{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:52:10Z","timestamp":1792219930466,"version":"4.4.0"},"reference-count":80,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The surgical management of spinal tumors has grown increasingly complex as treatment algorithms for both primary bone tumors of the spine and metastatic spinal disease have evolved in response to novel surgical techniques, rising complication rates, and additional data concerning adjunct therapies. In this review, we discuss actionable interventions for improved patient safety in the operative care for spinal tumors. Strategies for complication avoidance in the preoperative, intraoperative, and postoperative settings are discussed for approach-related morbidities, intraoperative hemorrhage, wound healing complications, cerebrospinal fluid (CSF) leak, thromboembolism, and failure of instrumentation and fusion. These strategies center on themes such as pre-operative imaging review and medical optimization, surgical dissection informed by meticulous attention to anatomic boundaries, and fastidious wound closure followed by thorough post-operative care.<\/jats:p>","DOI":"10.3390\/curroncol29030121","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T10:00:40Z","timestamp":1645783240000},"page":"1442-1454","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Complication Avoidance in Surgical Management of Vertebral Column Tumors"],"prefix":"10.3390","volume":"29","author":[{"given":"Joshua","family":"Feler","sequence":"first","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"},{"name":"Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Sun","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"},{"name":"Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankush","family":"Bajaj","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4130-3430","authenticated-orcid":false,"given":"Matthew","family":"Hagan","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6111-4461","authenticated-orcid":false,"given":"Samika","family":"Kanekar","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Leigh Zadnik","family":"Sullivan","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"},{"name":"Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared S.","family":"Fridley","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"},{"name":"Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA"},{"name":"Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12957-017-1136-1","article-title":"Epidemiological characteristics of primary spinal osseous tumors in Eastern China","volume":"15","author":"Zhou","year":"2017","journal-title":"World J. Surg. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1111\/os.12552","article-title":"Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study","volume":"11","author":"Wang","year":"2019","journal-title":"Orthop. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3171\/jns.1985.62.2.0227","article-title":"Intramedullary spinal cord metastasis. A Clinicopathological Study of 13 Cases","volume":"62","author":"Costigan","year":"1985","journal-title":"J. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta17420","article-title":"A systematic review of evidence on malignant spinal metastases: Natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression","volume":"17","author":"Sutcliffe","year":"2013","journal-title":"Health Technol. Assess."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1097\/BRS.0000000000002094","article-title":"En Bloc Resection Versus Intralesional Surgery in the Treatment of Giant Cell Tumor of the Spine","volume":"42","author":"Fisher","year":"2017","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"644","DOI":"10.3171\/2015.7.SPINE15201","article-title":"Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database","volume":"24","author":"Gokaslan","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/BRS.0000000000001485","article-title":"Surgical Management of Spinal Chondrosarcomas","volume":"41","author":"Fisher","year":"2016","journal-title":"Spine"},{"key":"ref_8","first-page":"166","article-title":"The treatment of vertebral metastases from renal cell carcinoma: A retrospective study","volume":"69","author":"Mosele","year":"2017","journal-title":"Minerva Urol. Nefrol. Ital. J. Urol. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"226","DOI":"10.21037\/atm.2019.01.25","article-title":"Total en bloc resection of primary and metastatic spine tumors","volume":"7","author":"Howell","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1634\/theoncologist.2012-0293","article-title":"The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors","volume":"18","author":"Laufer","year":"2013","journal-title":"Oncologist"},{"key":"ref_11","first-page":"396","article-title":"Neurological evaluation after radical resection of sacral neoplasms","volume":"32","author":"Fujimura","year":"1994","journal-title":"Paraplegia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s11999-015-4361-3","article-title":"How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function?","volume":"474","author":"Phukan","year":"2016","journal-title":"Clin. