Article Figures & Data
Figures
- Figure 1
Flow chart of systematic search and review process conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement criteria.
- Figure 2
The mean volume of blood loss associated with the primary diagnosis. The number of cases for each diagnosis is reported. There were single cases for some tumors and for these the actual volume of blood loss (not the mean) is depicted. Aneurysmal bone cyst (ABC), chondrosarcoma, and renal cancer were associated with the largest blood loss. GCT, giant cell tumor.
- Figure 3
Cases with reported blood loss and operative time are demonstrated. There is a general decrease in trend from T12 to L4 in blood loss. However, L5 is associated with the highest blood loss and operative time.
- Figure 4
Survival Kaplan-Meier graphs from the 3 types of tumors. Malignant primary and metastasis had the worst survival.
- Figure 5
Kaplan-Meier graph showing survival rates for malignant primary and metastatic tumors based on the excision margin. As expected, wide excision margin was associated with better survival.
- Figure 6
Comparing Frankel grade before and after surgery for a total of 83 cases. The neurological status of patients was generally better postoperatively.
Tables
- Table 1
Methodological quality and risk of bias were assessed using the 12-point Methodological Items for Nonrandomized Studies (MINORS) scale.a
Study Stated Aims Consecutive Patients Prospective Data Collection End Points Appropriate to the Aims Unbiased End Point Assessment Appropriate Follow-up Period <5% Loss to Follow-up Study Size Calculation Adequate
Control GroupContemporary Group Baseline Equivalence Group Statistical Analysis Total Score Abe 2000 1 2 0 1 0 2 2 0 0 0 0 1 9 Boriani 2000 2 2 0 2 0 2 2 0 1 1 1 0 13 Melcher 2007 1 2 0 2 0 2 2 0 0 0 0 2 11 Kawahara 2010 2 2 0 2 0 2 2 0 0 0 0 0 10 Liljenqvist 2010 1 2 0 2 2 2 2 0 0 0 0 0 11 Martin 2010 1 2 0 2 0 2 2 0 0 0 0 0 9 Disch 2011 1 2 2 0 2 0 2 2 0 0 0 0 12 Boriani 2012 2 2 0 1 0 2 2 0 0 0 0 1 9 Huang 2018 2 2 0 2 0 2 2 0 0 0 0 1 11 Xiong 2018 2 2 0 2 0 2 2 0 0 0 0 1 11 Shimuzu 2018 2 2 0 2 0 2 2 0 0 0 0 1 11 Yang 2019 2 2 0 2 0 2 2 0 0 0 0 1 11 Average score 11 aThe ideal MINORS scale score is 16.
Type Gender (n = 129), M:F Age, y, mean (range) Duration of FU,
mean (range)Excision margin n = 82
IL:Marg:WideMortality Recurrence Rate Overall total, 145 (100%) 65:64 40 (9–78) 70 (2–297) 30:17:35 26 (18%) 23 (16%) Primary malignant, 44 (30.3%) 23:13 40 (9–78) 47 (2–207) 9:4:16 15 (27) 13 (30%) Chondrosarcoma, 18 12:6 44 (20–78) 65 (2–207) 8:1:6 11 (61%) 11 (61%) Osteosarcoma, 9 5:2 37 (16–60) 21 (6–52) 0:0:3 2 (22%) 2 (22%) Ewing, 6 - 18 (9–29) 64 (12–96) 1:1:4 0 0 Chordoma, 5 4:1 48 (16–71) 40 (19–63) 0:1:0 0 0 Leiomyosarcoma, 2 0:2 57 (54–59) 31 (4–57) 0:0:2 1 (50%) 0 Synovial sarcoma, 2 1:1 45 (34–56) 27 (6–48) 0:0:1 1 (50%) 0 Neurofibrosarcoma, 1 1:0 16 17 0:1:0 0 0 Hemangiopericytoma, 1 0:1 46 100 - 0 0 Primary benign (aggressive), 62 (42.8%) 26:33 32 (6–69) 105 (6–295) 18:1:15 1 (2%) 7 (11%) GCT, 56 (90%) 21:32 32 (11–68) 104 (6–95) 18:1:15 1 (2%) 7 (13%) Hemangioma, 3 3:0 40 (36–48) 105 (24–224) - 0 0 ABC, 1 1:0 16 120 - 0 0 Neurofibroma, 1 0:1 51 51 - 0 0 Osteoblastoma, 1 1:0 6 208 - 0 0 Metastasis, 39 (26.9%) 16:18 51 (5–78) 41 (4–126) 3:12:4 10 (26%)_ 3 (8%) Breast, 6 1:5 51 (39–59) 41 (18–48) 0:2:1 1 (17%) 0 Thyroid, 6 3:3 59 (52–67) 34 (12–78) 0:2:0 0 0 Renal, 6 4:0 50 (40–56) 43 (12–84) 1:1:2 1 (17%) 1 (17%) Lung, 5 1:4 58 (47–78) 20 (4–42) 0:1:0 3 (60%) 1 (20%) Plasma cell tumor, 4 0:4 58 (46–66) 65 (24–126) - 0 0 Met osteosarcoma, 3 - 21 (16–29) 53 (8–114) 2:0:1 2 (67%) 0 Prostate, 2 2:00 63 (63–63) 61 (43–78) 0:1:0 1 (50%) 0 Teratoma, 2 2:0 16 (5–27) 55 (34–75) 0:2:0 0 0 Met Malignant Schwannoma, 1 0:1 72 19 0:1:0 0 0 Gastrointestinal, 1 1:0 55 25 - 1 (100%) 0 Endometrial cancer, 1 0:1 53 65 0:1:0 0 0 Hepatocellular, 1 1:0 65 24 0:1:0 1 (100%) 1 (100%) Liposarcoma, 1 1:0 54 14 - 0 0 aGender and excision margin were available for only 129 and 82 cases, respectively.
