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Banat M, Potthoff AL, Hamed M, Borger V, Scorzin JE, Lampmann T, Asoglu H, Khalafov L, Schmeel FC, Paech D, Radbruch A, Nitsch L, Weller J, Herrlinger U, Toma M, Gielen GH, Vatter H, Schneider M. Synchronous versus metachronous spinal metastasis: a comparative study of survival outcomes following neurosurgical treatment. J Cancer Res Clin Oncol 2024; 150:136. [PMID: 38502313 PMCID: PMC10951012 DOI: 10.1007/s00432-024-05657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Patients with spinal metastases (SM) from solid neoplasms typically exhibit progression to an advanced cancer stage. Such metastases can either develop concurrently with an existing cancer diagnosis (termed metachronous SM) or emerge as the initial indication of an undiagnosed malignancy (referred to as synchronous SM). The present study investigates the prognostic implications of synchronous compared to metachronous SM following surgical resection. METHODS From 2015 to 2020, a total of 211 individuals underwent surgical intervention for SM at our neuro-oncology facility. We conducted a survival analysis starting from the date of the neurosurgical procedure, comparing those diagnosed with synchronous SM against those with metachronous SM. RESULTS The predominant primary tumor types included lung cancer (23%), prostate cancer (21%), and breast cancer (11.3%). Of the participants, 97 (46%) had synchronous SM, while 114 (54%) had metachronous SM. The median overall survival post-surgery for those with synchronous SM was 13.5 months (95% confidence interval (CI) 6.1-15.8) compared to 13 months (95% CI 7.7-14.2) for those with metachronous SM (p = 0.74). CONCLUSIONS Our findings suggest that the timing of SM diagnosis (synchronous versus metachronous) does not significantly affect survival outcomes following neurosurgical treatment for SM. These results support the consideration of neurosurgical procedures regardless of the temporal pattern of SM manifestation.
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Affiliation(s)
- Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany.
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Jasmin E Scorzin
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Tim Lampmann
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Harun Asoglu
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Logman Khalafov
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | | | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Louisa Nitsch
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Johannes Weller
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - Gerrit H Gielen
- Institute for Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
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2
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Tsuang FY, Jeon JP, Huang AP, Chai CL. Overall Survival of Non-Small Cell Lung Cancer With Spinal Metastasis: A Systematic Review and Meta-Analysis. Neurospine 2023; 20:567-576. [PMID: 37401075 PMCID: PMC10323357 DOI: 10.14245/ns.2245026.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/22/2023] [Accepted: 03/23/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE The long-term survival data of lung cancer patients with spinal metastases are crucial for informed treatment decision-making. However, most studies in this field involve small sample sizes. Moreover, survival benchmarking and an analysis of changes in survival over time are required, but data are unavailable. To meet this need, we performed a metaanalysis of survival data from small studies to obtain a survival function based on largescale data. METHODS We performed a single-arm systematic review of survival function following a published protocol. Data of patients who received surgical, nonsurgical, and mixed modes of treatment were meta-analyzed separately. Survival data were extracted from published figures with a digitizer program and then processed in R. Median survival time was used as an effect size for moderator analysis to explain the heterogeneity. RESULTS Sixty-two studies with 5,242 participants were included for pooling. The survival functions showed a median survival of 6.72 months for surgery (95% confidence interval [CI], 61.9-7.01; 2,367 participants; 36 studies), 5.99 months for nonsurgery (95% CI, 5.33-6.47; 891 participants; 12 studies), and 5.96 months for mixed (95% CI, 5.67-6.43; 1,984 participants; 18 studies). Patients enrolled since 2010 showed the highest survival rates. CONCLUSION This study provides the first large-scale data for lung cancer with spinal metastasis that allows survival benchmarking. Data from patients enrolled since 2010 had the best survival and thus may more accurately reflect current survival. Researchers should focus on this subset in future benchmarking and remain optimistic in the management of these patients.
