Health-related Quality of Life in Patients with Metastatic Spinal Cord Compression

The role of combination surgery and radiotherapy in patients with metastatic spinal cord compression: What are the remaining grey areas? A systematic review

OBJECTIVE

Traditional management of patients with metastatic epidural spinal cord compression (MESCC) consists of radiotherapy (RT) with or without surgical decompression. With extensive literature and the introduction of clinical frameworks, such as the neurologic, oncologic, mechanical, and systemic criteria and the epidural spinal cord compression scale, progress has been made in refining the appropriate treatment regimen. In this review, we analyze the existing literature to identify the consensus frameworks and the remaining gaps in clinical knowledge.

METHODS

PubMed, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov were queried in January 2023. Only articles comparing combination therapy (surgery plus RT) to RT alone and assessing neurological and/or survival outcomes in patients with MESCC were retained for full-text review.

RESULTS

Out of 2157 unique articles, 29 met inclusion criteria. The most common primary cancer locations included lung (n=1031, 20.0 %), breast (n=747, 14.5 %), and prostate (n=712, 13.8 %), and back pain was the most common symptom reported (n=1186/1622, 73.1 %). While baseline patient characteristics were not controlled between the different treatment regimens, the included studies demonstrated a median survival of 4.0 months (interquartile range [IQR] 3.0-6.1 months) in patients receiving RT alone compared to 7.7 months (IQR 6.3-11.1 months) in the cohort receiving combination therapy. Similarly, in patients undergoing RT alone, a median of 29.0 % (IQR 16.0-37.9 %) of patients experienced a neurologic improvement, compared to 38.0 % (IQR 31.5-64.4 %) of patients undergoing combination therapy.

CONCLUSIONS

In patients with high-grade, symptomatic MESCC, combination therapy with direct circumferential decompression is superior to RT alone in patients with less radiosensitive tumors. In patients with high-grade asymptomatic MESCC, RT alone can be pursued for patients with the most radiosensitive tumors, such as myeloma and lymphoma; however, more research is needed on the treatment of less radiosensitive tumors. A major grey area exists in the treatment of patients with intermediate grade epidural involvement.

Remineralization of lytic spinal metastases after radiation therapy - A retrospective cohort study comparing conventional external beam radiation therapy with stereotactic ablative body radiation

Introduction

Osteolytic spinal metastases (SM) have a higher risk of fracture. In this study we aim to confirm the remineralization of lytic SM after radiation therapy. Secondary the influence of SBRT compared to cEBRT and tumor type will be analyzed.

Methods

A retrospective cohort study was performed.

Results

87 patients, 100 SM were included. 29 received SBRT, 71 cEBRT. Most common primary tumors were breast (35 %), lung (26 %) and renal (11 %). Both cEBRT and SBRT resulted in a significant increase of bone mineral density (BMD) (83.76 HU ± 5.72 → 241.41 HU ± 22.58 (p < 0.001) and 82.45 ± 9.13 → 179.38 ± 47.83p = 0.026). There was a significant increase in absolute difference of BMD between the SM and reference vertebrae (p < 0.001). There was no significant difference between SBRT and cEBRT. There was no increase of BMD in renal lytic SM after radiation therapy (pre-treatment: 85.96 HU ± 19.07; 3 m 92.00 HU ± 21.86 (p = 0.882); 6 m 92.06 HU ± 23.94 (p = 0.902); 9 m 70.44 HU ± 7.45 (p = 0.213); 12 m 98.08 HU ± 11.24 (p = 0.740)). In all other primary tumors, a significant increase of BMD after radiation therapy was demonstrated (p < 0,05).

Conclusion

We conclude that the BMD of lytic SM increases significantly after radiation therapy. Lytic SM of primary renal tumors are the exception; there is no significant remineralization of renal lytic SM after radiation therapy. There is no benefit of SBRT over cEBRT in this remineralization. These findings should be taken into account when deciding on surgery in the potentially unstable group defined by the spinal instability neoplastic score.

