{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:01:34Z","timestamp":1770742894735,"version":"3.49.0"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,3,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Osteosarcoma (OS) is a rare malignant bone tumor, with 4% of cases affecting the spine. OS in the spine is as common as Ewing sarcoma in the spine, comprising 10%\u201315% of cases, and occurs more frequently in older adults in comparison with OS of the limb. The standard treatment for limb OS involves neoadjuvant chemotherapy followed by en bloc resection with tumor-free margins. The prognosis for OS of the spine is significantly worse than that for OS of the limbs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This case report details a 17-year-old female with OS arising at T11, who has achieved a 20-year disease-free survival. The tumor affected 5 vertebrae, leading to motor paraplegia (American Spinal Injury Association grade B). Neoadjuvant chemotherapy and tumor-free margin en bloc resection, including the canal\u2019s contents, were completed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The case suggests that the poorer prognosis in spinal OS compared with limb OS is mainly due to the inability to achieve tumor-free margin en bloc resection, due to severe functional loss. In this peculiar case, subtotal paraplegia at the time of diagnosis helped the patient understand that cord amputation would result in a better final outcome. In all cases in which intentional transgression is required to preserve functions, gross-total excision combined with accelerated particle radiotherapy is an option, but long-term follow-up is still unclear.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24771\">https:\/\/thejns.org\/doi\/10.3171\/CASE24771<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24771","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T02:59:59Z","timestamp":1741575599000},"source":"Crossref","is-referenced-by-count":2,"title":["En bloc resection, including the cord for tumor-free margin, in a multilevel osteosarcoma of the spine: 20-year disease-free survival. Illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Federico","family":"Gaiani","sequence":"first","affiliation":[{"name":"Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Boriani","sequence":"additional","affiliation":[{"name":"Post Graduate Program of Orthopedics, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Gasbarrini","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"Cancer Treat Res","first-page":"3","article-title":"The epidemiology of osteosarcoma","volume":"152","author":"Ottaviani","year":"2009","unstructured":"Ottaviani GJaffe N.The epidemiology of osteosarcoma. Cancer Treat Res. 2009;152:3-13."},{"issue":"12","key":"bib2","series-title":"Spine J","first-page":"1941","article-title":"Epidemiologic and survival trends in adult primary bone tumors of the spine","volume":"19","author":"Kerr","year":"2019","unstructured":"Kerr DLDial BLLazarides ALEpidemiologic and survival trends in adult primary bone tumors of the spine. Spine J. 2019;19(12):1941-1949."},{"issue":"3","key":"bib3","series-title":"J Clin Oncol","first-page":"776","article-title":"Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols","volume":"20","author":"Bielack","year":"2002","unstructured":"Bielack SSKempf-Bielack BDelling GPrognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20(3):776-790."},{"issue":"4","key":"bib4","series-title":"Cancer","first-page":"1069","article-title":"Osteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group","volume":"94","author":"Ozaki","year":"2002","unstructured":"Ozaki TFlege SLiljenqvist UOsteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group. Cancer. 2002;94(4):1069-1077."},{"issue":"3","key":"bib5","series-title":"Eur Spine J","first-page":"405","article-title":"Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry","volume":"16","author":"Kelley","year":"2007","unstructured":"Kelley SPAshford RURao ASDickson RA.Primary bone tumours of the spine: a 42-year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J. 2007;16(3):405-409."},{"key":"bib6","series-title":"Clin Med Insights Oncol","first-page":"199","article-title":"Spinal osteosarcoma","volume":"7","author":"Katonis","year":"2013","unstructured":"Katonis PDatsis GKarantanas ASpinal osteosarcoma. Clin Med Insights Oncol. 2013;7:199-208."},{"issue":"1","key":"bib7","series-title":"Orthop Clin North Am","first-page":"21-v","article-title":"Primary malignant tumors of the spine","volume":"40","author":"Sundaresan","year":"2009","unstructured":"Sundaresan NRosen GBoriani S.Primary malignant tumors of the spine. Orthop Clin North Am. 2009;40(1):21-v."