척수종양 175예의 임상분석(1973~1986) : An Analysis of 175 Cases (1973~1986)

조병규,왕규창,한종우,정희원,김현집,한대희,심보성,최길수 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.3

The authors analyzed 175 cases of spinal cord tumor who had been operated upon at the Department of Neurosurgery of the Seoul National University Hospital from 1973 to 1986. The tumor was most common in the 5th decade of age (47 cases, 26.9%) and 24 cases (13.7%) were children. And the ratio of male to female was 1.2:1. The pathologic diagnosis was neurogenic tumor in 73 cases (41.7%), metastatic tumor in 29 cases (16.6%), glial tumor in 24 cases (13.7%), and meningeal tumor in 23 cases (13.1%) in the order of frequency, and the tumors of dysembryogenesis were only 2 cases (1.1%). The tumors were located most frequently in the thoracic area (79 cases, 45.1%) and in the intradural extramedullary space (79 cases, 45.1%). The most common initial presentation was pain (86 cases, 49.1%) and the mean duration of presentation was 20.6 months. On admission 70 cases (40.0%) were in the 'paraparesis stage'. The mean value of the CSF protein was 741 ㎎%. The rate of positivity of the plain spinal radiologic study was 55.7% and the most common positive finding was the increased interpedicular distance (46 cases, 29.1%). The total or gross total removal was possible in 105 cases (60.0%). The surgical result within the postoperative one month was recovery in 52 cases (29.7%), improvement in 76 cases (43.4%), stationary state in 36 cases (20.6%), progression in 11 cases (6.3%). After 20.1 months of the mean follow-up duration in 109 cases (62.3%), the result was recovery in 69 cases (63.3%), improvement in 16 cases (14.7%), stationary state in 8 cases (7.3%), progression in 16 cases (14.7%). As a major complication, there was a spinal deformity in 6 cases (3.4%), pulmonary embolism in 2 cases (1.1%), postoperative hematoma and meningitis in 1 case (0.6%) each. Ten cases (5.7%) were followed up to their deaths. And the authors discussed the clinical features of the spinal cord tumors reported in the literatures and the results of the present study with a more detailed consideration on each of major pathologies, neurogenic tumors, meningeal tumors, glial tumors, and metastatic tumors.

척수 종양 654예의 임상 분석(1973-1999)

최우진,정천기,조병규,김현집,Choe, Woo Jin,Chung, Chun-Kee,Cho, Byung-Kyu,Kim, Hyun Jib 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.8

Objective : The spinal cord tumors(including vertebral tumors) are increasingly diagnosed and operated due to development of refined diagnostic and therapeutic tools. It is necessary to re-evaluate clinical features and surgical results of spinal cord tumors with increasing cases and developing treatment modalities. The authors reviewed the spinal cord tumor cases to evaluate their clinical characteristics. Material and Methods : The retrospective review of 654 cases of spinal cord tumors between 1973 and 1999 was done. The clinical features, pathological analysis and surgical results were analyzed and compared to the literature. The results of the study are analyzed with a more detailed consideration of each of major pathologies : neurogenic tumors, meningeal tumors, neuroepithelial tumors, and metastatic tumors. Results and Conclusion : The spinal cord tumor was most common in the 5th decade of age(145 cases, 22.1%) and 78 cases(11.9%) were found in children under 15 years of age. The ratio of male to female was 1.2 : 1. The pathologic diagnosis was neurogenic tumor in 266 cases(40.7%), neuroepithelial tumor in 131(20.0%), metastatic tumor in 118(18.0%), and meningeal tumor in 94(14.4%) in the order of frequency. The tumor was located most frequently in the thoracic area(36.5%) and in the intradural extramedullary space(38.1%). The most common initial presentation was pain(40.1%) and the mean duration for presentation to operation was 14.8 months. The total or gross total removal was possible in 404 cases(61.7%) and the surgical result on the postoperative one month was recovery or improvement in 424 cases(64.8%), stationary in 188(28.7%), progression in 42(6.4%). As a surgical complication, there was a spinal deformity(12 cases), wound infection(5 cases), aspiration pneumonia(5 cases) etc. Neurogenic tumors and menigiomas showed good surgical results, whereas neuroepithelial tumors(except ependymoma) and metastatic tumors showed relatively poor prognosis.