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3171\/2009.9.SPINE09506","article-title":"Neurological function after total en bloc spondylectomy for thoracic spinal tumors","volume":"12","author":"Murakami","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5435\/JAAOS-23-01-38","article-title":"Management of Metastatic Cervical Spine Tumors","volume":"23","author":"Mesfin","year":"2015","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"791","DOI":"10.3171\/jns.1998.89.5.0791","article-title":"Microsurgical anatomy of the artery of Adamkiewicz and its segmental artery","volume":"89","author":"Alleyne","year":"1998","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4080","DOI":"10.1007\/s00586-016-4641-y","article-title":"Total en bloc spondylectomy for locally aggressive and primary malignant tumors of the lumbar spine","volume":"25","author":"Sciubba","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1001\/archsurg.141.10.1025","article-title":"Methods and Complications of Anterior Exposure of the Thoracic and Lumbar Spine","volume":"141","author":"Ikard","year":"2006","journal-title":"Arch. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.amjsurg.2006.08.085","article-title":"Open anterior approaches for lumbar spine procedures","volume":"194","author":"Gumbs","year":"2007","journal-title":"Am. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.3171\/2021.2.FOCUS201117","article-title":"Intraoperative blood loss in oncological spine surgery","volume":"50","author":"Mohme","year":"2021","journal-title":"Neurosurg. Focus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1097\/01.brs.0000174114.90657.74","article-title":"The Surgical Management of Primary Tumors of the Spine: Initial Results of an Ongoing Prospective Cohort Study","volume":"30","author":"Fisher","year":"2005","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1227\/NEU.0b013e318207780c","article-title":"Predictors of Survival after Surgical Treatment of Spinal Metastasis","volume":"68","author":"Arrigo","year":"2011","journal-title":"Neurosurgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e308","DOI":"10.1016\/j.wneu.2020.03.202","article-title":"Rates, Risk Factors, and Complications of Red Blood Cell Transfusion in Metastatic Spinal Tumor Surgery: An Analysis of a Prospective Multicenter Surgical Database","volume":"139","author":"Ramos","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.3171\/foc.2003.15.2.4","article-title":"Embolization of sacral tumors","volume":"15","author":"Gottfried","year":"2003","journal-title":"Neurosurg. Focus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s13244-016-0492-7","article-title":"MRI in multiple myeloma: A pictorial review of diagnostic and post-treatment findings","volume":"7","author":"Dutoit","year":"2016","journal-title":"Insights Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1245\/s10434-014-4001-2","article-title":"Improved Survival in Osteosarcoma Patients with Atypical Low Vascularization","volume":"22","author":"Kunz","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.jvir.2014.11.014","article-title":"Preoperative Embolization in Surgical Treatment of Spinal Metastases: Single-Blind, Randomized Controlled Clinical Trial of Efficacy in Decreasing Intraoperative Blood Loss","volume":"26","author":"Clausen","year":"2015","journal-title":"J. Vasc. Interv. Radiol. JVIR"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1007\/s00586-014-3504-7","article-title":"Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery","volume":"24","author":"Weber","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"217","DOI":"10.21037\/atm.2019.01.04","article-title":"Cerebrospinal fluid leaks after spine tumor resection: Avoidance, recognition and management","volume":"7","author":"Barber","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"460","DOI":"10.5455\/medarh.2016.70.460-465","article-title":"CSF-Related Complications After Intradural Spinal Tumor Surgery: Utility of an Autologous Fat Graft","volume":"70","author":"Arnautovic","year":"2016","journal-title":"Med Arch."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.spinee.2013.06.044","article-title":"Comparison of dural repair techniques","volume":"15","author":"Dafford","year":"2015","journal-title":"Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1053\/jhsu.2001.22933","article-title":"Comparison of continuous and interrupted suture techniques in microvascular anastomosis","volume":"26","author":"Chen","year":"2001","journal-title":"J. Hand Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/0974-8237.65479","article-title":"Comparison of dural grafts in Chiari decompression surgery: Review of the literature","volume":"1","author":"Abla","year":"2010","journal-title":"J. Craniovertebral Junction Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1227\/01.NEU.0000089481.87226.F7","article-title":"Toward Optimal Tissue Sealants for Neurosurgery: Use of a Novel Hydrogel Sealant in a Canine Durotomy Repair Model","volume":"53","author":"Preul","year":"2003","journal-title":"Neurosurgery"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3171\/2014.3.SPINE13719","article-title":"Management of intended durotomy in minimally invasive intradural spine surgery: Clinical Article","volume":"21","author":"Tan","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"799","DOI":"10.3340\/jkns.2020.0350","article-title":"Reliability of Early Ambulation after Intradural Spine Surgery: Risk Factors and a Preventive Method for Cerebrospinal Fluid Leak Related Complications","volume":"64","author":"Lee","year":"2021","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00586-019-06144-5","article-title":"No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: A randomized controlled trial","volume":"29","author":"Farshad","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1097\/00007632-199910010-00017","article-title":"Management of Incidental Durotomy Without Mandatory Bed Rest. A Retrospective Review of 20 Cases","volume":"24","author":"Hodges","year":"1999","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/BSD.0b013e31827d7ad8","article-title":"Complications of Flat Bed Rest After Incidental Durotomy","volume":"29","author":"Radcliff","year":"2016","journal-title":"Clin. Spine Surg. Spine Publ."