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Affiliation(s)
- Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - An-Ping Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung Liang Chai
- Department of Neurosurgery, Yee Zen General Hospital, Taoyuan, Taiwan
- School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
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3
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Hamed M, Brandecker S, Rana S, Potthoff AL, Eichhorn L, Bode C, Schmeel FC, Radbruch A, Schäfer N, Herrlinger U, Köksal M, Giordano FA, Vatter H, Schneider M, Banat M. Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis. Front Oncol 2022; 12:940790. [PMID: 36387073 PMCID: PMC9647167 DOI: 10.3389/fonc.2022.940790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Patients with spinal metastasis (SM) are at advanced stages of systemic cancer disease. Surgical therapy for SM is a common treatment modality enabling histopathological diagnosis and the prevention of severe neurological deficits. However, surgery for SM in this vulnerable patient cohort may require prolonged postoperative intensive care treatment, which could adversely affect the anticipated benefit of the surgery. We therefore assessed postoperative prolonged mechanical ventilation (PMV) as an indicator for intensive care treatment with regard to potential correlations with early postoperative mortality and overall survival (OS). Methods Between 2015 and 2019, 198 patients were surgically treated for SM at the author´s neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 hours. A multivariate analysis was performed to identify pre- and perioperative collectable predictors for 30 days mortality. Results Twenty out of 198 patients (10%) with SM suffered from postoperative PMV. Patients with PMV exhibited a median OS rate of 1 month compared to 12 months for patients without PMV (p < 0.0001). The 30 days mortality was 70% and after one year 100%. The multivariate analysis identified “PMV > 24 hrs” (p < 0.001, OR 0.3, 95% CI 0.02-0.4) as the only significant and independent predictor for 30 days mortality (Nagelkerke’s R2 0.38). Conclusions Our data indicate postoperative PMV to significantly correlate to high early postoperative mortality rates as well as to poor OS in patients with surgically treated SM. These findings might encourage the initiation of further multicenter studies to comprehensively investigate PMV as a so far underestimated negative prognostic factor in the course of surgical treatment for SM.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Simon Brandecker
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Shaleen Rana
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- *Correspondence: Mohammed Banat,
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4
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Jaman E, Zhang X, Allen J, Saraiya RG, Tollefson S, Hamilton DK, Amankulor NM. Percutaneous fixation for the treatment of metastatic spinal disease provides effective symptom palliation with low rates of hardware failure. Surg Neurol Int 2022; 13:50. [PMID: 35242416 PMCID: PMC8888300 DOI: 10.25259/sni_1110_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The incidence of survival from metastatic spinal disease (MSD) continues to rise. However, open surgery for MSD is associated with significant perioperative morbidity, while minimally invasive percutaneous pedicle screw fixation (MIPPSF) offers reduced tissue trauma, less blood loss, and a reduction in complications. Lytic bone disease plus perioperative radiation further increase risk for instrument failure, especially in long construct MIPPSF. Here, we compared 6 short construct and 14 long construct outcomes for MIPPSF performed in MSD patients, including multiple myeloma (MM). Methods: For 20 patients undergoing MIPPSF for MSD, we evaluated disease type, location, the extent of surgery, outcomes, and survival rates. Statistical comparisons were performed between long-segment construct and short-segment construct patients utilizing Kaplan–Meier survival curves, Mann–Whitney U, and Chi-squared tests. Results: No instrument failure and comparable symptomatic relief were observed for both short and long MIPPSF constructs. However, long construct patients experienced; a higher incidence of postoperative complications, including screw loosening, but exhibited longer overall survivals (likely related to underlying type of MSD, with MM patients making up the largest portion of long construct patients). Conclusion: Long construct MIPPSF in MSD did not have increased risk of construct failure and offered effective symptomatic relief, including for MM patients, without introducing a greater risk construct instability.