척수종양 105례에 대한 임상분석 : Review of 105 Cases(1981-1991)

윤성운,임영진,김태성,이봉암,김국기,임언 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.11

The authors analyzed 105 cases of spinal cord tumor in regarding to the age, sex, location and distribution, clinical presentation and postoperative outcomes. They were confirmed by pathologic study at the Kyung Hee Medical Cented from 1981 to 1991. The incidence of spinal cord tumors was slightly predominant in males. The most commom tumor was neurogenic tumor. The neurogenic tumor composed 43.8%(46 cases), and the rests were meningioma 15.2%(16 cases), metstasis 10.5%(11 cases) and others. The tumor were located most frequently in the thoracic area(31.4%) and in the intradural extramedullary space(56.1%). Most common initial symptom of spinal cord tumors were pain and it's mean duration was 8.3 month. The patients were assigned to one of four groups according to their neurologic deficit. About 66.6%(70 cases) of the patients were included in Groups Ⅰ and Ⅱ(mild neurologic deficit), and others were classified in Groups Ⅲ and Ⅳ(significant to sever neurologic deficit). Complete tumor removal was achieved in 70.4%(4 cases) of the patients, and subtotal removal was performed in 26.7%(28 cases), and biopay was performed in 2.9%(3 cases). Among the 105 patients, the postoperative outcomes on dischage were recovery in 36 cases(34.3%), improved in 45 cases(42.9%), stationary state in 12 cases(11.4%), and progression in 12 cases(11.4%).

전이성 척추종양에 대한 수술적 치료에 관한 고찰

강희인,오석전,김영수,고용,오성훈,김남규,정환영,김광명 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.8

The authors analysed 33 cases of metastatic spinal tumors admitted to the department of neurosurgery, Hanyang University Hospital from January 1983 to December 1992. During this period, we operated 12 cases of 33 cases. The results were as follows : 1) The common incidence of age was fifth decade, the most frequent primary site of metastatic tumors was lung, and the thoracic region was the most common site of metastatic tumors. 2) The most common complaints of patients were pain, weakness of extremitia and sphincter disturbance in order. 3) The indication to surgical treatments comprises spinal instability, aggravation of neurologic symptom, diagnosis in doubt, known radioresistance of tumor and intractable pain. Antexior approach was used in cervical area for tumor removal and fusion, and posterior approach was used in the thoracolumbar area for decompressive laminectomy. The result was better in surgery group. 4) Early identification of spinal metastasis were considered to be important for better prognosis 5) The survival rate of the primary lesion may imfeuence on the pregnosk of metastatic spinal tumor.

Implantation of Liquid Nitrogen Frozen Tumor Tissue after Posterior Decompression and Stabilization for Metastatic Spinal Tumors

Kazuya Shinmura,Hideki Murakami,Satoru Demura,Satoshi Kato,Katsuhito Yoshioka,Hiroyuki Hayashi,Noriaki Yokogawa,Takashi Igarashi,Moriyuki Fujii,Noritaka Yonezawa,Hiroyuki Tsuchiya 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6

Study Design: A retrospective study. Purpose: To evaluate the immunity-enhancing effect of implantation of a liquid nitrogen-treated tumor. Overview of Literature: We have developed a new technique of implanting a tumor frozen in liquid nitrogen after posterior decompression and stabilization, with the aim of enhancing antitumor immunity in order to prolong the survival period of the patient. In the current study, the immunity-enhancing effect of this new technique has been evaluated. Methods: The subjects were 19 patients in whom we had earlier performed decompression and stabilization between April 2011 and September 2013. The 19 subjects were divided into two groups, namely a frozen autologous tumor tissue implantation group (n=15; “implantation group”), which consisted of patients, who underwent implantation with autologous tumor tissue frozen in liquid nitrogen, and a control group (n=4), which consisted of patients, who did not undergo autologous cancer transplantation. To evaluate the immunity-enhancing effect of the protocol, plasma cytokines (interferon [IFN]-γ and interleukin [IL]-12) were analyzed before surgery and a month after surgery. Results: The mean rate of increase in IFN-γ was significantly higher in the implantation group (p =0.03). Regarding IL-12, no significant difference was observed between the groups, although the implantation group exhibited increased levels of IL-12 (p =0.22). Conclusions: Decompression and stabilization combined with autologous frozen tumor cell implantation can enhance cancer immunity in metastatic spinal tumor patients. It is hypothesized that this procedure might prevent local recurrence and prolong survival period.