},{"issue":"suppl 1","key":"bib8","series-title":"Neurooncol Pract","first-page":"i10","article-title":"An overview of the tumors affecting the spine-inside to out","volume":"7","author":"Kumar","year":"2020","unstructured":"Kumar NTan WLBWei WVellayappan BA.An overview of the tumors affecting the spine-inside to out. Neurooncol Pract. 2020;7(suppl 1):i10-i17."},{"issue":"12","key":"bib9","series-title":"Spine","first-page":"1344","article-title":"Paget sarcoma of the spine: Scottish Bone Tumor Registry experience","volume":"31","author":"Scottish Bone Tumor Registry","year":"2006","unstructured":"Scottish Bone Tumor RegistrySharma HMehdi SA Paget sarcoma of the spine: Scottish Bone Tumor Registry experience. Spine. 2006;31(12):1344-1350."},{"key":"bib10","series-title":"Am Soc Clin Oncol Educ Book","first-page":"e656","article-title":"Chemotherapy for bone sarcomas in adults: the MD Anderson experience","author":"Benjamin","year":"2015","unstructured":"Benjamin RSWagner MJLivingston JARavi VPatel SR.Chemotherapy for bone sarcomas in adults: the MD Anderson experience. Am Soc Clin Oncol Educ Book. 2015:e656-e660."},{"issue":"4","key":"bib11","series-title":"Cancer Treat Rev","first-page":"523","article-title":"Osteosarcoma treatment\u2014where do we stand? A state of the art review","volume":"40","author":"Luetke","year":"2014","unstructured":"Luetke AMeyers PALewis IJuergens H.Osteosarcoma treatment\u2014where do we stand? A state of the art review. Cancer Treat Rev. 2014;40(4):523-532."},{"key":"bib12","series-title":"J Bone Oncol","article-title":"Prognostic factors in osteosarcoma: A study level meta-analysis and systematic review of current practice","volume":"21","author":"Xin","year":"2020","unstructured":"Xin SWei G.Prognostic factors in osteosarcoma: A study level meta-analysis and systematic review of current practice. J Bone Oncol. 2020;21:100281."},{"issue":"2","key":"bib13","series-title":"Semin Spine Surg","first-page":"76","article-title":"The role of \u201ctumor-free margins\u201d in the resection of spinal tumors: who should be treating spine tumors?","volume":"21","author":"Boriani","year":"2009","unstructured":"Boriani SWeinstein JN.The role of \u201ctumor-free margins\u201d in the resection of spinal tumors: who should be treating spine tumors? Semin Spine Surg. 2009;21(2):76-85."},{"issue":"3","key":"bib14","series-title":"J Spine Surg","first-page":"668","article-title":"En bloc resection in the spine: a procedure of surgical oncology","volume":"4","author":"Boriani","year":"2018","unstructured":"Boriani S. En bloc resection in the spine: a procedure of surgical oncology. 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Spine. 2011;36(10):830-836."},{"issue":"17","key":"bib19","series-title":"Spine","first-page":"E334","article-title":"Dura resection in combination with en bloc spondylectomy for primary malignant tumors of the spine","volume":"28","author":"Krepler","year":"2003","unstructured":"Krepler PWindhager RToma CDKitz KKotz R.Dura resection in combination with en bloc spondylectomy for primary malignant tumors of the spine. Spine. 2003;28(17):E334-E338."},{"issue":"1","key":"bib20","series-title":"J Clin Neurosci","first-page":"70","article-title":"Two-level total en bloc lumbar spondylectomy with dural resection for metastatic renal cell carcinoma","volume":"15","author":"Aryan","year":"2008","unstructured":"Aryan HEAcosta FLAmes CP.Two-level total en bloc lumbar spondylectomy with dural resection for metastatic renal cell carcinoma. J Clin Neurosci. 2008;15(1):70-72."},{"issue":"4","key":"bib21","series-title":"Spine","first-page":"E97","article-title":"Ligation and partial excision of the cauda equina as part of a wide resection of vertebral osteosarcoma: a case report and description of surgical technique","volume":"30","author":"Keynan","year":"2005","unstructured":"Keynan OFisher CGBoyd MCO\u2019Connell JXDvorak MF.Ligation and partial excision of the cauda equina as part of a wide resection of vertebral osteosarcoma: a case report and description of surgical technique. 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J Bone Joint Surg Br. 2002;84(1):88-92."},{"issue":"2","key":"bib24","series-title":"Neurosurgery","first-page":"A54","article-title":"Stereotactic radiosurgery for the treatment of primary sarcomas and sarcoma metastases of the spine","volume":"64","author":"Levine","year":"2009","unstructured":"Levine AMColeman CHorasek S.Stereotactic radiosurgery for the treatment of primary sarcomas and sarcoma metastases of the spine. Neurosurgery. 2009;64(2 suppl):A54-A59."