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Affiliation(s)
- Emade Jaman
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Xiaoran Zhang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Jordan Allen
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Raj G. Saraiya
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Savannah Tollefson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - D. Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania, United States
| | - Nduka M. Amankulor
- Department of Neurological Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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5
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Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Villarreal-Espinosa JB, Tellez-Garcia E, Bueno-Gutierrez LC, Rodriguez-Barreda JR, Flores-Villalba E, Martinez HR, Benvenutti-Regato M, Figueroa-Sanchez JA. Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis. Asian Spine J 2021; 16:583-597. [PMID: 34465015 PMCID: PMC9441425 DOI: 10.31616/asj.2020.0637] [Citation(s) in RCA: 10] [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: 12/14/2020] [Accepted: 05/11/2021] [Indexed: 12/29/2022] Open
Abstract
Bones are the third most common location for solid tumor metastasis affecting up to 10% of patients with solid tumors. When the spine is involved, thoracic and lumbar vertebrae are frequently affected. Access to spinal lesions can be through minimally invasive surgery (MIS) or traditional open surgery (OS). This study aims to determine which method provides an advantage. Following the PRISMA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines, a systematic review was conducted to identify studies that compare MIS with OS in patients with spinal metastatic disease. Data were analyzed using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). Ten studies were included. Operative time was similar among groups at −35.23 minutes (95% confidence interval [CI], −73.36 to 2.91 minutes; p=0.07). Intraoperative bleeding was lower in MIS at −562.59 mL (95% CI, −776.97 to −348.20 mL; p<0.00001). OS procedures had higher odds of requiring blood transfusions at 0.26 (95% CI, 0.15 to 0.45; p<0.00001). Both approaches instrumented similar numbers of levels at −0.05 levels (95% CI, −0.75 to 0.66 levels; p=0.89). We observed a decreased need for postoperative bed rest at −1.60 days (95% CI, −2.46 to −0.74 days; p=0.0003), a shorter length of stay at −3.08 days (95% CI, −4.50 to −1.66 days; p=0.001), and decreased odds of complications at 0.60 (95% CI, 0.37 to 0.96; p=0.03) in the MIS group. Both approaches revealed similar reintervention rates at 0.65 (95% CI, 0.15 to 2.84; p=0.57), effective rates of reducing metastasis-related pain at −0.74 (95% CI, −2.41 to 0.94; p=0.39), and comparable scores of the Tokuhashi scale at −0.52 (95% CI, −2.08 to 1.05; p=0.41), Frankel scale at 1.00 (95% CI, 0.60 to 1.68; p=1.0), and American Spinal Injury Association Scale at 0.53 (95% CI, 0.21 to 1.37; p=0.19). MIS appears to provide advantages over OS. Larger and prospective studies should fully detail the role of MIS as a treatment for spine metastasis.
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Affiliation(s)
| | | | | | - Eduardo Tellez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | | | | | | | - Hector R Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.,Instituto de Neurologia y Neurocirugia, Hospital Zambrano Hellion, San Pedro Garza Garcia, Mexico
| | - Mario Benvenutti-Regato
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.,Instituto de Neurologia y Neurocirugia, Hospital Zambrano Hellion, San Pedro Garza Garcia, Mexico
| | - Jose Antonio Figueroa-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.,Instituto de Neurologia y Neurocirugia, Hospital Zambrano Hellion, San Pedro Garza Garcia, Mexico
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6
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Tassemeier T, Haversath M, Brandenburger D, Schutzbach M, Serong S, Jäger M. [Atraumatic fractures of the spine : Current strategies for diagnosis and treatment]. DER ORTHOPADE 2019; 48:879-896. [PMID: 31511916 DOI: 10.1007/s00132-019-03804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.
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Affiliation(s)
- T Tassemeier
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland.
| | - M Haversath
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - D Brandenburger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - M Schutzbach
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - S Serong
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - M Jäger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
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Dabravolski D, Eßer J, Lahm A, Merk H. Surgical treatment of tumours and metastases of the spine by minimally invasive cavity-coblation method. J Orthop Surg (Hong Kong) 2017; 25:2309499016684505. [PMID: 28176600 DOI: 10.1177/2309499016684505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Tumours and metastases of the spine are extremely stressful for patients, especially for elderly multimorbid patients. The modern cavity/coblation method offers a very good therapeutic alternative for such patients. The goal of this article was to evaluate and present the characteristics, significance, opportunities, issues of the minimum invasive cavity/coblation method as well as the results of the treatment of 302 patients with vertebral tumours and metastases.
