery can alleviate pain and disability
caused by metastatic disease of the spine. No clear consensus exists for
deciding the appropriate treatment and timing for surgery in such patients
Treament modality depends on the patient’s life expectancy at the time of
diagnosis Most authors agree that surgery would be an option if the anticipated survival is more than 3 months.
PURPOSE: We set out to review the parameters which were present in
the patients at the outset of diagnosis of spinal metastases and correlate them
with the outcome after spine surgery relating to the complications, and
survival period post-surgery.
STUDY DESIGN/SETTING: Retrospective review of patients who underwent palliative surgery for spinal metastases in our institution between Jan
1998 and Dec 2002. All patients were operated on by 3 surgeons from the
department. All patients underwent surgery based on assessment by their
respective surgeon. Criteria for surgery included patients who were expected
to survive more than 3 months from the date of surgery and who presented with pain or disability or evidence of instability of the spine.
PATIENT SAMPLE: Between January 1998 and December 2002, our
institution performed 121 palliative operations for metastatic spine disease.
Of these, 19 patients were either nonresidents or lost to follow-up postdischarge and omitted from the study. We performed a retrospective study
involving the remaining 102 patients with metastatic spine disease who
underwent palliative surgery.
OUTCOME MEASURES: Assessment included calculation of the Tokuhashi score and Tomita score; which included the general condition (performance status), number of extra-spinal bone metastases foci, number of
metastases in vertebral body, metastases in major internal organs, primary
site of the cancer, presence of spinal cord palsy. Each patient was also
evaluated for the presence of bowel and bladder involvement and neurologic
state by Frankel grading both before and after surgery and review of the time
from primary diagnosis to the time of presentation as spinal secondaries.
METHODS: We assessed all the above named parameters in correlation
with survival, and complications of surgery. A test of significance was
used to correlate the Tokuhashi score and Tomita score with survival and
also each parameter was tested against strength of correlation with survival.
RESULTS: Tokuhashi and Tomita scores correlate significantly with the
length of survival. Postoperative survival in spinal secondaries are significanty influenced by: The tumor of primary origin, The extent of spread
of cancer both in the bone and visceral organs, The general condition of
the patient before surgery. The time lag between diagnosis or the primary