갑상선 여포상 암종에서 상부 흉추 및 하부 흉추로의 전이성 척추종양 1례 : 증례보고 Case Report

정성원,조봉수,이동열 침례병원 1998 浸禮病院學術誌 Vol.14 No.-

Atypical Presentation of Spinal Tuberculosis Misadiagnosed as Metastatic Spine Tumor

Kim, Dong-Woo,Choi, Hyu-Jin,Kim, Hyung-Dong,Song, Young-Jin The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.39 No.6

We present a case of a 68-year-old female with an atypical form of spinal tuberculosis, which involved posterior elements with multiple foci in two noncontiguous vertebral levels. The lesions caused spastic paraparesis and urinary hesitation. There was no evidence of pulmonary or other extrapulmonary tuberculous disease. Based on clinical and radiographic findings, this atypical spinal tuberculosis was preoperatively misdiagnosed as metastatic spine tumor. The histopathologic finding confirmed tuberculosis and the patient was treated successfully with surgery and antituberculous therapy. In case of a spinal lesion of unknown origin, it is important to be aware that atypical spinal tuberculosis can mimic metastatic spine tumor and tuberculosis should always be considered.

Trends in Survival and Surgical Methods in Patients Surgically Treated for Metastatic Spinal Tumors: 25-Year Experience in a Single Institution

Se-Jun Park,Jin-Sung Park,Chong-Suh Lee,Byeong-Jik Kang,Choong-Won Jung 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.1

Background: This study aimed to examine trends in postoperative survival and surgical methods over a 25-year period in patients surgically treated for metastatic spinal tumors. Methods: We performed a retrospective study of patients who underwent surgical treatment for metastatic spinal tumors between 1996 and 2020. For trend analysis, the study cohort was divided into three groups according to the year of surgery: 1996– 2004, 2005–2012, and 2013–2020. A Kaplan-Meier survival analysis was performed to examine survival, and the log-rank test was used to compare the survival of the top six common cancers among the periods. The surgical methods were grouped and examined as follows: fixation only, palliative decompression and fixation, gross total removal and fixation, and total en bloc spondylectomy. Results: This study included a total of 608 patients. There were 78 patients in 1996–2004, 236 in 2005–2012, and 294 in 2013– 2020. Regarding the overall survival trend, the group 2013–2020 had a significantly improved survival as compared to the other two groups (p < 0.001). According to specific cancer sites, significant survival improvement was observed in patients with lung, kidney, and breast cancers (p < 0.001, p < 0.001, and p = 0.022, respectively). There were no significant changes in the primary sites of the liver, colorectum, or prostate. Regarding surgical methods, the proportion of gross total tumor removal declined, whereas the proportion of palliative decompression and fixation and fixation only procedures increased. Conclusions: During the past 25 years, significant survival improvement was observed in patients with lung, kidney, and breast cancers. There was no improvement in survival in patients with liver, colorectal, and prostate cancers. In terms of surgical techniques, palliative decompression and fixation only procedures increased, while gross total tumor removal declined.

갑상선 여포상 암종에서 상부 흉추 및 하부 흉추로의 전이성 척추종양 1례 : 증례보고 Case Report

정성원,조봉수,이동열 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.8

전이성 척추 종양의 척추 전 절제술 후 발생한 급성 및 지연성 경막외 혈종 - 증례 보고 -

김영규,김정훈 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.3

연구 계획: 증례 보고목적: 전 척추 절제술 시행 후 두 차례 발생한 수술 후 경막 외 혈종 증례를 보고하고자 한다. 선행 연구 문헌의 요약: 척추 수술 후 경막 외 혈종은 드물며 혈종 제거술을 시행한 뒤 지연성 경막 외 혈종이 다시 나타난 예는 보고된 적이 없었다. 대상 및 방법: 74세 여환에서 제 9흉추(T9)의 전이성 척추 종양에 의한 병적 골절이 발생하여 전 척추 절제술을 시행하였으며 수술 직후 발생한 경막 외혈종으로 신경학적 증상이 악화되어 혈종 제거술을 시행하여 증상이 호전되었으나 수술 10일 후 신경학적 증상이 다시 악화되어 촬영한 자기 공명 영상검사상 지연성 경막 외 혈종이 또 다시 발견되어 혈종 제거술을 다시 시행하였다. 결과: 지연성 혈종 제거술 재 시행 후 신경학적 증상이 호전되었다. 결론: 일차적인 혈종 제거술 후에도 증상을 일으키는 지연된 혈종이 나타날 수 있으며, 혈종 제거술 후에도 신경학적 증상의 악화가 보인다면 혈종의 재발 가능성을 고려해야 한다. 또한 전 척추 절제술을 시행하기 전에 예방적 색전술을 시행할 것을 추천한다. 약칭 제목: 척추 수술 후 재발한 척수 경막 외 혈종 Study Design: Case report. Objectives: We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor. Summary of Literature Review: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported. Materials and Methods: A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again. Results: The patient’s neurological symptoms improved after delayed hematoma removal. Conclusions: Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended. Key Words: Delayed epidural hematoma, Metastatic spinal tumor, total spondylectomy