Buchowski Spine Tumor

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Spine Tumor Case

Example• Assistant Professor ofOrthopaedic and NeurologicalSurgery, Washington Universityin St. Louis

• Director, Center for SpinalTumors

• Interest:

• Spinal tumors

• Deformity surgery

• Enjoys photography and travel

• Contact: www.neareastspine.org

Jacob M. Buchowski, MD, MS

http://www.neareastspine.org/

http://www.neareastspine.org/



Jacob M. Buchowski, M.D., M.S.

Assistant Professor of Orthopaedic and Neurological SurgeryDirector, Center for Spinal TumorsWashington University in St. Louis

St. Louis, MO

Spine Tumor CaseExample

S.P.I.N.E. Annual MeetingBeirut, Lebanon, June 23-36, 2010



Disclosures

• Consultant for Stryker, Inc. (<$10,000per year)



Speakers

• Dr. Ibrahim Sbeih

• Dr. John P. Kostuik

• Dr. Daniel Shedid



Outline

•Case introduction

• Speaker’s comments

• What was done

• Questions and answers



Case SH• 42 y.o. woman developed right sided chest pain in October of 2009

which precipitated a CT and MRI

• Demonstrated a mass in right upper lobe adjacent to T2

• Biopsy performed in October demonstrating non-small cell lungcancer

• Mediastinoscopy revealed no evidence of malignancy

• No pain radiation into her upper or lower extremities

• No numbness or weakness at the upper or lower extremities.

• No loss of bowel or bladder control

• No problems with balance or tripping



Case SH• Married, with 3 children

• Works in a bank

• Smoked 1 PPD until diagnosis of lungcancer

• Otherwise healthy

• Hysterectomy

• Colon polyps



Case SH

• 5’6", weight is 165 pounds.

• Normal gait

• Normal motor strength and sensation

• Reflexes 2+

• Babinski sign is negative

• Romberg sign is negative

• No Horner’s syndrome



Case SH



Case SH



Case SH



Case SH



Case SH



Diagnosis?

• Right superior sulcus nonsmall cell lungcancer (NSCLC) with no evidence of

metastatic disease



Treatment Options

• Nonoperative: XRT and Chemotherapy

• Operative:

• Anterior/Posterior

•Anterior only

• Posterior only



Speakers

• Dr. Ibrahim Sbeih

• Dr. John P. Kostuik

•Dr. Daniel Shedid



Treatment?

• Induction chemotherapy and radiationtherapy

• Video-assisted thoracoscopy withresection of right upper lobe from hilarstructures

• Posterior partial corpectomy and tumorresection with spinal stabilization



Case SH



Case SH



Case SH



Literature• 17 patients with superior sulcus tumors

stage T4 with vertebral body invasiontreated with total or partial vertebral

resection or foraminal or transverseprocess resection. 16 received pre or postop radiation.

• All 6 with positive margins had recurrence

and 0% 2-year survival while 1 of 11 withnegative margins had recurrence and 80%2-year survival.

Gandhi et al. Ann Thorac Surg 1999;68(5):1778-84.21



Literature

• Patients with T4N0M0 treated with radical resectionhave a 31% 5 year survival

• 5-year survival rates reported to be between 10 and42%. Factors that contribute to improved survival areresponse to neoadjuvant therapy, ability to achievecomplete histological resection, and absence of nodaldisease

Rice et al Surg ClinNorth Am2002;82(3):573-87.

Mulligan CR, Kuklo TR,Corcoran PC. Chest2004;126:961S-962S.

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Buchowski Spine Tumor