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Cui Y, Mi C, Wang B, Pan Y, Lin Y, Shi X. Mini-open compared with the trans-tubular approach in patients with spinal metastases underwent decompression surgery---a retrospective cohort study. BMC Cancer 2023; 23:1226. [PMID: 38093349 PMCID: PMC10720050 DOI: 10.1186/s12885-023-11730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the perioperative safety and efficacy of the Mini-open and trans-tubular approach in patients with spinal metastases who underwent decompression surgery. METHODS 37 consecutive patients with spinal metastases who underwent decompression surgery through a Mini-open or trans-tubular approach were retrospectively reviewed between June 2017 and June 2022. Thirty-four patients were included in this study. 19 underwent decompression surgery through the Mini-open approach, and 15 underwent the Trans-tubular approach. T-test and chi-square test were used to evaluate the difference between baseline data and primary and secondary outcomes. RESULTS Baseline characteristics did not differ significantly between Trans-tubular and Mini-open groups except for the Ambulatory status (P < 0.001). There was no significant difference in blood loss between the two groups (P = 0.061). Operative time, intraoperative blood transfusion, intraoperative complication (dural tear), and postoperative hospitalization were comparable in the two groups (P > 0.05). The trans-tubular group had significantly less amount of postoperative drainage (133.5 ± 30.9 ml vs. 364.5 ± 64.2 ml, p = 0.003), and the time of drainage (3.1 ± 0.2 days vs. 4.6 ± 0.5 days, p = 0.019) compared with Mini-open group (P < 0.05). Sub-group analysis showed that for patients with hypo-vascular tumors, the Trans-tubular group had significantly less blood loss than the Mini-open group (951.1 ± 171.7 ml vs. 1599.1 ± 105.7 ml, P = 0.026). CONCLUSIONS Decompression through Mini-open or Trans-tubular was safe and effective for patients with spinal metastases. The trans-tubular approach might be more suitable for patients with hypo-vascular tumors.
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Affiliation(s)
- Yunpeng Cui
- Department of Orthopaedics, Peking University First Hospital, Beijing, China
| | - Chuan Mi
- Department of Orthopaedics, Peking University First Hospital, Beijing, China
| | - Bing Wang
- Department of Orthopaedics, Peking University First Hospital, Beijing, China
| | - Yuanxing Pan
- Department of Orthopaedics, Peking University First Hospital, Beijing, China
| | - Yunfei Lin
- Department of Orthopaedics, Peking University First Hospital, Beijing, China
| | - Xuedong Shi
- Department of Orthopaedics, Peking University First Hospital, Beijing, China.
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2
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Pipola V, Pasini S, Ghermandi R, Girolami M, Falzetti L, Pérez S, Bas T, Gasbarrini A. Management of symptomatic spine metastases: A multidisciplinary approach based flow-chart. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S552-S559. [PMID: 37774915 DOI: 10.1016/j.recot.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 10/01/2023] Open
Abstract
We described an algorithm for the management of spinal metastases in which the importance of single parameters varies depending on when they are contemplated. Each patient follows his own «personal» sequential process which does not necessarily consider all the parameters each time as some may be irrelevant for the purpose of choosing the type of treatment for that single individual. For instance, a patient in general poor condition with a high ASA score is usually not a candidate for surgery, regardless of the primary tumor nature or the number of metastases. For this patient, the most important element would be the sensitivity of the tumor to adjuvant treatment. Similarly, a patient with acute and progressive spinal cord injury would undergo surgical decompression and stabilization without considering a more strenuous intervention.
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Affiliation(s)
- V Pipola
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia.
| | - S Pasini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - R Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - M Girolami
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - L Falzetti
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - S Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - T Bas
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
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3
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Pipola V, Pasini S, Ghermandi R, Girolami M, Falzetti L, Pérez S, Bas T, Gasbarrini A. Management of symptomatic spine metastases: A multidisciplinary approach based flow-chart. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:552-559. [PMID: 37343934 DOI: 10.1016/j.recot.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
We described an algorithm for the management of spinal metastases in which the importance of single parameters varies depending on when they are contemplated. Each patient follows his own "personal" sequential process which does not necessarily consider all the parameters each time as some may be irrelevant for the purpose of choosing the type of treatment for that single individual. For instance, a patient in general poor condition with a high "ASA" score is usually not a candidate for surgery, regardless of the primary tumor nature or the number of metastases. For this patient, the most important element would be the sensitivity of the tumor to adjuvant treatment. Similarly, a patient with acute and progressive spinal cord injury would undergo surgical decompression and stabilization without considering a more strenuous intervention.