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"386","DOI":"10.14444\/6053","article-title":"Safe Discharge of Patients from an Ambulatory Care Center after Incidental Durotomy during Minimally Invasive Spine Surgery","volume":"13","author":"Francavilla","year":"2019","journal-title":"Int. J. Spine Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S262","DOI":"10.1097\/BRS.0000000000001817","article-title":"Changing the Adverse Event Profile in Metastatic Spine Surgery: An Evidence-Based Approach to Target Wound Complications and Instrumentation Failure","volume":"41","author":"Mesfin","year":"2016","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3171\/2017.10.SPINE1765","article-title":"Risk factors for wound-related reoperations in patients with metastatic spine tumor","volume":"28","author":"Carl","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"ref_42","first-page":"1862","article-title":"Risk factors for surgical site infections following spinal surgery","volume":"22","author":"Meng","year":"2015","journal-title":"J. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"368","DOI":"10.21037\/jss.2018.05.05","article-title":"Timing of surgery and radiotherapy in the management of metastatic spine disease: Expert opinion","volume":"4","author":"Lee","year":"2018","journal-title":"J. Spine Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1097\/BRS.0b013e3181f48fa9","article-title":"Postoperative Surgical Site Infections in Patients Undergoing Spinal Tumor Surgery: Incidence and Risk Factors","volume":"36","author":"Omeis","year":"2011","journal-title":"Spine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3171\/spi.2003.98.2.0149","article-title":"Risk factors for surgical site infection in spinal surgery","volume":"98","author":"Olsen","year":"2003","journal-title":"J. Neurosurg. Spine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3171\/2019.12.SPINE191238","article-title":"Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients","volume":"33","author":"Leary","year":"2020","journal-title":"J. Neurosurg. Spine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5114\/ada.2018.72585","article-title":"Wound healing complications in oncological patients: Perspectives for cellular therapy","volume":"36","author":"Wardowska","year":"2019","journal-title":"Postepy Dermatol. Allergol."},{"key":"ref_48","first-page":"533","article-title":"Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review","volume":"36","author":"Itshayek","year":"2010","journal-title":"Int. J. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1179\/1743132814Y.0000000380","article-title":"Timing of stereotactic radiosurgery and surgery and wound healing in patients with spinal tumors: A systematic review and expert opinions","volume":"36","author":"Itshayek","year":"2014","journal-title":"Neurol. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"5S","DOI":"10.1177\/2192568218799056","article-title":"Surgical Site Infection in Spine Surgery: Who Is at Risk?","volume":"8","author":"Yao","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"405","DOI":"10.3109\/07357907.2015.1048871","article-title":"Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Awareness and Prophylaxis Practices Reported by Patients with Cancer","volume":"33","author":"Aggarwal","year":"2015","journal-title":"Cancer Investig."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Razak, N.B.A., Jones, G., Bhandari, M., Berndt, M.C., and Metharom, P. (2018). Cancer-Associated Thrombosis: An Overview of Mechanisms, Risk Factors, and Treatment. Cancers, 10.","DOI":"10.3390\/cancers10100380"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1016\/S0049-3848(15)50432-5","article-title":"The mechanisms of cancer-associated thrombosis","volume":"135","author":"Falanga","year":"2015","journal-title":"Thromb. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1097\/CORR.0000000000000733","article-title":"High Risk of Symptomatic Venous Thromboembolism after Surgery for Spine Metastatic Bone Lesions: A Retrospective Study","volume":"477","author":"Groot","year":"2019","journal-title":"Clin. Orthop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"I-9","DOI":"10.1161\/01.CIR.0000078469.07362.E6","article-title":"Risk Factors for Venous Thromboembolism","volume":"107","author":"Anderson","year":"2003","journal-title":"Circulation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"681","DOI":"10.3171\/2017.3.SPINE161076","article-title":"Timing and risks of chemoprophylaxis after spinal surgery: A single-center experience with 6869 consecutive patients","volume":"27","author":"Dhillon","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"381S","DOI":"10.1378\/chest.08-0656","article-title":"Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)","volume":"133","author":"Geerts","year":"2008","journal-title":"Chest"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.surneu.2005.04.039","article-title":"A review of the risks and benefits of differing prophylaxis regimens for the treatment of deep venous thrombosis and pulmonary embolism in neurosurgery","volume":"64","author":"Epstein","year":"2005","journal-title":"Surg. