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Amelot A, Terrier LM, Le Nail LR, Buffenoir K, Cook AR, François P, Marie-Hardy L, Mathon B. Spine Metastasis: Patients With Poor Performance Status (ECOG) Could benefit From Palliative Surgical Care! A Prospective Cohort Study. Spine (Phila Pa 1976) 2023; 48:476-483. [PMID: 36728778 DOI: 10.1097/brs.0000000000004568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This study used a French prospective national multi-center database of patients with spine metastasis (SpM). OBJECTIVE The main challenge was to clarify if SpM patients presenting poor ECOG-PS could benefit from a surgical intervention. BACKGROUND Spine metastases (SpM) are debilitating lesions commonly found in the evolution of cancer. At present, patients with poor ECOG-PS do not benefit from surgical care. MATERIALS AND METHODS Between 2014 and 2017, 176 SpM patients with poor initial ECOG-PS (3 or 4) were identified. RESULTS The median overall survival of patients was 2.1 months (SD 0.2). Seventy-one patients (40.3%) underwent surgery: for 49 patients (27.8%) the intervention consisted of a simple decompression and for 22 patients (12.5%) the previous was associated with an osteosynthesis. Patients who underwent surgery demonstrated significantly longer median overall survival than those who did not: 3.5 months (SD 0.4) versus 1.6 (SD 0.2) ( P <0.0001). No significant differences between operated/nonoperated patients were noted concerning median age (66.4 vs. 64.2 y, P =0.897), the median number of SpM (4.1 vs. 4.2, P =0.374), ECOG-PS 4 ratio (41.6 vs. 39.3%, P =0.616), or for primary tumors ( P =0.103). Patients who underwent surgery statistically improved their neurological impairment according to the Frankel score: 5/11 (45.4%) from A to C, 5/17 (29.4%) from B to C or D, 6/11 (54.5%) from C to D and 2/4 (50%). Twelve patients (16.9%) presented a postoperative complication. CONCLUSION Patients with poor ECOG-PS could benefit from surgery. Even though survival gain is small, it permits the preservation of their neurological function. By making ambulation possible, pain is decreased during the last months of their lives.
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Affiliation(s)
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille
| | | | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes
| | - Ann-Rose Cook
- Department of Neurosurgery, Hospital Bretonneau, Tours
| | | | - Laura Marie-Hardy
- Department of Orthopaedic Surgery, Pitié-Salpêtrière Hospital, Paris
| | - Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière Hospital, Paris, France
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Beaufort Q, Terrier LM, Dubory A, Le Nail LR, Cook AR, Cristini J, Buffenoir K, Pascal-Moussellard H, Carpentier A, Mathon B, Amelot A. Spine Metastasis in Elderly: Encouraging Results for Better Survival. Spine (Phila Pa 1976) 2021; 46:751-759. [PMID: 33332789 DOI: 10.1097/brs.0000000000003881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI The incidence of spinal metastasis (SpM) is increasing, and life expectancy for patients with malignancy is also rising. The "elderly" represent a population with steady growth in SpM proportion. Bracing is associated with lower survival. We believe that surgery should be considered, regardless of the patient's age.
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Affiliation(s)
| | | | - Arnaud Dubory
- Department of Orthopaedic surgery, Henri-Mondor Hospital, Créteil, France
| | | | - Ann-Rose Cook
- Department of Neurosurgery, CHRU de Tours, Tours, France
| | - Joseph Cristini
- Department of Neurotraumatology, CHU de Nantes, Nantes, France
| | - Kévin Buffenoir
- Department of Neurotraumatology, CHU de Nantes, Nantes, France
| | | | | | - Bertrand Mathon
- Department of Neurosurgery, Pitié Salpétrière Hospital, Paris, France
| | - Aymeric Amelot
- Department of Neurosurgery, CHRU de Tours, Tours, France
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Macdonald AG, Lynch D, Garbett I, Nazeer N. Malignant spinal cord compression. J R Coll Physicians Edinb 2020; 49:151-156. [PMID: 31188350 DOI: 10.4997/jrcpe.2019.217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Malignant spinal cord compression (MSCC) is a potentially devastating consequence of cancer. Early recognition of the signs and symptoms of MSCC can allow diagnosis prior to the development of irreversible complications. Information provision to patients and doctors regarding the risk of MSCC and a streamlined pathway for further investigation are both key to improving the outcome for patients developing this condition. Described in this paper is the development of such a pathway at Aberdeen Royal Infirmary.