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Affiliation(s)
- V Pipola
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
| | - S Pasini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - R Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - M Girolami
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - L Falzetti
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - S Pérez
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - T Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - A Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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4
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Xu L, Huang W, Cai W, Sun Z, Fang M, Ji Y, Wang S, Zhang J, Hu T, Cheng M, Yan W. Comparison of Surgical Outcomes Between Separation Surgery and Piecemeal Spondylectomy for Spinal Metastasis: A Retrospective Analysis. Front Surg 2021; 8:686930. [PMID: 34881284 PMCID: PMC8645642 DOI: 10.3389/fsurg.2021.686930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to compare the outcomes between piecemeal spondylectomy and separation surgery for patients with spinal metastasis. Summary of Background Data: Piecemeal spondylectomy and separation surgery are two widely-used treatment options for spinal metastasis. However, no studies have compared the surgical outcomes between both treatment modalities. Methods: Patients with spinal metastasis who underwent piecemeal spondylectomy or separation surgery between August 2017 and April 2020 at our spine center were recruited. Demographic, preoperative, perioperative, and follow-up data were collected and analyzed. Kaplan–Meier analysis and the log-rank test were used to analyze overall survival (OS) and progression-free survival (PFS) in patients with spinal metastasis. Results: Overall, 26 patients were treated with piecemeal spondylectomy, and 29 underwent separation surgery with postoperative stereotactic radiosurgery. Both groups showed significant postoperative improvements in neurological status. The piecemeal spondylectomy group had significantly more blood loss (1784.62 ± 833.64 vs. 1165.52 ± 307.38 ml) and required longer operative time (4.76 ± 0.93 vs. 3.73 ± 1.15 h) than the separation surgery group. No significant difference in OS was found between the groups (P = 0.064); however, patients in the separation surgery group experienced less local recurrence than those in the piecemeal spondylectomy group (P = 0.0014). Notably, significant differences were detected in the development of complications between the groups (P = 0.029). Conclusion: Separation surgery led to less blood loss and reduced complications and had shorter operation time than piecemeal spondylectomy. Although no significant differences were found in OS between the groups, separation surgery was associated with better PFS compared with piecemeal spondylectomy. These findings suggest that separation surgery has some advantages over piecemeal spondylectomy for patients with spinal metastatic disease.
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Affiliation(s)
- Lun Xu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wending Huang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiluo Cai
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - ZhengWang Sun
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Meng Fang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yingzheng Ji
- Department of Orthopedic, Naval Medical Center of PLA, Second Military Medical University, Shanghai, China
| | - Shuoer Wang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianing Zhang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tu Hu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mo Cheng
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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5
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Porras JL, Pennington Z, Hung B, Hersh A, Schilling A, Goodwin CR, Sciubba DM. Radiotherapy and Surgical Advances in the Treatment of Metastatic Spine Tumors: A Narrative Review. World Neurosurg 2021; 151:147-154. [PMID: 34023467 DOI: 10.1016/j.wneu.2021.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
Spine tumors encompass a wide range of diseases with a commensurately broad spectrum of available treatments, ranging from radiation for spinal metastases to highly invasive en bloc resection for primary vertebral column malignancies. This high variability in treatment approaches stems both from variability in the goals of surgery (e.g., oncologic cure vs. symptom palliation) and from the significant advancements in surgical technologies that have been made over the past 2 decades. Among these advancements are improvements in surgical technique, namely minimally invasive approaches, increased availability of focused radiation modalities (e.g., proton therapy and linear accelerator devices), and new surgical technologies, such as carbon fiber-reinforced polyether ether ketone rods. In addition, several groups have described nonsurgical interventions, such as vertebroplasty and kyphoplasty for spinal instability secondary to pathologic fracture, and lesion ablation with spinal laser interstitial thermoablation, radiofrequency ablation, or cryoablation. We provide an overview of the latest technological advancements in spinal oncology and their potential usefulness for modern spinal oncologists.
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Affiliation(s)
- Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bethany Hung
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
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6
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Is Open Surgery for Metastatic Spinal Cord Compression Secondary to Lung Cancer Really Beneficial? A Systematic Review. World Neurosurg 2020; 144:e253-e263. [PMID: 32827738 DOI: 10.1016/j.wneu.2020.08.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Spinal cord compression secondary to metastatic epidural lung cancer generally has a worse prognosis when compared with other metastatic tumors. The purpose of this study was to determine the impact of open surgery on the survival time, ambulation status, and associated prognostic variables of these patients over the past 2 decades. METHODS We searched the PubMed, MEDLINE, and CENTRAL databases to identify patients with spinal cord compression secondary to metastatic lung cancer. We assessed the role of the following factors on survival outcome and ambulation recovery: Karnofsky Performance Scale, number of extraspinal bone metastases, number of metastases in the vertebrae, major internal organs involvement, vertebral location of spinal metastases, and neurologic status. RESULTS Our initial search yielded 367 articles, from which 11 studies met the eligibility criteria for a total of 395 patients. Significant correlations with the survival period and the recovery in ambulation were found in the prognostic score for the number of metastases in vertebrae (R = 0.74 and 0.88, respectively), and in the prognostic score for metastases to major internal organs (R = 0.82 and 0.81, respectively). A significant correlation with survival period was found in the numbers of extraspinal bone metastases (R = -0.82). The rates of major complications were comparable with those for open surgery for metastatic tumors of other origin. CONCLUSIONS Fewer vertebral metastases and less major internal organ involvement were associated with longer survival periods and greater ambulation recovery in patients undergoing open surgery for spinal cord compression secondary to metastatic lung cancer.
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7
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MERELES MAXIMILIANOE, ESTEFAN MARTÍNM, PETRACCHI MATÍASG, BASSANI JULIOE, GRUENBERG MARCELO, SOLÁ CARLOSA. EN BLOC VERTEBRAL RESECTION FOR PRIMARY AND METASTATIC SPINE TUMORS. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201901222788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective Primary and secondary spine tumors occur frequently and treating them surgically has gained prominence. The objective of this study was to evaluate the outcomes and complications in a series of patients with primary and secondary vertebral tumors treated by en bloc vertebral resection. Methods A retrospective review of the patients who underwent en bloc vertebral resection between 2004 and 2017 was conducted. Results During the study period, 16 patients underwent en bloc vertebral resection. They were divided into primary tumor and metastatic tumor groups, 11 being primary tumors and 5 metastatic tumors. The average follow-up period was 95 months (3-156 months). The patients were treated by the same surgical team and the analysis was carried out by an independent observer. Conclusion In this case series, the results where comparable to those reported in the literature in terms of complications, survival, recurrence and neurological status. It is a demanding surgical technique, with a high percentage of morbidity and mortality, nevertheless, it allows local control and recurrence of the lesion. Level of evidence I; Case Series.