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1161\/CIRCULATIONAHA.113.002690","article-title":"Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients","volume":"128","author":"Ho","year":"2013","journal-title":"Circulation"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1177\/2192568220962439","article-title":"Venous Thromboembolism Prophylaxis in Elective Spine Surgery","volume":"11","author":"Solaru","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"E16","DOI":"10.3171\/2016.8.FOCUS16112","article-title":"Bone graft options for spinal fusion following resection of spinal column tumors: Systematic review and meta-analysis","volume":"42","author":"Elder","year":"2017","journal-title":"Neurosurg. Focus"},{"key":"ref_62","first-page":"609","article-title":"Analysis of mechanical failure associated with reoperation in spinal fusion to the sacrum in adult spinal deformity","volume":"20","author":"Inoue","year":"2015","journal-title":"J. Orthop. Sci. Off. J. Jpn. Orthop. Assoc."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1016\/j.spinee.2013.10.028","article-title":"The incidence and patterns of hardware failure after separation surgery in patients with spinal metastatic tumors","volume":"14","author":"Amankulor","year":"2014","journal-title":"Spine J. Off. J. N. Am. Spine Soc."},{"key":"ref_64","first-page":"166","article-title":"Hardware failure in patients with metastatic cancer to the spine","volume":"45","author":"Pedreira","year":"2017","journal-title":"J. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3171\/spi.2005.3.2.0159","article-title":"Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: Operative and nonoperative management","volume":"3","author":"Donovan","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1002\/jcp.22807","article-title":"Methotrexate chemotherapy reduces osteogenesis but increases adipogenic potential in the bone marrow","volume":"227","author":"Georgiou","year":"2012","journal-title":"J. Cell. Physiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"E683","DOI":"10.1097\/BSD.0000000000000315","article-title":"The Correlation between Cage Subsidence, Bone Mineral Density, and Clinical Results in Posterior Lumbar Interbody Fusion","volume":"30","author":"Oh","year":"2017","journal-title":"Clin. Spine"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1097\/00007632-199411000-00008","article-title":"Effects of Bone Mineral Density on Pedicle Screw Fixation","volume":"19","author":"Halvorson","year":"1994","journal-title":"Spine"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.spinee.2020.08.002","article-title":"Osteoporosis increases the likelihood of revision surgery following a long spinal fusion for adult spinal deformity","volume":"21","author":"Gupta","year":"2021","journal-title":"Spine J. Off. J. N. Am. Spine Soc."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/j.spinee.2015.03.037","article-title":"Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability","volume":"15","author":"Moussazadeh","year":"2015","journal-title":"Spine J. Off. J. N. Am. Spine Soc."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.wneu.2021.06.078","article-title":"Cement-Augmented and Dual-Headed Posterior Screw Reconstruction after Corpectomy for Metastatic Tumor Resection","volume":"152","author":"Gilbert","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1093\/ons\/opy186","article-title":"Utility of Cement Augmentation via Percutaneous Fenestrated Pedicle Screws for Stabilization of Cancer-Related Spinal Instability","volume":"16","author":"Barzilai","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1177\/2192568217699392","article-title":"Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity","volume":"7","author":"Merrill","year":"2017","journal-title":"Glob. Spine J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1097\/BRS.0000000000000556","article-title":"Comparison of Standard 2-Rod Constructs to Multiple-Rod Constructs for Fixation Across 3-Column Spinal Osteotomies","volume":"39","author":"Hyun","year":"2014","journal-title":"Spine"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/BRS.0000000000000254","article-title":"Bone Marrow Concentrate With Allograft Equivalent to Autograft in Lumbar Fusions","volume":"39","author":"Johnson","year":"2014","journal-title":"Spine"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S205","DOI":"10.1097\/BRS.0000000000001835","article-title":"A Systematic Review with Consensus Expert Opinion of Best Reconstructive Techniques after Osseous En Bloc Spinal Column Tumor Resection","volume":"41","author":"Glennie","year":"2016","journal-title":"Spine"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1038\/s41393-019-0281-5","article-title":"Symptomatic postoperative spinal epidural hematoma after spine tumor surgery: Incidence, clinical features, and risk factors","volume":"57","author":"Gao","year":"2019","journal-title":"Spinal Cord"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1213\/ANE.0000000000001485","article-title":"Spine Surgery and Blood Loss: Systematic Review of Clinical Evidence","volume":"123","author":"Willner","year":"2016","journal-title":"Anesth. 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