Fanous / Wang / Levi Spine and Spinal Cord Tumors

Classification, Management, and Treatment
1. Auflage 2025
ISBN: 978-1-63853-682-6
Verlag: Thieme
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 524 Seiten, ePub

With recent advances in molecular genetics and biotechnology, understanding of spinal tumors is rapidly advancing and significantly altering treatment paradigms for these pathologies. fills a void in the literature, providing an in-depth, current resource on the diagnosis, classification, and management of spinal column and spinal cord tumors. Edited by renowned spine surgeons Andrew A. Fanous, Michael Y. Wang, and Allan D. Levi, this reader-friendly textbook features contributions from leading international experts across nine countries and six continents.

The text is divided into six parts, with 44 chapters encompassing the latest standard of care, including state-of-the-art radiation therapy and surgical treatment. The introductory part discusses spinal anatomy, as well as general classification, presentation, evaluation, and diagnosis of spinal tumors. Part II on primary tumors of the vertebral column includes chapters on staging, classification, pathology, and cytogenetics of adult and pediatric lesions. Parts III and IV cover spinal cord, meningeal, and peripheral nerve tumors, and metastatic spinal tumors. Part V discusses adjuvant treatment modalities, including chemotherapy, radiation therapy, and angiographic embolization. The last part features 17 chapters dedicated to surgical management, including intraoperative neurophysiological monitoring, technological advances, surgical approaches, and reconstruction techniques.

Key Highlights

• Contributions from experts in various subspecialties provide diverse perspectives and treatment philosophies
• Invaluable clinical pearls provide insights on complications and pitfall prevention strategies
• A wealth of illustrations and perioperative images enhance understanding of pathologies

This book lays a solid foundation of knowledge on the management of spinal tumors, making it an essential resource for training and practicing neurosurgeons and orthopaedic surgeons, interventional radiologists, radiation oncologists, and medical oncologists.

This print book includes complimentary access to a digital copy on https://medone.thieme.com.

Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product.

Autoren/Hrsg.

Fanous, Andrew

Wang, Michael

Wang, Michael Y.

Levi, Allan

Levi, Allan D.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie

Inhaltsverzeichnis

Part I: Introduction to Spinal Tumors
1. Spine and Spinal Cord Anatomy
2. Classification of Vertebral and Spinal Neoplasms
3. Neurological Presentation and Clinical Diagnosis of Spine Tumors
4. Radiologic Evaluation of Spinal Tumors
5. Image-Guided Percutaneous Biopsy for Spinal Tumors
Part II: Primary Vertebral Column Tumors
6. Surgical Grading of Primary Spinal Column Tumors
7. Benign Tumors of the Vertebral Column in Adults
8. Malignant Tumors of the Vertebral Column in Adults
9. Non-Neoplastic Lesions of the Vertebral Column
10. Primary Tumors of the Sacrum in Adults
11. Vertebral Column Tumors in the Pediatric Population
12. Pathology of Primary Vertebral Column Neoplasms
Part III: Spinal Cord, Meningeal, and Peripheral Nerve Tumors
13. Staging of Spinal Cord Neoplasms
14. Cellular and Molecular Biology of the Spinal Cord, Meningeal, and Peripheral Nerve Neoplasms
15. Intramedullary Spinal Cord Tumors in Adults
16. Intradural Extramedullary Spinal Tumors in Adults
17. Pediatric Spinal Cord Neoplasms
18. Pathology of Spinal Cord Neoplasms
Part IV: Metastatic Spinal Tumors
19. Pathophysiology, Classification, and Staging of Metastatic Spinal Tumors
20. Pathology of Metastatic Spinal and Vertebral Column Neoplasms
21. Scoring Systems and Management of Metastatic Spinal Tumors
22. Metastatic Tumors of the Sacrum in Adults
Part V: Adjuvant Treatment Modalities for Spinal Tumors
23. Systemic and Intrathecal Chemotherapy for Spinal Tumors
24. Percutaneous Spinal Tumor Ablation
25. External Beam Radiation Therapy for Tumors of the Spine
26. Stereotactic Body Radiotherapy and Radiosurgery for Spinal Tumors
27. Angiographic Embolization of Spinal Neoplasms
Part VI: Surgical Approaches for Tumors of the Spine
28. Intraoperative Neurophysiological Monitoring in Spinal Tumor Surgery
29. Exoscopic Surgery for Spinal Tumors
30. Surgery for Intramedullary Spinal Cord Tumors
31. Surgery for Extramedullary Spinal Tumors
32. Surgical Approaches to Tumors of the Craniocervical Junction
33. Surgical Approaches for Tumors of the Cervical Spine
34. Total Spondylectomy for Tumors of the Cervical and Thoracic Spine
35. Thoracoscopic Procedures for Tumors of the Spine
36. Corpectomy and Anterior Lateral Fixation for Tumors of the Thoracic and Lumbar Spine
37. Posterolateral Surgical Approaches to Tumors of the Thoracic and Lumbar Spine
38. Posterior Instrumentation for Tumors of the Thoracic and Lumbar Spine
39. Kyphoplasty and Vertebroplasty for Spinal Tumors
40. Anterior Transperitoneal and Retroperitoneal Approaches to Tumors of the Lumbar Spine
41. Lateral Retroperitoneal Approaches to Tumors of the Lumbar Spine
42. Minimally Invasive Strategies for Spinal Tumor Treatment
43. Surgical Approaches to Sacral Tumors
44. Lumbosacral and Pelvic Reconstruction in Tumor Patients

