title: Increase of IL-12 following reconstruction for total en bloc spondylectomy using frozen autografts treated with liquid nitrogen.
abstract: BACKGROUND
  Total en bloc spondylectomy (TES) is a surgery designed to achieve complete resection of a malignant spinal tumor such as spinal metastasis. Although this procedure decreases the rate of local recurrence, it is questionable whether local control prolongs patient's survival. We developed a "second-generation TES" that brings about TES enhancing antitumor immunity to prolong patient's survival. Our purpose is to present a second-generation TES applied tumor-induced cryoimmunology and assess the immunity-enhancing effect after implementing this surgery.
  
  
  METHODS
  We performed a retrospective review of prospectively collected data in second-generation TES as carried out in 56 cases. In second-generation TES, instead of harvesting autograft from the ilium or fibula, the resected lamina and vertebral body from TES are frozen using liquid nitrogen and used as grafted bone for spinal reconstruction. In recent 26 of the 56 cases, in addition to the TES procedure, a small amount of the tumor tissue from the resected tumor-bearing vertebra was also placed into liquid nitrogen. This small amount of tumor tissue was then implanted subcutaneously on one side of the axilla. In 52 of 56 cases, measurement of interleukin 12 (IL-12) was performed before surgery and at both 1 and 3 months after surgery.
  
  
  RESULTS
  IL-12 increased after TES surgery in 38 of 52 cases (73.1%). The mean IL-12 relative concentrations at both 1 and 3 months after surgery, as compared to before surgery, were significantly higher (121±89 and 149±111%: P<0.05 and P<0.01).
  
  
  CONCLUSIONS
  Our results show that second-generation TES may provide not only a local radical cure but also a systemic immunological enhancement. Further prolonged survival in patients with a malignant spinal tumor is promising by second-generation TES.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan. hmuraka@med.kanazawa-u.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.forename: Satoru
authors.initials: S
authors.lastname: Demura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kato
authors.forename: Hideji
authors.initials: H
authors.lastname: Nishida
authors.forename: Katsuhito
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Kei
authors.initials: K
authors.lastname: Inoue
authors.forename: Takashi
authors.initials: T
authors.lastname: Ota
authors.forename: Kazuya
authors.initials: K
authors.lastname: Shinmura
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yokogawa
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D015925:Cryopreservation / Q000379:methods; D005260:Female; D005360:Fibula / Q000637:transplantation; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D018664:Interleukin-12 / Q000378:metabolism*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009584:Nitrogen; D019651:Plastic Surgery Procedures / Q000379:methods*; D012447:Sacrum / Q000601:surgery; D013125:Spinal Neoplasms / Q000378:metabolism / Q000556:secondary / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018664:Interleukin-12; D009584:Nitrogen