Targeted therapy has greatly improved the outlook for patients with spinal metastatic cancers. Scoring systems like the Tokuhashi or Tomita scores are commonly used to predict prognosis and inform surgical decisions, but they are outdated and fail to consider recent advancements. We aimed to investigate the current state of the literature and treatment options pertaining to advancements in targeted therapy compared to other forms of medical management for metastatic spinal tumors. This study represents the first comprehensive systematic review that encompasses the most common primary cancers that metastasize to the spine and evaluates the median overall survival (mOS) across five different medical treatment modalities as well as surgical intervention. Additionally, our study analyzes the tumor receptor status in conjunction with these treatments. A PubMed search was conducted, and according to the PRISMA guidelines, 28 articles out of 1834 met the inclusion criteria. The pooled data analysis highlighted the superior efficacy of targeted therapy, evidenced by a significant improvement in the mOS and lower hazard ratios in patients with lung and breast cancers who received targeted therapy compared to those who did not. Our study provides valuable insights into the recent advancements in the medical management of metastatic spinal tumors. Future indications include incorporating this literature into personalized treatment approaches for metastatic spinal tumors.

Limited operating room access in publicly funded institutions, particularly for emergencies, highlights the need for improved prioritization rules for common pathologies, including acute cholecystitis (AC). We compared the performance of our institution's surgical prioritization rules to the Tokyo diagnostic criteria and to develop a novel decision rule to predict AC on surgical pathology. All adult patients undergoing emergency cholecystectomy (EC) at a single academic institution (2017-2021) were reviewed. The primary outcome was the diagnosis of acute inflammation on final pathologic analysis. Multiple logistic regression was performed with a training subset using relevant clinical variables that were selected a priori. A simple weighted decision rule was created and compared to the Tokyo Guidelines and the institution's existing prioritization rules via an analysis of receiver operator curves. Among 756 patients undergoing EC, 97.6% met the criteria for AC as per Tokyo diagnostic criteria. Urgent booking category (area under the curve [AUC] = 0.58, sensitivity 89%, specificity 26%) and Tokyo criteria (AUC = 0.51, sensitivity 99%, specificity 3%) poorly discriminated for acute inflammation on final pathology. Discrimination of the hospital's case prioritization rules was moderate (AUC = 0.63, sensitivity 48%, specificity 78%), and a new decision rule was significantly higher (AUC = 0.71, sensitivity 72%, specificity 64%, P < 0.003). The Tokyo Guidelines were highly sensitive but nonspecific for the presence of acute inflammation on final pathology. An existing institutional case prioritization rule demonstrated moderate discrimination but was outperformed by a new rule incorporating clinical exam, fever, degree of leukocytosis, and inflammatory changes on imaging. These findings may aid AC prioritization in busy centers, though external validation is needed.

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Study Design: This was a single-institution, retrospective cohort study. Objective: The objective of this study was to assess a surgical technique for spinal reconstruction after corpectomy, integrating an allograft/autograft within a vertebral body replacement cage linked to spinal rods via pedicle screws. This method aims to enhance biomechanical stability and promote long-term fusion without cage endcaps. Summary of Background data: Recent advancements in spinal surgery feature innovative constructs that improve healing and fusion rates. FDA-approved mesh cages provide enhanced stability and superior fusion with fewer complications. Our approach combines allografts/autografts with vertebral replacements, using a pedicle screw through the cage for significant biomechanical enhancement. Methods: Two patients undergoing cervical and lumbar spinal reconstructions due to different pathologies were selected. The surgical technique involved shaping the allograft/autograft to fit precisely within the cage, extending beyond its ends to facilitate fusion at both ends, and securing the construct to the spinal rods with pedicle screws for added stability. Patient outcomes were assessed based on post-operative stability, fusion rates, and the presence of any complications. Results: Both cases successfully utilized the technique, achieving stabilization and fusion. Improvements were noted in post-operative recovery. There were no instances of cage subsidence, or any significant complications directly related to the novel construct. Conclusions: Our case series highlights a post-corpectomy reconstruction technique involving a mesh cage construct integrated with an autograft/allograft and connected to posterior instrumentation for enhanced stability. This technique was applied successfully in two cases, demonstrating its feasibility, durability, and potential to promote biological integration. Further studies with larger cohorts and extended follow-up periods are necessary to refine the approach for wider clinical use.