(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.

The use of three-dimensional (3D)-printed custom-made implants is spreading in the orthopedics field for the reconstruction of bone losses or for joint replacement, thanks to their unparalleled versatility. In particular, this novel technology opens new perspectives to formulate custom-made fixation strategies for the upper cervical region, sacrum and pelvis, where reconstruction is challenging. We report and analyze the literature concerning upper cervical reconstruction with 3D-printed personalized implants after tumor surgery, and discuss two cases of patients where this technology was used to reconstruct the anterior column after extracapsular debulking of C2 recurrent chordoma at our institution.

Epithelioid hemangioma is recognized by the World Health Organization as a distinct benign neoplasm; however, it is characterized by locally aggressive and rarely metastasizing behavior. Epithelioid vascular tumors are rare bony vascular lesions with varying degrees of malignant potential that remain controversial because of their rarity, unusual morphological features, and unpredictable biological behavior. The application of new molecular tools, such as massive parallel sequencing technologies, have provided new diagnostic markers and an opportunity to further refine the classification of bone vascular neoplasms. Very few cases of EH of the spine have been reported in the literature; therefore, it is difficult to make evidence-based therapeutic decisions for these patients. We report herein our experience with eleven patients suffering from EH of the spine. The study population included three males and eight females treated in our center from 2016 to the present; the average age was 44.8 years (range 14–75 years). The surgical, clinical, and radiographic data were retrospectively analyzed. The mean follow-up was 34.8 months. All patients presented lytic vertebral body lesions, six of them with pathological fracture. The majority of patients (80%) presented myelo-radicular compression. All patients were surgically treated, and preoperative embolization was performed in all cases. In light of the literature review and the clinical experience of our center, we can consider EH a locally aggressive tumor that requires surgical treatment in case of symptoms. Here, we propose a treatment algorithm that could be useful in the management of patients with this rare disease.

Background: Surgical site infections (SSIs) following spinal instrumentation surgery are among the most concerning complications. This study is aimed at assessing the effectiveness of a new treatment approach for SSIs that includes a single-stage approach with the removal of the previous hardware, accurate debridement, and single-stage instrumentation using a silver fixation system (SFS) made of titanium alloy coated with silver (Norm Medical, Ankara, Turkey) by means of a retrospective observational study. Materials and Methods: The demographic data, type of surgery, comorbidities, pathogens, and treatment details of consecutive patients with an SSI who received the SFS between 2018 and 2021 were extracted from their medical records and analyzed. The patients treated with the SFS for primary pyogenic infections were excluded. The patients were re-evaluated at multiple endpoints in order to assess the rate of reinfection and the local and general complications. Results: Fifty-six patients were treated with the SFS and thirty-four patients met the inclusion criteria. Out of those 34 patients, the rate of infection recurrence or insurgence after the implantation of the SFS was 11.8%, with infection detected in 4 out of 34 cases and mechanical problems detected in 2 of the 34 cases (5.9%). The overall success rate in controlling infection recurrence or emergence was 88.2% (30 out of 34 cases). The overall survival rate of the SFS was 87%, 78%, and 71% at one, two, and three years, respectively. Conclusions: The surgical strategy with the SFS demonstrated promising outcomes in preventing infection recurrence or insurgence, with a low incidence of mechanical complications. However, further structured and comprehensive studies are essential for validating these initial findings.