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Affiliation(s)
- MAXIMILIANO E MERELES
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - MARTÍN M ESTEFAN
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - MATÍAS G PETRACCHI
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - JULIO E BASSANI
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - MARCELO GRUENBERG
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
| | - CARLOS A SOLÁ
- Instituto de Ortopedia "Carlos E. Ottolenghi, Argentina; Hospital Italiano de Buenos Aires, Argentina
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8
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Lun DX, Xu LN, Wang F, Yang XG, Yu XC, Zhang GC, Hu YC. Prognostic Differences in Patients with Solitary and Multiple Spinal Metastases. Orthop Surg 2019; 11:443-450. [PMID: 31179610 PMCID: PMC6595110 DOI: 10.1111/os.12470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives To investigate the association between the number of metastases to the spine and survival in patients with metastatic spinal cord compression (MSCC), as well as the prognosis difference between patients with solitary spinal metastasis (SSM) and multiple spinal metastases (MSM). Methods Three institutional databases were searched to identify all patients who had undergone spinal surgery for metastatic spinal tumors between March 2002 and June 2010. As well as age and gender, preoperative medical conditions were collected from medical records, including primary tumor, preoperative Frankel score, other bone metastases, preoperative Karnofsky performance status (KPS), number of involved vertebrae, pathological fracture metastasis site, serum albumin, sphincter dysfunction and the time of developing motor deficits before surgery. Survival data were obtained from medical records or via telephone follow‐ups. Univariate and multivariate predictors of overall survival for each group were assessed using the Cox proportional hazards model. Results The median postoperative survival time was 6.0 ± 0.6 months (95% confidence interval [CI] 4.8–7.2) in patients with SSM and 7.0 ± 1.0 months (95% CI 5.1–8.9) in patients with MSM (P = 0.238). The difference in survival was not significant between groups. Furthermore, univariate analysis showed that the number of spinal metastases had no significant association with survival (P = 0.075). Primary tumor (P = 0.004) and preoperative KPS (P < 0.001) were independent prognostic factors in the whole cohort; primary tumor (P = 0.020), time of developing motor deficit (P = 0.041) and preoperative KPS (P = 0.038) were independent prognostic factors in patients with SSM; while preoperative KPS (P = 0.001) and serum album level (P < 0.001) were independent prognostic factors in patients with MSM. Conclusion The number of spinal metastases has not proven to be useful in predicting the prognosis for patients with MSCC. Consequently, more aggressive operations should be considered for patients with multiple spinal metastases.
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Affiliation(s)
- Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Li-Na Xu
- Department of Respiratory Medicine, Weifang People's Hospital, Weifang, China
| | - Feng Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | | | - Xiu-Chun Yu
- Department of Orthopaedic Oncology, Jinan Military General Hospital, Jinan, China
| | - Guo-Chuan Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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9
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Barzilai O, Boriani S, Fisher CG, Sahgal A, Verlaan JJ, Gokaslan ZL, Lazary A, Bettegowda C, Rhines LD, Laufer I. Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice. Global Spine J 2019; 9:98S-107S. [PMID: 31157152 PMCID: PMC6512191 DOI: 10.1177/2192568219830323] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVE To provide an overview of the recent advances in spinal oncology, emphasizing the key role of the surgeon in the treatment of patients with spinal metastatic tumors. METHODS Literature review. RESULTS Therapeutic advances led to longer survival times among cancer patients, placing significant emphasis on durable local control, optimization of quality of life, and daily function for patients with spinal metastatic tumors. Recent integration of modern diagnostic tools, precision oncologic treatment, and widespread use of new technologies has transformed the treatment of spinal metastases. Currently, multidisciplinary spinal oncology teams include spinal surgeons, radiation and medical oncologists, pain and rehabilitation specialists, and interventional radiologists. Consistent use of common language facilitates communication, definition of treatment indications and outcomes, alongside comparative clinical research. The main parameters used to characterize patients with spinal metastases include functional status and health-related quality of life, the spinal instability neoplastic score, the epidural spinal cord compression scale, tumor histology, and genomic profile. CONCLUSIONS Stereotactic body radiotherapy revolutionized spinal oncology through delivery of durable local tumor control regardless of tumor histology. Currently, the major surgical indications include mechanical instability and high-grade spinal cord compression, when applicable, with surgery providing notable improvement in the quality of life and functional status for appropriately selected patients. Surgical trends include less invasive surgery with emphasis on durable local control and spinal stabilization.