Leseproben

1 Spine and Spinal Cord Anatomy

Andrew A. Fanous

Abstract

The anatomy of the spine is complex and multifaceted. It comprises the spine’s bony, soft tissue, vascular, and nervous anatomies. The vertebral column is divided into five major regions, each with its own distinct features. Within the central canal, the spinal cord transmits the nerves that emerge from the brain, and terminates with the conus medullaris, where it turns into the cauda equina. Nerve roots exit the spinal cord and cauda equina through foramina to innervate the various muscles in the body and to carry sensory stimuli from the periphery to the brain. The cervical spine, with its lordotic curvature, is composed of two distinctive regions: the atlantoaxial and the subaxial spines, which are distinct both anatomically and functionally. The thoracic spine, which articulates with the rib cage and is therefore largely immobile, has a kyphotic curvature. Conversely, the more mobile lumbar spine tends to be lordotic. With the exception of the atlantoaxial region and the sacrococcygeal spine, intervertebral disks composed of a central nucleus pulposus and an outer annulus fibrosus rest between the vertebrae and act as mechanical shock absorbers. The major vessels in the cervical spine are the vertebral arteries, which constitute the major blood supply to the brainstem, cerebellum, and posterior cerebrum. The major blood supply of the thoracic and lumbar spines is provided through the descending aorta via a pair of segmental arteries.

1.1 Introduction

The spine is the part of the axial skeleton that connects the head to the limbs. It comprises the vertebral column and the neural elements, namely the spinal cord and its ensuing peripheral nerves. The vertebral column is divided into five major regions: cervical, thoracic, lumbar, sacral, and coccygeal. Each of these regions contains a specific number of vertebrae ( ? Fig. 1.1), although variations are not uncommon. Intervertebral disks separate the different vertebrae in the cervical (except in the atlantoaxial complex), thoracic, and lumbar spines. Intervertebral disks are fused in the sacral and coccygeal regions ( ? Fig. 1.1). The curvature of the spine assumes a lordotic configuration in the cervical and lumbar spines of approximately 30 and 55 degrees, respectively, while the thoracic spine has a kyphotic curvature of approximately 35 degrees ( ? Fig. 1.2). The spinal cord ends with the conus medullaris at approximately the L1 level, at which level it turns into the cauda equina nerve roots ( ? Fig. 1.3).

Fig. 1.1 Anterior view of the human vertebral column. (From: Schünke M, Schulte E, Schumacher U. THIEME Atlas of Anatomy. Volume 1: General Anatomy and Musculoskeletal System. Illustrations by Voll M and Wesker K. 4th Edition. New York: Thieme Medical Publishers; 2024.)

Fig. 1.2 Lateral view of the vertebral column and its neural elements. (Reproduced from Neuroanatomy. In: An H, Singh K, ed. Synopsis of Spine Surgery. 3rd Edition. New York: Thieme; 2016.)

Fig. 1.3 Posterior view of the vertebral column after removal of the posterior elements, demonstrating the spinal cord and neural elements. (From: Schünke M, Schulte E, Schumacher U. THIEME Atlas of Anatomy. Volume 3: Head, Neck, and Neuroanatomy. Illustrations by Voll M and Wesker K. 4th Edition. New York: Thieme Medical Publishers; 2024.)

