Leiomyogenic Tumor of the Spine: A Systematic Review
by
,
Abdurrahman F. Kharbat
1,*,
Kishore Balasubramanian
2,
Kiran Sankarappan
2,
Ryan D. Morgan
3,
Khawaja M. Hassan
4,
Paolo Palmisciano
5,
Panayiotis E. Pelargos
1, 
Michael Chukwu
6,
Othman Bin Alamer
7,
Ali S. Haider
8,
Tarek Y. El Ahmadieh
9 and
John F. Burke
1 1
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
2
Division of Neurosurgery, Texas A&M University College of Medicine, Bryan, TX 77807, USA
3
Division of Neurosurgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
4
Department of Neurosurgery, King Edward Medical University, Lahore 54000, Pakistan
5
Department of Neurosurgery, University of California Davis, Davis, CA 95616, USA
6
Department of Surgery, New York Presbyterian Hospital/Weill Cornell, New York, NY 10065, USA
7
Department of Neurosurgery, University of Pittsburg Medical Center, Pittsburg, PA 15219, USA
8
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
9
Department of Neurosurgery, Loma Linda University, Loma Linda, CA 92354, USA
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(4), 748; https://doi.org/10.3390/cancers16040748
Submission received: 24 December 2023
/
Revised: 28 January 2024
/
Accepted: 29 January 2024
/
Published: 10 February 2024
(This article belongs to the Special Issue Bone and Spine Metastases)
Simple Summary
Due to limited published data and a lack of formal guidelines, the management of leiomyogenic spine tumors (LTS) is challenging. Here, we report the clinical characteristics of patients with LTSs, analyze treatment modalities and outcomes, and highlight prognostic factors associated with morbidity and survival. Additionally, we endeavor to delineate the efficacy of en bloc resection versus other surgical techniques and understand the impact of surgical techniques on surgical outcomes. In this study, we performed a systematic review of the literature to encapsulate the clinical characteristics of patients afflicted with LTSs, analyze treatment modalities and outcomes, and highlight prognostic factors that inform clinicians on morbidity and survival.
Abstract
The study cohort consisted of 83 patients with a mean age of 49.55 (SD 13.72) with a female preponderance (60 patients). Here, 32.14% of patients had primary LTS; the remaining were metastases. Clinical presentation included nonspecific back pain (57.83%), weakness (21.69%) and radicular pain (18.07%). History of uterine neoplasia was found in 33.73% of patients. LTS preferentially affected the thoracic spine (51.81%), followed by the lumbar (21.67%) spine. MRI alone was the most common imaging modality (33.33%); in other cases, it was used with CT (22.92%) or X-ray (16.67%); 19.23% of patients had Resection/Fixation, 15.38% had Total en bloc spondylectomy, and 10.26% had Corpectomy. A minority of patients had laminectomy and decompression. Among those with resection, 45.83% had a gross total resection, 29.17% had a subtotal resection, and 16.67% had a near total resection. Immunohistochemistry demonstrated positivity for actin (43.37%), desmin (31.33%), and Ki67 (25.30). At a follow-up of 19.3 months, 61.97% of patients were alive; 26.25% of 80 patients received no additional treatment, 23.75% received combination radiotherapy and chemotherapy, only chemotherapy was given to 20%, and radiotherapy was given to 17.5%. Few (2.5%) had further resection. For an average of 12.50 months, 42.31% had no symptoms, while others had residual (19.23%), other metastasis (15.38%), and pain (7.69%). On follow-up of 29 patients, most (68.97%) had resolved symptoms; 61.97% of the 71 patients followed were alive.