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Affiliation(s)
- Ori Barzilai
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Charles G. Fisher
- University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Arjun Sahgal
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Aron Lazary
- National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | | | | | - Ilya Laufer
- Memorial Sloan-Kettering Cancer Center, New York, NY
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10
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Tsagozis P, Bauer HCF. Outcome of Surgical Treatment for Spinal Cord Compression in Patients With Hematological Malignancy. Int J Spine Surg 2019; 13:186-191. [PMID: 31131219 DOI: 10.14444/6025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background We investigated the outcome of surgical treatment of patients with radiosensitive hematological malignancies presenting with spinal cord compression. Methods Retrospective review of 50 patients who had treatment between 1993 and 2012. Results The neurological outcome was favorable in 35 patients, stable in 12, whereas 3 patients deteriorated. Decompression within 48 hours from referral was associated with a superior neurological recovery (P = .001). Complications were noted in 11 patients, and 6 of these underwent secondary surgery. Early (30-day) mortality was 8%. Radiotherapy was associated with increased incidence of complications (χ2 = 0.009). Patients who had low blood hemoglobin preoperatively as well as those who remained totally bedridden postoperatively had an inferior overall survival rate (P < .001). Conclusion Patients with cord compression from hematological malignancy benefit from early surgical decompression. There is an inherent high risk for complications, which increases further if radiotherapy is given. Patients failing to ambulate after surgery have a poor prognosis.
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Affiliation(s)
- Panagiotis Tsagozis
- Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik C F Bauer
- Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
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11
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Dai T, Pan T, Zhang X, Chen G, Lu P, Shi K. Feasibility of total en-bloc spondylectomy on L5 by a posterior-only approach: An autopsy study. J Bone Oncol 2019; 14:100204. [PMID: 30627510 PMCID: PMC6260441 DOI: 10.1016/j.jbo.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Purpose To obtain a better understanding of the structures around L5 vertebra and provide some anatomical evidence of the feasibility of total en-bloc spondylectomy (TES) on L5 in a posterior-only approach. Methods 12 simulated TESs on L5 by a posterior-only approach were conducted on human cadavers. The distance between the traction point of L4 nerve root and the dural sac (Da), the anterior-posterior diameter of the vertebral body,(Va), the distance between the start point of L4 nerve root and the traction point of L5 nerve root (Dh) and the height of the vertebral body (Vh) were measured. Paired t-test and liner regression were performed to determine the difference and correlation between Da and Va, and between Dh and Vh. The risk of nerve roots or blood vessels damages, and the obstruction caused by iliac wings were evaluated. Results Liner correlations were found between Da and Va, and between Dh and Vh. The regression equations were Da = 0.6673Va + 11.28 and Dh = 1.009Vh + 1.003. There are statistical significant differences between Dh and Vh, and between Da and Va in those whose Va < 34.96 mm. Nerve roots or blood vessels damages and the obstruction caused by iliac wing were able to be avoided. Conclusions If the patient has an anterior-posterior diameter of L5 vertebral body shorter than 34.96 mm, it is possible that the vertebral body can be taken out during TES in a posterior-only approach. Prevention of nerve roots or blood vessels damages, and the obstruction caused by iliac wings are difficulties of this procedure yet not insurmountable. TES on L5 by a posterior-only approach might a possible alternative in treating diseases like L5 vertebral body tumors.
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Affiliation(s)
- Teng Dai
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Ting Pan
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Xing Zhang
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Gang Chen
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Pei Lu
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Keqin Shi
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
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12
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Ohashi M, Hirano T, Watanabe K, Hasegawa K, Ito T, Katsumi K, Shoji H, Mizouchi T, Takahashi I, Homma T, Endo N. En Bloc Spondylectomy for Spinal Metastases: Detailed Oncological Outcomes at a Minimum of 2 Years after Surgery. Asian Spine J 2018; 13:296-304. [PMID: 30481978 PMCID: PMC6454284 DOI: 10.31616/asj.2018.0145] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/12/2018] [Indexed: 01/06/2023] Open
Abstract
Study Design Retrospective case series. Purpose To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. Overview of Literature Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. Methods We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40–77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan–Meier method, and groups were compared using the log-rank method. Results The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71–39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. Conclusions Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.
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Affiliation(s)
- Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | | | - Takui Ito
- Department of Orthopedic Surgery, Niigata City General Hospital, Niigata, Japan
| | - Keiichi Katsumi
- Department of Orthopedic Surgery, Uonuma Kikan Hospital, Niigata, Japan
| | - Hirokazu Shoji
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tatsuki Mizouchi
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Ikuko Takahashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takao Homma
- Niigata Spine Surgery Center, Niigata, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
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Liu P, Jiang L, Liang Y, Wang H, Zhou H, Li X, Lin H, Zhou X, Dong J. Are older patients with solitary spinal metastases fit for total en-bloc surgery? Clin Neurol Neurosurg 2018; 170:20-26. [DOI: 10.1016/j.clineuro.2018.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 11/16/2022]
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Kumar N, Patel R, Wadhwa AC, Kumar A, Milavec HM, Sonawane D, Singh G, Benneker LM. Basic concepts in metal work failure after metastatic spine tumour surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:806-814. [DOI: 10.1007/s00586-017-5405-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/07/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
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Roato I, Massè A, Piana R, Ferracini R. Bone Metastasis from Solid Tumors: Biologic and Clinical State of the Art. Clin Rev Bone Miner Metab 2017. [DOI: 10.1007/s12018-017-9233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Bian C, Chen N, Li XL, Zhou XG, Lin H, Jiang LB, Liu WM, Chen Q, Dong J. Surgery Combined with Radiotherapy to Treat Spinal Tumors: A Review of Published Reports. Orthop Surg 2017; 8:97-104. [PMID: 27384717 DOI: 10.1111/os.12230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
Spinal tumors result in high morbidity and a high rate of lower limb paralysis. Both surgical therapy and radiation therapy (RT) are used to treat spinal tumors; however, how best to combine these two therapies to maximize the benefits and minimize the risks is still being debated. It is also difficult to decide the optimal timing, course and dose of RT, especially in pregnant women and children. The aim of this review is to assist surgeons who are dealing with spinal tumors by providing comprehensive information about advanced techniques for administering RT with greater precision and safety, and about the impact of various ways of combining surgery and RT on therapeutic outcomes. We here review published reports about treating spinal tumors with a combination of these two forms of therapy and attempt to draw appropriate conclusions concerning selection of optimal treatment protocols. Our conclusion is that postoperative radiotherapy, especially with high-precision, low-dose and multiple fractions, and brachytherapy are promising therapies to combined with surgery.