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Affiliation(s)
- Dzmitry Dabravolski
- 1 Department of Orthopaedics and Orthopaedic Surgery, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.,2 Center of Spine Surgery, Clinikum Fichtelgebirge, Weissenbacher Str., Germany
| | - Jan Eßer
- 1 Department of Orthopaedics and Orthopaedic Surgery, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Andreas Lahm
- 1 Department of Orthopaedics and Orthopaedic Surgery, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.,3 Tumor Center, Maria Hilf Clinics Mönchengladbach, Academic Teaching Hospital of the RWTH Aachen, Mönchengladbach, Germany
| | - Harry Merk
- 1 Department of Orthopaedics and Orthopaedic Surgery, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
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8
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Abi Lahoud G, Abi Jaoude S. [Role of surgery in the management of vertebral metastases. General revue]. Cancer Radiother 2016; 20:484-92. [PMID: 27614512 DOI: 10.1016/j.canrad.2016.07.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/12/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
The spine is the most common site of skeletal metastases. Treatment decisions for patients with spinal metastases can be challenging and greatly depend on survival prognosis. Surgery remains a valuable weapon in the therapeutic arsenal. A review of the literature describing the role of surgery, the various surgical approaches and the prognostic scores available for the management of spinal metastases was performed and summarized. Surgery for spinal metastases has 3 main objectives: management of pain, achievement of mechanical stability and preservation or restoration of neurological function. A variety of surgical approaches are available and depend on location of tumor, presence of instability, neurological status, oncologic prognosis, general performance status and subsequent treatment measures. The goal of any therapeutic course for a spinal metastasis is the best oncologic and functional result with the least aggressive treatment. Novelty surgical and adjunctive measures allow a multidisciplinary approach to the metastatic spine.
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Affiliation(s)
- G Abi Lahoud
- Unité de chirurgie de la colonne vertébrale et de la moelle épinière, service de neurochirurgie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - S Abi Jaoude
- Unité de chirurgie de la colonne vertébrale et de la moelle épinière, service de neurochirurgie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
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9
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[Tumours and metastases of the spine : cavity/coblation surgery and vertebroplasty/kyphoplasty]. DER ORTHOPADE 2015. [PMID: 26205356 DOI: 10.1007/s00132-015-3138-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Radical surgery for metastases in the spine is in many cases not possible, includingthe higher risk of surgery in older patients with co-morbidities. The aims of treatment are: minimally invasive and maximally effective tumour removal, fracture position, stabilization, pain reduction, and improved quality of life. The specific features and problems of diagnosis and treatment using the cavity/coblation method, , the surgical technique, and the results of the treatment of 250 patients with spinal tumours/metastases are presented. MATERIALS AND METHODS Tumour resection is carried out by plasma field, via percutaneous trans-/extrapedicular access, followed by kyphoplasty. Clinical and radiological follow-up was carried out postoperatively, including data on pain reduction and improvement of quality of life. RESULTS Within 6 years (March 2008t February 2014) a total of 250 patients, or 812 spines were treated. In 59 cases dorsal percutaneous instrumentation and straightening were carried out. Minimal blood loss and a very low complication rate were recorded. After surgery, significant pain reduction, satisfaction, early mobilization, and improvement in quality of life were demonstrated in all patients. Immediate radio- and chemotherapy could be carried out. In 38 cases cement escaped laterally into the intervertebral space, but this had no clinical relevance. 188 patients have since died because of tumour manifestations. CONCLUSIONS The cavity/coblation method has been demonstrated to be a safe, minimally invasive procedure, with good short- and long-term results and lower complication rates. A comprehensive diagnostic, including tumour staging, the correct indication, and prognosis estimation, is important.
