Management of Chordoma of the Sacrum and Mobile Spine

Park, Andrew Jae-Min; McDowell, Susan; Mesfin, Addisu

doi:10.2106/jbjs.rvw.22.00162

Cited by 2 publications

(1 citation statement)

References 84 publications

(175 reference statements)

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“…Sacral tumors account for 1% to 4% of spinal tumors and include a wide range of primary and secondary tumors. [ 1 ] Radiographic changes caused by sacral tumors are known to be slight. [ 2 ] Therefore, advanced imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) play important roles in accurate lesion characterization and management guidance.…”

Section: Introductionmentioning

confidence: 99%

Characterization of sacral chordoma and differential diagnosis from other sacral malignancy using [18F]FDG PET/CT

Lee,

Kim,

Ryu

et al. 2024

Medicine

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2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography (PET)/computed tomography (CT) is known to be a helpful imaging modality for sacral chordoma, but its detailed characteristics have not been fully described. The purpose of our study was to identify the [18F]FDG PET/CT imaging characteristics of sacral chordoma and compare them with other sacral malignancy. This retrospective study included patients who underwent [18F]FDG PET/CT because of a mass involving the sacrum. Investigated visual findings included visual score and distribution, and semiquantitative parameters measured included standardized uptake values (SUVmax, SUVpeak, SUVmean), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and tumor size. Comparison studies and receiver operating characteristics (ROC) curve analysis were performed to differentiate between sacral chordoma and other sacral malignancy. Ten patients with sacral chordoma were finally included (M:F = 6:4, median age = 67 yr). On [18F]FDG PET/CT, sacral chordomas presented as a mass with minimal–moderate uptake with a usually heterogenous distribution. Compared with 12 patients with other sacral malignancies (M:F = 4:8, median age 42 yr), sacral chordoma showed a significantly lower TLR (median value 2.1 vs 6.3, P = .021). In ROC curve analysis, TLR showed the largest area under the curve (AUC) of 0.79 (cutoff ≤ 4.0; sensitivity 100.0%, specificity 58.3%; P = .004), and SUVmax showed the second largest AUC of 0.73 (cutoff ≤ 6.9; sensitivity 80.0%, specificity 66.7%; P = .034). [18F]FDG PET/CT of sacral chordoma showed minimal–moderate uptake. The TLR of [18F]FDG PET/CT was significantly lower than that of other sacral malignancy and was the most useful parameter for differentiating sacral chordoma, with the largest AUC. SUVmax could be another helpful semiquantitative parameter.

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Section: Introductionmentioning

confidence: 99%

Characterization of sacral chordoma and differential diagnosis from other sacral malignancy using [18F]FDG PET/CT

Lee,

Kim,

Ryu

et al. 2024

Medicine

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Risk Factors for Surgical Site Infections and the Effects of Betadine Irrigation and Intrawound Vancomycin Powder on Infection Rates in Spine Tumor Surgery

Mesfin,

Botros,

Benn

et al. 2024

Cureus

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Background Surgical site infection (SSI) following spine tumor surgery results in delays in radiation therapy and the initiation of systemic treatment. The study aims to assess risk factors for SSI in malignancy-related spinal infections and rates of infection observed in a single center with the use of betadine irrigation (BI) and intrawound vancomycin powder (IVP). Methods Spine tumor patients managed from 11/2012 to 11/2023 were identified using a surgical database (JotLogs, Efficient Surgical Apps, Portland, Maine). Inclusion criteria were patients receiving BI and IVP and alive at 30 days post-op. Exclusion criteria were patients not receiving a combination of BI and IVP due to allergies and mortality within 30 days of surgery. Patient demographics, histology, history of pre-operative and post-operative radiation treatment history, tumor location, procedure type, number of procedures per patient, SSI, wound culture results, and mortality were collected. Results One hundred two patients undergoing 130 procedures had an SSI rate of 3.85% (5/130). There were 18.6% primary and 81.4% metastatic tumors. Demographics were average age 59.5 years old (range 7-92), 60.8% male, 39.2% female, White 88.2%, Black 9.8%, and others 2%. Pre-operative radiation therapy was significantly associated with the risk of SSI (p=0.005). Percutaneous instrumentation did not lead to a significant difference in infection rates (p=0.139). There was no significant difference in infection rates between primary and metastatic tumors (p=0.58). Multivariable regression analysis revealed pre-operative radiation (OR: 18.1; 95%CI: 1.9-172.7; p=0.009) as the statistically significant independent risk factor. Conclusions Pre-operative radiation therapy remains a risk factor for SSI. However, percutaneous instrumentation did not lead to SSI, and there was no significant difference in infection rates between primary and metastatic tumors. SSI rate was 3.85% in patients who had a combination of BI and IVP in spine tumor surgery.

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Management of Chordoma of the Sacrum and Mobile Spine

Abstract: Chordomas account for 1% to 4% of primary tumors of the spine and sacrum.En bloc resection is the preferred surgical treatment for the management of chordomas.Proton beam radiation is increasingly being used as a postoperative radiation modality for the treatment of chordomas.

Cited by 2 publications

References 84 publications

Characterization of sacral chordoma and differential diagnosis from other sacral malignancy using [18F]FDG PET/CT

Characterization of sacral chordoma and differential diagnosis from other sacral malignancy using [18F]FDG PET/CT

Risk Factors for Surgical Site Infections and the Effects of Betadine Irrigation and Intrawound Vancomycin Powder on Infection Rates in Spine Tumor Surgery

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