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Affiliation(s)
- Chong Bian
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nong Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai, China
| | - Xi-Lei Li
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Gang Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Bo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang-Mi Liu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qian Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Tang Y, Qu J, Wu J, Li S, Zhou Y, Xiao J. Metastatic Spinal Cord Compression from Non-Small-Cell Lung Cancer Treated with Surgery and Adjuvant Therapies: A Retrospective Analysis of Outcomes and Prognostic Factors in 116 Patients. J Bone Joint Surg Am 2015; 97:1418-25. [PMID: 26333737 PMCID: PMC7535090 DOI: 10.2106/jbjs.n.01124] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metastatic spinal cord compression is a disastrous consequence of non-small-cell lung cancer (NSCLC). There have been few studies of the outcomes or prognostic factors in patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies. METHODS From 2002 to 2013, 116 patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies were enrolled in this retrospective analysis. Kaplan-Meier methods and Cox regression analysis were used to estimate overall survival and identify prognostic factors for survival. RESULTS Multivariate analysis suggested that the Eastern Cooperative Oncology Group performance status (ECOG-PS), preoperative and postoperative Frankel scores, postoperative adjuvant radiation therapy, and target therapy were independent prognostic factors. Ninety patients died at a median of twelve months (range, three to forty-seven months) postoperatively, and twenty-six patients were still alive at the time of final follow-up (at a median of fifteen months [range, five to fifty-four months]). CONCLUSIONS The complete disappearance of deficits in spinal cord function after surgery was the most robust predictor of survival. Adjuvant radiation therapy and target therapy were also associated with a better prognosis. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yu Tang
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No. 2, Xinqiao Street, Shapingba District, Chongqing 400037, People’s Republic of China. E-mail address for Y. Zhou:
| | - Jintao Qu
- Department of Orthopaedic Surgery, No. 44 Military Hospital, No. 67 Huang He Road, Xiao He District, Guiyang, Guizhou 550009, People’s Republic of China
| | - Juan Wu
- Department of Pharmacy, General Hospital of Chengdu Military Region, Chengdu 610083, People’s Republic of China
| | - Song Li
- Department of Bone Tumors, Changzheng Hospital, The Second Military Medical University, No. 415 Feng Yang Road, Huang Pu District, Shanghai 200003, People’s Republic of China. E-mail address for J. Xiao:
| | - Yue Zhou
- Department of Orthopaedic Surgery, Affiliated Xinqiao Hospital, The Third Military Medical University, No. 2, Xinqiao Street, Shapingba District, Chongqing 400037, People’s Republic of China. E-mail address for Y. Zhou:
| | - Jianru Xiao
- Department of Bone Tumors, Changzheng Hospital, The Second Military Medical University, No. 415 Feng Yang Road, Huang Pu District, Shanghai 200003, People’s Republic of China. E-mail address for J. Xiao:
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Ha KY, Kim YH, Ahn JH, Park HY. Factors Affecting Survival in Patients Undergoing Palliative Spine Surgery for Metastatic Lung and Hepatocellular Cancer: Dose the Type of Surgery Influence the Surgical Results for Metastatic Spine Disease? Clin Orthop Surg 2015; 7:344-50. [PMID: 26330957 PMCID: PMC4553283 DOI: 10.4055/cios.2015.7.3.344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/21/2015] [Indexed: 11/15/2022] Open
Abstract
Background Surgical treatment for metastatic spine disease has been becoming more prominent with the help of technological advances and a few favorable reports on the surgery. In cases of this peculiar condition, it is necessary to establish the role of surgery and analyze the factors affecting survival. Methods From January 2011 to April 2015, 119 patients were surgically treated for metastatic spine lesions. To reduce the bias along the heterogeneous cancers, the primary cancer was confined to either the lung (n = 25) or the liver (n = 18). Forty-three patients (male, 32; female, 11; mean age, 57.5 years) who had undergone palliative surgery were enrolled in this study. Posterior decompression and fusion was performed in 30 patients (P group), and anteroposterior (AP) reconstruction was performed in 13 patients (AP group) for palliative surgery. Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared. The survival period and related hazard factors were also assessed by Kaplan-Meier and Cox regression analysis. Results Most patients experienced improvements in pain and performance status (12.3% ± 17.2%) at 3 months postoperatively. In terms of neurologic recovery, 9 patients (20.9%) graded ASIA D experienced neurological improvement to ASIA E while the remainder was status quo. In an analysis according to operation type, there was no significant difference in patient demographics. At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% for the P group and the AP group, respectively (p > 0.05). Survival was not affected by the pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, or operation type. Preoperative Karnofsky performance score (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96) and improvement of performance status after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97) significantly affected survival after operation. Conclusions There was no significant difference in surgical outcomes and survival rates between posterior and AP surgery for metastatic lesions resulting from lung and hepatocellular cancer. Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.