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10
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Predictive value of Tokuhashi scoring systems in spinal metastases, focusing on various primary tumor groups: evaluation of 448 patients in the Aarhus spinal metastases database. Spine (Phila Pa 1976) 2012; 37:573-82. [PMID: 21796024 DOI: 10.1097/brs.0b013e31822bd6b0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We conducted a prospective cohort study of 448 patients with spinal metastases from a variety of cancer groups. OBJECTIVE To determine the specific predictive value of the Tokuhashi scoring system (T12) and its revised version (T15) in spinal metastases of various primary tumors. SUMMARY OF BACKGROUND DATA The life expectancy of patients with spinal metastases is one of the most important factors in selecting the treatment modality. Tokuhashi et al formulated a prognostic scoring system with a total sum of 12 points for preoperative prediction of life expectancy in 1990 and revised it in 2005 to a total sum of 15 points. There is a lack of knowledge about the specific predictive value of those scoring systems in patients with spinal metastases from a variety of cancer groups. METHODS We included 448 patients with vertebral metastases who underwent surgical treatment during November 1992 to November 2009 in Aarhus University Hospital NBG. Data were retrieved from Aarhus Metastases Database. Scores based on T12 and T15 were calculated prospectively for each patient. We divided all the patients into different groups dictated by the site of their primary tumor. Predictive value and accuracy rate of the 2 scoring systems were compared in each cancer group. RESULTS Both the T12 and T15 scoring systems showed statistically significant predictive value when the 448 patients were analyzed in total (T12, P < 0.0001; T15, P < 0.0001). The accuracy rate was significantly higher in T15 (P < 0.0001) than in T12. The further analyses by primary cancer groups showed that the predictive value of T12 and T15 was primarily determined by the prostate (P = 0.0003) and breast group (P = 0.0385). Only T12 displayed predictive value in the colon group (P = 0.0011). Neither of the scoring systems showed significant predictive value in the lung (P > 0.05), renal (P > 0.05), or miscellaneous primary tumor groups (P > 0.05). The accuracy rate of prognosis in T15 was significantly improved in the prostate (P = 0.0032) and breast group (P < 0.0001). CONCLUSION Both T12 and T15 showed significant predictive value in patients with spinal metastases. T15 has a statistically higher accuracy rate than T12. Among the various cancer groups, the 2 scoring systems are especially reliable in prostate and breast metastases groups. T15 is recommended as superior to T12 because of its higher accuracy rate.
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11
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Actual and predicted survival time of patients with spinal metastases of lung cancer: evaluation of the robustness of the Tokuhashi score. Spine (Phila Pa 1976) 2011; 36:983-9. [PMID: 21217434 DOI: 10.1097/brs.0b013e3181e8f7f8] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In a retrospective analysis we evaluated the achieved and the predicted survival times according to the Tokuhashi score for patients with spinal metastases of lung cancer (lc). OBJECTIVE Our aim was to investigate the robustness of the Tokuhashi Score for this group of patients. SUMMARY OF BACKGROUND DATA The decision on operative versus conservative treatment for cancer patients with vertebral metastases depend on their predicted lifespan. Although the score of Tokuhashi is commonly used for prognostic predictions, it's reliability for specific tumor types (e.g., lc), has not been validated. METHODS Seventy-six patients who had undergone spinal surgery for lc metastases between 1999 and 2004 were verified according to the Tokuhashi score and predicted versus achieved survival times were compared. RESULTS The median overall survival (OS) after surgery for all patients was 108 (3-1767) days (102 [5-1767] days for patients with NSCLC [n = 49; 64.5%] and 108 [3-473] days for patients with SCLC [n = 24; 31.6%]). Survival times differed depending on the time period of procedure performance (OS 81 [3-435] days for patients operated between 1999 and 2001 [n = 38], 135 [8-1767] days for patients who received surgery between 2002 and 2004 [n = 38]). Actual and predicted survival were similar in 51 of 76 cases (67.1%), while there was no correlation in 25 of 76 (32.9%) cases. Results were comparable for all histologic subgroups. CONCLUSION Although the survival time of patients with vertebral metastases from lc has increased over the last 10 years, the overall outcome is still poor. For the prediction of an individual prognosis in the group of lc patients the score of Tokuhashi seems to be a suboptimal tool. We conclude that therapeutic decisions for such patients should be made based on interdisciplinary platforms, especially in the light of improved systemic treatment options.