ABC, aneurysmal bone cyst; FU, follow-up; GCT, giant cell tumor; IL, intralesional; Marg, marginal.
Approach Type of Tumor, N(%) Compartment,
Extra:Intra n = 28Total Blood Loss in mL Total Operation Time in Minutes SSI
N/
Total NWeakness
N/
Total NAny Form of Complication
N/
Total NRecurrence
N/
Total NTotal, n = 72 19:9 2934 (150–19225) 680 (245–1516) 6/58 33/58 72/72 9/72 Posterior
Total, 35 (49%) 14:9 2024 (150–5500) 421 (245–675) 0/21 9/21 35/35 3/25 Primary malignant, 6 (17%) 1:2 1462 (180–2688) 476 (290–655) 0/5 2/5 6/6 0/6 Primary benign (aggressive), 10 (29%) 1:3 1702 (15–5500) 449 (320–675) 0/10 4/10 10/10 0/10 Metastasis, 19 (54%) 11:4 2372 (1000–4000) 388 (245–630) 0/6 3/6 19/10 3/19 Combined
Total, 37 (51%) 5:0 3794 (160–19225) 926 (475–1516) 6/37 24/37 37/37 4/37 Primary malignant, 9 (24%) 1:0 4273 (190–19225) 856 (540–1325) 3/9 8/9 9/9 3/9 Primary benign (aggressive), 18 (49%) 1:0 3853 (160–12370) 1083 (475–1516) 3/18 12/18 18/18 1/18 Metastasis, 10 (27%) 3:0 3257 (900–13460) 704 (540–990) 0/10 4/10 10/10 0/10 aSSI and weakness data were available for only 58 cases. Extra:Intracompartment ratio data were available for only 28 cases
N, number of cases; SSI, surgical site infection.
- Table 4
Univariate logistic regression model of factors predictive of recurrence and complications.
Recurrence Complications Variable Odd Ratio (95% CI) P Odds Ratio (95% CI) P Age 0.99 (0.96–1.02) 0.407 1.04 (1.02–1.06) 0.001 Gender (female vs male) 1.75 (0.67–1.56) 0.252 0.85 (0.43–1.70) 0.650 Metastatic disease (vs benign primary) 0.66 (0.16–2.70) 0.560 5.61 (2.17–14.52) <0.001 Primary malignancy (vs benign primary) 3.30 (1.19–9.13) 0.022 0.63 (0.28–1.40) 0.254 Primary malignancy (vs metastatic disease) 5.03 (1.31–19.30) 0.018 0.78 (0.07–0.46) <0.001 Extra compartmental tumor (vs intra- compartmental tumor) 7.5 (0.9–61.8) 0.060 0.50 (0.16–1.52) 0.223 Combined approach (vs single approach) 1.29 (0.27–6.24) 0.749 - - Adjuvant chemo and/or radiotherapy (vs no adjuvant treatment) 0.97 (0.32–2.93) 0.95 20.31 (5.21–79.21) 0.001 Intra-lesional margins (vs complete resection) 5.17 (1.45–18.4) 0.011 1.0 (0.00−E) 1 Marginal (vs complete resection) 1.03 (0.17–6.29) 0.97 1.0 1
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