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Affiliation(s)
- Kee-Yong Ha
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju-Hyun Ahn
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2201-8. [DOI: 10.1007/s00586-015-4122-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 11/25/2022]
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Wang M, Bünger CE, Li H, Sun M, Helmig P, Borhani-Khomani G, Wu CS, Hansen ES, Choi D, Hoey K. Improved patient selection by stratified surgical intervention: Aarhus Spinal Metastases Algorithm. Spine J 2015; 15:1554-62. [PMID: 25777743 DOI: 10.1016/j.spinee.2015.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 02/20/2015] [Accepted: 03/07/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose the most appropriate surgical intervention for patients with spinal metastases. PURPOSE The purpose of this study was to evaluate the clinical outcome of stratified surgical interventions based on the ASMA, which combines life expectancy and the anatomical classification of patients with spinal metastases to inform surgical decision making. STUDY DESIGN/SETTING This is a retrospective study based on a prospective database. PATIENT SAMPLE A consecutive series of 515 spinal metastatic patients who underwent surgically treatment from December 1992 to June 2012 in Aarhus University Hospital were included prospectively and analyzed in detail retrospectively. OUTCOME MEASURES Survival time after surgery was determined for all patients. Neurological function was assessed using the Frankel score preoperatively and postoperatively (at the time of discharge). Complete outcome data were retrieved in 97.5% of this cohort. METHODS Patients with spinal metastases were identified from an institutional database that prospectively collected data since 1992. Survival status data were obtained from a national registry. Neurological function was determined from the same institutional database or local Electronic Patient Journal system. Surgeons evaluated and classified patients into five surgical groups preoperatively by using the revised Tokuhashi score (TS) and the Tomita anatomical classification (TC). RESULTS The overall median survival time of the cohort was 6.8 (95% confidence interval: 6.1-7.9) months. The median survival times in the five surgical groups determined by the ASMA were 2.1 (TS 0-4, TC 1-7), 5.1 (TS 5-8, TC 1-7), 12.1 (TS 9-11, TC 1-7 or TS 12-15, TC 7), 26.0 (TS 12-15, TC 4-6), and 36.0 (TS 12-15, TC 1-3) months. The 30-day mortality rate was 7.5%. Postoperative neurological function was maintained or improved in 469 patients (92.3%). Overall reoperation rate was 13.5%, commonly because of postoperative hematoma and new limb weakness. CONCLUSIONS The ASMA recommends at least two surgical options for a particular patient by determining the preoperative life expectancy and anatomical classification of the spinal metastases. This algorithm could help spine surgeons to discriminate the risks of surgeries. The ASMA provides a tool to guild surgeons to evaluate the spinal metastases patients, select potential optimal surgery, and avoid life-threatening risks.
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Affiliation(s)
- Miao Wang
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark.
| | - Cody E Bünger
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
| | - Haisheng Li
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
| | - Ming Sun
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
| | - Peter Helmig
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
| | - Gilava Borhani-Khomani
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
| | - Chun S Wu
- Research Unit of Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Winsløwparken 19, 3. sal. DK-5000 Odense C, Denmark
| | - Ebbe S Hansen
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
| | - David Choi
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Kristian Hoey
- Department of Orthopaedic E, Aarhus University Hospital (NBG), Noerrebrogade 44, Bldg 1A, DK-8000 Aarhus C, Denmark
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Vieillard MH, Zairi F, Assaker R, Bonneterre J. Métastase osseuse solitaire : existe-t-il une prise en charge spécifique ? ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Setzer M, Robinson LA, Vrionis FD. Management of locally advanced pancoast (superior sulcus) tumors with spine involvement. Cancer Control 2015; 21:158-67. [PMID: 24667403 DOI: 10.1177/107327481402100209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection. METHODS A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence. RESULTS A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%. CONCLUSIONS Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
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Affiliation(s)
- Matthias Setzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
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Boriani S, Bandiera S, Colangeli S, Ghermandi R, Gasbarrini A. En bloc resection of primary tumors of the thoracic spine: indications, planning, morbidity. Neurol Res 2014; 36:566-76. [PMID: 24725289 DOI: 10.1179/1743132814y.0000000369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES We aimed to describe surgical planning, technique, and complications of en bloc resection in the thoracic spine in patients who opted for surgery with en bloc resection and a tumor-free margin. METHODS Oncologic and functional results were recorded for 134 patients (53% male, age 44 ± 18 years) who had undergone en bloc resection for primary tumors (90 cases) and bone metastases (44 cases). Patients were followed until death or the latest follow-up examination (0-211 months, median 47 months). Surgeries were performed from 1990 to 2007 by the same team. An ongoing critical analysis of local control rates, surgical complications, and expected versus actual loss of function enabled the authors to refine the surgical technique and propose seven different types of resection. RESULTS AND DISCUSSION En bloc resection is a demanding procedure and requires careful planning after a careful decision-making process. The patient has to correctly understand the purpose of the surgery, based on oncological staging, in order to accept or decide against the procedure after weighing the possible morbidity and functional loss against the expected final result. TECHNIQUES OF EN BLOC RESECTION: Seven different strategies to perform en bloc resection in the thoracic spine, based on four combinations of surgical approaches (anterior, posterior, anterior followed by posterior, and posterior followed by simultaneous anterior and posterior) are identified and proposed. This planning is based on Weinstein-Boriani-Biagini (WBB) surgical staging. The surgical plan was designed to achieve the required oncologic margin with the minimum achievable morbidity.