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12
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Delank KS, Wendtner C, Eich HT, Eysel P. The treatment of spinal metastases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:71-9; quiz 80. [PMID: 21311714 PMCID: PMC3036978 DOI: 10.3238/arztebl.2011.0071] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 11/30/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The rising life expectancy of cancer patients has led to a greater need for treatment of spinal metastases. Interdisciplinary collaboration is important so that each patient's treatment can be properly tailored to the overall prognosis. The main factors to be considered are the histology of the primary tumor, potential spinal instability, and compression of neural structures. METHODS We discuss the treatment options for spinal metastases on the basis of a selective literature review and our own extensive experience in an interdisciplinary tumor center. RESULTS For spinal canal compression or impending spinal instability, the treatment of choice is decompression and stabilization, by either a dorsal approach (lumbar and thoracic spine) or a ventral approach (cervical spine). Radical ventral tumor resection is indicated only for solitary metastases in patients with a favorable long-range prognosis. If the tumor is radiosensitive, radiotherapy is given either as adjuvant treatment after surgery or as the primary treatment for multiple spinal metastases in the absence of an acute neurological deficit. Various fractionation schemes with different total radiation doses are used. Bisphosphonate treatment is an integral component of the overall treatment strategy. CONCLUSION The treatment of spinal metastases requires interdisciplinary collaboration and must be tailored to each patient's overall prognosis.
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Affiliation(s)
- Karl-Stefan Delank
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität Köln, Köln, Germany.
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Fattal C, Fabbro M, Gelis A, Bauchet L. Metastatic paraplegia and vital prognosis: perspectives and limitations for rehabilitation care. Part 1. Arch Phys Med Rehabil 2011; 92:125-33. [PMID: 21187215 DOI: 10.1016/j.apmr.2010.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the vital prognosis of patients with metastatic epidural spinal cord compression (MESCC) to determine the relevance and duration of physical medicine and rehabilitation (PM&R) admission. DATA SOURCES Publications from 1980 to January 2010 selected from 3 databases. STUDY SELECTION Publications reporting data correlated with survival and prognosis factors, highlighting publications with level A scientific evidence (prospective randomized controlled studies with significant casuistry and relevant judgment criteria). The work focused on patients with MESCC below T1. DATA EXTRACTION Standardized reading grid. DATA SYNTHESIS Thirty-eight studies met the inclusion criteria. Most were retrospective. For survival rate at 1 year, they reported data ranging from 12% to 58%. The 12-month and median survival rates were the data reported most often in the articles. The median survival rate ranged from 2.4 to 30 months, and 12-month survival rates ranged from 12% to 58%. Of publications that chose this parameter, 95% reported 12-month survival rates less than 55.2% (95th percentile) regardless of patients' functional status and associated risk factors (eg, location of primary cancer, metastases spreading, pretreatment ambulatory status). CONCLUSIONS Despite major progress in cancer care, patients with MESCC still have a limited vital prognosis. The relevance and duration of PM&R care must be evaluated against the patient's functional need for rehabilitation while making time for family. The hypothesis of a 1-month stay extended only once appears reasonable for patients to adapt to their new functional status without taking precious time away from their loved ones.
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Affiliation(s)
- Charles Fattal
- Centre Mutualiste Neurologique Propara, Montpellier, France.
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Hessler C, Regelsberger J, Raimund F, Heese O, Madert J, Eggers C. Prognose nach operativem Wirbelsäuleneingriff bei Bronchialkarzinommetastasen. Chirurg 2008; 79:671-9. [DOI: 10.1007/s00104-008-1541-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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