1.2 Cervical Spine Anatomy

The cervical spine is characterized by small vertebral bodies. It can be anatomically divided into two distinct partitions. The first are the two special vertebrae, the axis and the atlas, and the second is the subaxial spine from the third to the seventh cervical vertebrae. These two regions are both anatomically and functionally distinct. Except in young infants, the cervical spine normally has a slightly lordotic curve, with the convexity of the curve facing anteriorly.

1.2.1 Atlantoaxial Spine

The atlas is the first cervical vertebra, which connects the spine to the skull ( ? Fig. 1.4). It is named after the Greek mythological Titan who was condemned to hold up the globe (in this case the cranium) for eternity. This first cervical vertebra has the shape of a ring with small lateral masses. The lateral masses of the atlas comprise the transverse processes that contain the transverse foramina through which the vertebral arteries exit the cervical spine. The atlas is unique in that it encompasses neither the vertebral body nor the posterior elements found in the other vertebrae. There is nonetheless a small vestigial spinous process, known as the posterior tubercle, formed by the connection of the two posterior arches of the atlas in the midline.

Fig. 1.4 (a) Superior and (b) posterior views of the atlantoaxial (C1–C2) complex. (Used with permission from the Barrow Neurological Institute.)

The atlas comprises five different joints: two articulate with the occipital condyles of the skull, two articulate with the lateral masses of the second cervical vertebra, and the fifth—known as the atlantoaxial joint—articulates with the odontoid process of the second cervical vertebra. The two atlantal joints that articulate with the occipital condyles permit a moderate amount of flexion and extension, but prevent axial rotation or lateral bending. ? [1] The two that articulate with the lateral masses of the axis are the largest joints of the cervical spine, and allow axial rotation, while limiting axial bending and flexion/extension movements. ? [2] The atlantoaxial joint is the major joint that permits axial rotation of the head over the spine.

The second cervical vertebra is known as the axis ( ? Fig. 1.4). The axis is composed of a vertebral body with a superior projection, known as the odontoid (Greek for tooth) process. The odontoid process is also known as the dens. The odontoid articulates with the posterior aspect of the anterior arch of the atlas, in order to permit axial rotation. The pedicle of the axis is the largest of all the cervical vertebrae. ? [3] It is wider superiorly than inferiorly. There are no facet joints at C1–C2, and there is no intervertebral disk at C1–C2.

1.2.2 Subaxial Spine

The subaxial spine is composed of five different vertebrae ( ? Fig. 1.5). These vertebrae tend to be small in size in comparison with their more caudal counterparts. Vertebral bodies of the subaxial spine are also unique in that they comprise uncinate processes, which are lateral bony protrusions extending rostrally from the superior endplates of the vertebral bodies. The uncinate process on each side causes the superior endplate of the subaxial vertebral body to form a shallow concave shape into which settles the complementary convex inferior endplate of the more superior vertebra. The uncinate processes are also known as the joints of Luschka or uncovertebral joints, but are not true joints because they contain no synovium. ? [4] The width of the cervical vertebral bodies increases from C3 to C7. ? [5]

Fig. 1.5 Anatomy of the upper cervical vertebrae in (a) superior and (b) lateral views, and the lower cervical vertebrae in (c) superior and (d) lateral views. (Reproduced from Surgical Anatomy. In: An H, Singh K, ed. Synopsis of Spine Surgery. 3rd Edition. New York: Thieme; 2016.)

Intervertebral disks are composed of a central core known as the nucleus pulposus and an outer surrounding ring known as the annulus fibrosus. The depth of the intervertebral disk also increases as one moves down the subaxial cervical spine. It averages 16 mm at the rostral levels and increases to an average of 20 mm at the most caudal levels. ? [5] The height of the disk at the midline is greater than its height laterally. ? [5] The superior aspect of the disk is concave in shape, corresponding to the inferior endplate of the superior vertebra. Conversely, its inferior surface is convex, corresponding to the superior endplate of the inferior vertebral body.

The posterior components of the axis and the subaxial vertebrae are known as the vertebral arch or the neural arch. These consist of pedicles, laminae, and spinous processes. The pedicles connect the vertebral bodies anteriorly to the laminae posteriorly. The cervical pedicles are relatively short compared to their thoracic and lumbar counterparts. They average a height of 6.0 mm rostrally and 6.5 mm caudally in the cervical spine. ? [6] The average diameter of the cervical pedicles is approximately 3.0 mm and tends to be larger in men than in women. ? [7] The facet joints, formed by the inferior articular process of the level above and the superior articular process of the level below, are oriented at 45 degrees in the coronal plane. The superior articular process is located...