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Gasbarrini A, Boriani S, Capanna R, Casadei R, Di Martino A, Silvia Spinelli M, Papapietro N, Piccioli A. Management of patients with metastasis to the vertebrae: recommendations from the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Expert Rev Anticancer Ther 2013; 14:143-50. [DOI: 10.1586/14737140.2014.856532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Os, cible thérapeutique (RPC 2013). ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2353-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The multiplicity of clinical presentations and the lack of consensus explain that the treatment of spine metastasis remains controversial. Optimal treatment requires a truly multidisciplinary approach, involving oncologists, interventional radiologists, radiation oncologists, rheumatologists and spine surgeons. Recent progress in all these areas have allowed to provide safe and effective therapeutic solutions tailored to each situation. We remind, in this work, the main progress in the surgical field, specifying the role of surgery in the current therapeutic arsenal.
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Pre- and postoperative lower extremity motor power and ambulatory status of patients with spinal cord compression due to a metastatic spinal tumor. Spine (Phila Pa 1976) 2013; 38:E798-802. [PMID: 23532120 DOI: 10.1097/brs.0b013e3182927559] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of medical records. OBJECTIVE To describe pre- and postoperative ambulatory status and lower limb motor power, and compare characteristics of patients with metastatic spinal cord compression (MSCC) who were ambulatory at 48 hours postoperatively with those of patients with MSCC who were nonambulatory. SUMMARY OF BACKGROUND DATA Preoperative motor power of the lower extremities is a predictor of postoperative ambulatory status in patients with MSCC. METHODS We retrospectively evaluated the medical records of 102 consecutive patients with MSCC who presented for decompressive surgery with lower extremity weakness between January 1997 and December 2010. A single surgeon classified the preoperative and 48-hour postoperative motor power of the lower extremities on a 6-point scale. Ambulation status was determined 48 hours after surgery and patients were classified as ambulatory (including normal ambulation, ambulation with aid, and ambulation without aid) or nonambulatory. Demographic and clinical characteristics were compared between patients who were ambulatory and those who were nonambulatory at 48 hours postoperatively. RESULTS Motor power was improved 1.05 ± 0.73 grades after operation. Two-thirds of patients who were preoperatively classified as nonambulatory were ambulatory at 48 hours postoperatively. The only significantly different affecting factor between the postoperative ambulatory group and the nonambulatory group was preoperative lower extremity power and preoperative capability of ambulation. In addition, grade III of lower extremity motor power was significant criteria for postoperative ambulation. CONCLUSION We recommend aggressive decompressive surgery in patients with MSCC if preoperative lower extremity motor power is at least grade III, although all groups of preoperative lower extremity motor power had 1 or more patients who returned to ambulation. LEVEL OF EVIDENCE 3.
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Nouvelles avancées dans la prise en charge chirurgicale des métastases vertébrales symptomatiques. Bull Cancer 2013; 100:435-41. [DOI: 10.1684/bdc.2013.1748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Quraishi NA, Rajagopal TS, Manoharan SR, Elsayed S, Edwards KL, Boszczyk BM. Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:1383-8. [PMID: 23275041 DOI: 10.1007/s00586-012-2635-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/08/2012] [Accepted: 12/16/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Metastatic spinal cord compression (MSCC) requires expeditious treatment. While there is no ambiguity in the literature about the urgency of care for patients with MSCC, the effect of timing of surgical intervention has not been investigated in detail. The objective of our study was to investigate whether or not the 'timing of surgery' is an important factor in survival and neurological outcome in patients with MSCC. METHODS All patients with MSCC presenting to our unit from October 2005 to March 2010 were included in this study. Patients were divided into three groups-those who underwent surgery within 24 h (Group 1, n = 45), between 24 and 48 h (Group 2, n = 23) and after 48 h (Group 3, n = 53) from acute presentation of neurological symptoms. The outcome measures studied were neurological outcome (change in Frankel grade post-operatively), survival (survival rate and median survival in days), incidence of infection, length of stay and complications. RESULTS Patients' age, gender, revised Tokuhashi score, level of spinal metastasis and primary tumour type were not significantly different between the three groups. Greatest improvement in neurology was observed in Group 1, although not significantly when compared against Group 2 (24-48 h; (p = 0.09). When comparisons of neurological outcome were performed for all patients having surgery within 48 h (Groups 1 and 2) versus after 48 h (Group 3), the Frankel grade improvement was significant (p = 0.048) favouring surgery within 48 h of presentation. There was a negative correlation (-0.17) between the delay in surgery and the immediate neurological improvement, suggesting less improvement in those who had delayed surgery. There was no difference in length of hospital stay, incidence of infection, post-operative complications or survival between the groups. CONCLUSIONS Our results show that surgery should be performed sooner rather than later. Furthermore, earlier surgical treatment within 48 h in patients with MSCC resulted in significantly better neurological outcome. However, the timing of surgery did not influence length of hospital stay, complication rate or patient survival.
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Affiliation(s)
- N A Quraishi
- Centre for Spinal Studies and Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:569-76. [PMID: 23076644 DOI: 10.1007/s00586-012-2534-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/22/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to discuss the clinical presentation, imaging findings, treatments received, and outcome of therapies for patients with epidural spinal cord compression caused by thyroid spinal metastases, with the goal of emphasizing the importance of surgery in this setting and discussing therapeutic plan for treating these patients. METHODS A total of 22 patients with spinal cord compression due to thyroid tumor spinal metastases who received surgery in our department were identified from 2004 to 2011. The series of 22 patients collected from our institution over the past 7 years was used to discuss treatment options for thyroid cancer spinal metastases on the basis of literature review and our own extensive experience. RESULTS The mean age of the patients in this study was 57 years (range 37-78 years). The duration of the preoperative symptoms was 1-24 months, with an average of approximately 6 months. All patients attained improvement of at least one level of the Frankel classification after surgery. Two patients received more than one operation at our institution. Two patients died during follow-up, two patients had stable disease, and all other patients maintained a disease-free status during follow-up. CONCLUSIONS As thyroid tumor spinal metastases have a favorable prognosis, a radical therapeutic attitude should be considered in decision-making. Dorsal spinal decompression through curettage and stabilization can preserve or restore neurological function for most patients. For patients who have more than one metastatic lesion of the spine, surgeries can be sequentially performed based on the urgency of the case. In addition to treatment of primary disease, surgery and bisphosphonate treatment are the most important therapies for these patients.