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Affiliation(s)
- A Graham Macdonald
- Clinic D, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK,
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Abstract
Metastatic spinal cord compression is compression of the spinal cord or cauda equina as a result of metastatic deposits in the spinal column. It affects approximately 4000 cases per year in England and Wales. Prompt identification and treatment of metastatic spinal cord compression is necessary to prevent irreversible neurological injury, treat pain and maintain patients' mobility, function and independence. Survival of patients with common malignancies has improved significantly with the ongoing development of radiotherapy and chemotherapy, as well as improved surgical treatment of resectable primary tumours. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.
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Affiliation(s)
- Surendra Patnaik
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Joseph Turner
- Department of Trauma and Orthopaedic Surgery, Frimley Park Hospital, Frimley Health NHS Foundation Trust, Camberley, UK
| | - Praveen Inaparthy
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Will Km Kieffer
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
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Paniagua-Collado M, Cauli O. Non-pharmacological interventions in patients with spinal cord compression: a systematic review. J Neurooncol 2017; 136:423-434. [PMID: 29159776 DOI: 10.1007/s11060-017-2684-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/11/2017] [Indexed: 12/22/2022]
Abstract
Spinal cord compression is a complex and challenging condition that greatly affects the quality of life. Non-pharmacological techniques have only been studied to a very lesser extent; although they are evidence to be beneficial. We performed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) analysis of the scientific literature in several databases (Medline, Cochrane, Scopus, Cuiden, Pubmed, Lilacs and Embase); using the following keywords: spinal cord compression, spine compression, mobilization, positioning, brace and bracing. Eleven studies met the inclusion criteria and were finally included in the systematic review. 3 of them were related to metastatic spinal cord compression, 5 to spinal cord compression due to other causes and the last 3 of them regarded the health professional´s knowledge in oncology patients. In all cases, it seems possible to manage spinal cord compression by using external mobilization and braces and that this treatment is beneficial to patients. Positioning plays a massive role in the disease and can improve or worsen the condition when used improperly; the supine position is overused and can have a negative impact both physically and psychologically. Non-pharmacological interventions could be useful for pain management, cardiovascular alterations and patients' well-being. One randomized clinical trial demonstrated that massage therapy, using either broad compression massage or light contact touch massage improved pain control. There is an urgent need of randomized clinical trials with these interventions in order to achieve an improved care of these patients.
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Affiliation(s)
| | - Omar Cauli
- Department of Nursing, University of Valencia, c/Jaume Roig s/n, 46010, Valencia, Spain.
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Defining spinal instability and methods of classification to optimise care for patients with malignant spinal cord compression: A systematic review. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lee SH, Grant R, Kennedy C, Kilbride L, Cochrane Pain, Palliative and Supportive Care Group. Positioning and spinal bracing for pain relief in metastatic spinal cord compression in adults. Cochrane Database Syst Rev 2015; 2015:CD007609. [PMID: 26400848 PMCID: PMC7199117 DOI: 10.1002/14651858.cd007609.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 3 (Lee 2012) on patient positioning (mobilisation) and bracing for pain relief and spinal stability in adults with metastatic spinal cord compression.Many patients with metastatic spinal cord compression (MSCC) have spinal instability, but their clinician has determined that due to their advanced disease they are unsuitable for surgical internal fixation. Mobilising may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (whether a patient should be managed with bed rest or allowed to mobilise) and whether spinal bracing is helpful, is contradictory. OBJECTIVES To investigate the correct positioning and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. SEARCH METHODS For this update, we searched for relevant studies from February 2012 to 31 March 2015. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, EMBASE, AMED, CINAHL, TRIP, SIGN, NICE, UK Clinical Research Network, National Guideline Clearinghouse and PEDro database. We also searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov, UK Clinical Trials Gateway (UKCTG), WHO International Clinical Trials Registry Platform (ICTRP) and Australia New Zealand Clinical Trials Registry (ANZCTR).For the original version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse, and PEDro database, in February 2012. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning (mobilisation) and bracing. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each possible study for inclusion and quality. MAIN RESULTS For the original version of the review, we screened 1611 potentially relevant studies. No studies met the inclusion criteria. Many papers identified the importance of mobilisation, but no RCTs of bed rest versus mobilisation have been undertaken. We identified no RCTs of bracing in MSCC.For this update, we identified 347 potential titles. We screened 300 titles and abstracts after removal of duplicates. We did not identify any additional studies for inclusion. AUTHORS' CONCLUSIONS Since publication of the original version of this review, no new studies were found and our conclusions remain unchanged.There is a lack of evidence-based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area.