},{"issue":"2","key":"bib25","series-title":"J Surg Oncol","first-page":"115","article-title":"Long-term results of Phase II study of high dose photon\/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas","volume":"110","author":"DeLaney","year":"2014","unstructured":"DeLaney TFLiebsch NJPedlow FXLong-term results of Phase II study of high dose photon\/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas. J Surg Oncol. 2014;110(2):115-122."},{"issue":"4","key":"bib26","series-title":"Eur Spine J","first-page":"874","article-title":"Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report","volume":"27","author":"Boriani","year":"2018","unstructured":"Boriani STedesco GMing LCarbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: a preliminary report. Eur Spine J. 2018;27(4):874-881."},{"issue":"4","key":"bib27","series-title":"Neurosurg Rev","first-page":"2163","article-title":"Carbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging","volume":"44","author":"Kr\u00e4tzig","year":"2021","unstructured":"Kr\u00e4tzig TMende KCMohme MCarbon fiber-reinforced PEEK versus titanium implants: an in vitro comparison of susceptibility artifacts in CT and MR imaging. Neurosurg Rev. 2021;44(4):2163-2170."},{"issue":"24","key":"bib28","series-title":"Phys Med Biol","first-page":"245031","article-title":"Assessing the advantages of CFR-PEEK over titanium spinal stabilization implants in proton therapy\u2014a phantom study","volume":"65","author":"Poel","year":"2020","unstructured":"Poel RBelosi FAlbertini FAssessing the advantages of CFR-PEEK over titanium spinal stabilization implants in proton therapy\u2014a phantom study. Phys Med Biol. 2020;65(24):245031."},{"issue":"5","key":"bib29","series-title":"Neurosurg Focus","article-title":"Carbon fiber-reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes","volume":"50","author":"Neal","year":"2021","unstructured":"Neal MTRichards AECurley KLCarbon fiber-reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes. Neurosurg Focus. 2021;50(5):E13."},{"issue":"3","key":"bib30","series-title":"J Spine Surg","first-page":"323","article-title":"Composite PEEK\/carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors","volume":"3","author":"Tedesco","year":"2017","unstructured":"Tedesco GGasbarrini ABandiera SGhermandi RBoriani S.Composite PEEK\/carbon fiber implants can increase the effectiveness of radiotherapy in the management of spine tumors. J Spine Surg. 2017;3(3):323-329."},{"issue":"1","key":"bib31","series-title":"Spine","first-page":"46","article-title":"The role of en bloc resection in the modern era for primary spine tumors","volume":"49","author":"Yeung","year":"2024","unstructured":"Yeung CMBilsky MBoland PJVaynrub M.The role of en bloc resection in the modern era for primary spine tumors. Spine. 2024;49(1):46-57."},{"issue":"16_suppl","key":"bib32","series-title":"JCO","first-page":"11532","article-title":"Spine high-grade osteosarcoma in the era of radiotherapy with high-energy charged particles: a single institution retrospective analysis","volume":"40","author":"Evangelisti","year":"2022","unstructured":"Evangelisti GFalzetti LPalmerini ESpine high-grade osteosarcoma in the era of radiotherapy with high-energy charged particles: a single institution retrospective analysis. JCO. 2022;40(16_suppl):11532-11532."},{"issue":"6","key":"bib33","series-title":"Cancer J","first-page":"409","article-title":"Proton therapy for sarcomas","volume":"20","author":"Keole","year":"2014","unstructured":"Keole SAshman JBDaniels TB.Proton therapy for sarcomas. Cancer J. 2014;20(6):409-414."},{"key":"bib1","series-title":"Cancer Treat Res","first-page":"3","article-title":"The epidemiology of osteosarcoma","volume":"152","author":"Ottaviani","year":"2009","unstructured":"Ottaviani GJaffe N.The epidemiology of osteosarcoma. Cancer Treat Res. 2009;152:3-13."},{"issue":"12","key":"bib2","series-title":"Spine J","first-page":"1941","article-title":"Epidemiologic and survival trends in adult primary bone tumors of the spine","volume":"19","author":"Kerr","year":"2019","unstructured":"Kerr DLDial BLLazarides ALEpidemiologic and survival trends in adult primary bone tumors of the spine. Spine J. 2019;19(12):1941-1949."},{"issue":"3","key":"bib3","series-title":"J Clin Oncol","first-page":"776","article-title":"Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols","volume":"20","author":"Bielack","year":"2002","unstructured":"Bielack SSKempf-Bielack BDelling GPrognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20(3):776-790."},{"issue":"4","key":"bib4","series-title":"Cancer","first-page":"1069","article-title":"Osteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group","volume":"94","author":"Ozaki","year":"2002","unstructured":"Ozaki TFlege SLiljenqvist UOsteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group. 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