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Park JH, Rhim SC, Jeon SR. Efficacy of decompression and fixation for metastatic spinal cord compression: analysis of factors prognostic for survival and postoperative ambulation. J Korean Neurosurg Soc 2011; 50:434-40. [PMID: 22259690 DOI: 10.3340/jkns.2011.50.5.434] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/14/2011] [Accepted: 11/21/2011] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. METHODS We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively. RESULTS Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) (p=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; p=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; p=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; p=0.038) were prognostic of postoperative ambulation. CONCLUSION We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.
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Affiliation(s)
- Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Walter J, Reichart R, Waschke A, Kalff R, Ewald C. Palliative considerations in the surgical treatment of spinal metastases: evaluation of posterolateral decompression combined with posterior instrumentation. J Cancer Res Clin Oncol 2011; 138:301-10. [PMID: 22127369 DOI: 10.1007/s00432-011-1100-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 11/10/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the outcome of patients with spinal metastases, treated under palliative considerations by spinal decompression and sole posterior instrumentation, in respect to survival, neurological symptomatology, pain, ECOG grade, and Tomita's prognostic score (TPS). PATIENTS AND METHODS Fifty-seven consecutive patients with metastatic vertebral tumors were treated using a posterolateral approach for decompression combined with posterior instrumentation. Mean age was 58.6 years. In average, 3.4 vertebral segments were involved in instrumentation. RESULTS Preoperative mean TPS was 5.9. The majority of the patients (70.2%) presented with an ECOG grade ≤2. The distribution of the metastatic lesions that needed surgical treatment was: 7.8% cervical, 60.9% thoracical, and 31.3% lumbar. In 52.6% the tumor led to pathological vertebral fractures. Mean pain VAS scores improved significantly in all but one patient from 6.6 preoperatively to 3.1 postoperatively. Post-surgical Frankel grades decreased. Mean postoperative survival was 11.4 months. Ten patients survived until now. Forty-seven patients have died with a mean survival of 9 months. Complication rate was only 5.3% with two superficial wound infections and one seroma. Not a single case of posterior spinal instrumentation fatigue failure was detected. CONCLUSIONS Palliative surgical treatment for metastatic spinal tumors using a decompressive posterolateral approach combined with sole posterior instrumentation achieved convincing clinical results. All patients with intractable pain showed significant improvement postoperatively, and neurological deterioration was avoided. Since patients with spinal metastases enter the terminal stage of their disease, it is generally agreed that they require only palliative surgical treatments. Accordingly, spinal decompression and stabilization may be performed to improve the quality of the remaining life of cancer patients.
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Affiliation(s)
- Jan Walter
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
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Denaro V, Di Martino A, Papalia R, Denaro L. Patients with cervical metastasis and neoplastic pachymeningitis are less likely to improve neurologically after surgery. Clin Orthop Relat Res 2011; 469:708-14. [PMID: 20945121 PMCID: PMC3032852 DOI: 10.1007/s11999-010-1617-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve better pain relief and improvement of neurologic function. QUESTIONS/PURPOSES (1) Does tumor removal with reconstruction improve the neurologic status? (2) Is any subset of patients more likely to have neurological recovery from palliative surgery? (3) What is the rate of surgery-related complications? PATIENTS AND METHODS We retrospectively reviewed 46 patients who had palliative surgery for metastatic solid tumor metastases of the subaxial cervical spine. Indications were neurologic deficits, life expectancy longer than 6 months, and a Karnofsky Performance Score of 50 to 70. Surgery consisted of anterior tumor removal and reconstruction with titanium mesh cages and/or tricortical iliac crest allograft plus plate fixation or of a combined procedure with adjunctive posterior decompression and stabilization with lateral mass screw fixation. Postoperatively, neurologic Frankel score grade, Karnofsky Performance Score, and complications were recorded. RESULTS Five of 18 nonambulatory patients (Frankel B/C) became ambulatory again (Frankel D). No patients were Frankel Grade E preoperatively, whereas 19 of 46 gained Frankel Grade E after surgery. One patient worsened neurologically and died 4 months after surgery. Patients with neoplastic pachymeningitis had less neurologic recovery than those without. Complications included dural tears (three), wound infection (three), and tumor relapse at the same or an adjacent level (four). Two of these four patients had instrumentation-related complications. CONCLUSIONS Surgery improved clinical and neurologic status according to Frankel score; patients with neoplastic pachymeningitis are likely to experience less neurologic recovery. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vincenzo Denaro
- Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Alberto Di Martino
- Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Luca Denaro
- Dipartimento di Neuroscienze, Cattedra di Neurochirurgia, Università di Padova, Padova, Italy
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2009. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:11-8. [PMID: 20024664 DOI: 10.1007/s00586-009-1245-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 01/17/2023]
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