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Affiliation(s)
- Siew Hwa Lee
- University of LimerickDepartment of Nursing and Midwifery, Faculty of Education and Health SciencesHealth Sciences BuildingRoom HS3‐029LimerickIreland
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghScotlandUKEH4 2XU
| | - Catriona Kennedy
- University of LimerickDepartment of Nursing and Midwifery, Faculty of Education and Health SciencesHealth Sciences BuildingRoom HS3‐029LimerickIreland
| | - Lynn Kilbride
- Glasgow Caledonian UniversityNursing and Community HealthGlasgowUK
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Lee SH, Cox KM, Grant R, Kennedy C, Kilbride L. Patient positioning (mobilisation) and bracing for pain relief and spinal stability in metastatic spinal cord compression in adults. Cochrane Database Syst Rev 2012:CD007609. [PMID: 22419325 DOI: 10.1002/14651858.cd007609.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many patients with metastatic spinal cord compression (MSCC) have spinal instability but are determined, by their clinician, to be unsuitable for surgical internal fixation due to their advanced disease. Mobilisation may be hazardous in the presence of spinal instability as further vertebral collapse can occur. Current guidance on positioning (or mobilisation) and spinal bracing is contradictory. OBJECTIVES To investigate the correct positioning (or mobilisation) and examine the effects of spinal bracing to relieve pain or to prevent further vertebral collapse in patients with MSCC. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, NICE, SIGN, AMED, TRIP, National Guideline Clearinghouse and PEDro database were searched; the last search was run in February 2012. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of adults with MSCC of interventions on positioning or mobilisation and bracing. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each possible study for inclusion and quality. MAIN RESULTS One thousand, six hundred and eleven potentially relevant studies were screened. No studies met the inclusion criteria. Many papers identified the importance of mobilisation but no RCTs have been undertaken. No RCTs of bracing in MSCC were identified. AUTHORS' CONCLUSIONS There is lack of evidence based guidance around how to correctly position and when to mobilise patients with MSCC or if spinal bracing is an effective technique for reducing pain or improving quality of life. RCTs are required in this important area.
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Affiliation(s)
- Siew Hwa Lee
- School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Edinburgh,UK
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Kilbride L, Cox M, Kennedy CM, Lee SH, Grant R. Metastatic spinal cord compression: a review of practice and care. J Clin Nurs 2010; 19:1767-83. [DOI: 10.1111/j.1365-2702.2010.03236.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Warnock C, Cafferty C, Hodson S, Kirkham E, Osguthorpe C, Siddall J, Walsh R, Foran B. Evaluating the care of patients with malignant spinal cord compression at a regional cancer centre. Int J Palliat Nurs 2008; 14:510-5. [DOI: 10.12968/ijpn.2008.14.10.31496] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Clare Warnock
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christine Cafferty
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzanne Hodson
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Elizabeth Kirkham
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charles Osguthorpe
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jan Siddall
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Walsh
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bernadette Foran
- Consultant Lead to the SCC Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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