Quality-of-life outcomes in metastatic spinal cord compression: findings from the SCORAD trial

PURPOSE

This article reports detailed quality-of-life data including preferred and actual place of care from SCORAD, the only large prospective randomized trial in metastatic spinal cord compression (MSCC).

METHODS

SCORAD compared 2 doses of radiotherapy in patients with MSCC: 8 Gy single fraction and 20 Gy in 5 fractions. In total, 686 patients were randomized, of whom 590 had Health-Related Quality of Life (HRQoL) data collected at baseline and at least 1 later time point. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 supplemented with the QLU-C10D and data on place of care at weeks 1, 4, 8, and 12 postrandomization. Quality-of-Life Adjusted Survival was computed by multiplying Kaplan-Meier survival probabilities with the UK utility weights obtained from the QLU-C10D.

RESULTS

Patients with a baseline physical functioning score of above 50 demonstrated a 28% reduction in the risk of death (hazard ratio [HR] = 0.72, 99% confidence interval [CI] = 0.54 to 0.95; P = .003). An increased risk of death was associated with fatigue (HR = 1.35, 99% CI = 1.03 to 1.76; P = .0040), dyspnea (HR = 1.61, 99% CI = 1.24 to 2.08; P < .001), and appetite loss (HR = 1.25, 99% CI = 0.99 to 1.59; P = .014). The preferred place of care for the majority was at home or with relatives (61%-74% across the 12 weeks) but achieved by only 53% at 8 weeks.

CONCLUSIONS

Prolonged survival in patients with MSCC was associated with better HRQoL. More than 60% of patients preferred to be cared for at home or with relatives, but only half were able to achieve this. There was no difference in HRQoL between the multifraction and single-fraction groups.

TRIAL REGISTRATION

ISRCTN97555949 and ISRCTN97108008.

Translation and Cross-cultural Adaptation of the SOSG-OQ 2.0 Questionnaire into Brazilian Portuguese

Objective:  To perform the cross-cultural adaptation and translation into Brazilian Portuguese of the Spine Oncology Study Group - Outcomes Questionnaire 2.0 (SOSG-OQ 2.0) to enable its application to Brazilian patients and to allow Brazilian researchers to use a questionnaire that is on trend in the scientific literature. Materials and Methods:  The present is a basic, non-randomized, non-comparative study. The translation followed the proposal by Reichenheime and Moraes, mainly for the semantic equivalence and measurement equivalence sessions, as well as the recommendations by Coster and Mancini mainly in the translation stage. The stages were as follows: first - translation into Brazilian Portuguese; second - back-translation; third - semantic comparison; fourth - validation of the final construct. Results:  The translations of the SOSG-OQ 2.0 made by three translators presented a high degree of similarity for most questions. The translators kept all question titles and subtitles, as well as their internal and external orders. Two sworn translators, with native proficiency in English, performed the back-translation of the amalgamated text. Both back-translations were quite similar, and any differences were solved through consensus between the main author and the sworn translators, and the translated text was considered the final version. Conclusion:  The present study shows a translated version of the SOSG-OQ 2.0 with semantic validity with the original version published in English. As such, researchers can apply the questionnaire to the Brazilian population, adding another tool for spine surgeons to improve the monitoring of this complex group of patients.

Quality of life in patients with malignant spinal cord compression: a systematic review

INTRODUCTION

Malignant spinal cord compression (MSCC) is an oncological emergency that may result in a devastating combination of malignancy and disability. Existing quality of life (QoL) questionnaires commonly used in MSCC literature (EORTC QLQ-C30, BM-22, Brief Pain Inventory, and Spine Oncology Study Group Outcomes) may not capture all the commonly reported symptoms and lack specificity to MSCC. The primary objective of this systematic review is to determine unmet patient needs and underreported QoL issues and compile a comprehensive list of QoL issues. The secondary objective of this review is to compile all existing QoL tools and questionnaires and determine whether any QoL issues are not addressed in the existing tools currently used in the literature.

METHODS

A literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and February 6, 2023, to compile all QoL issues and existing questionnaires used to assess QoL in patients with MSCC. All study designs were included given that they discussed QoL issues specific to patients with MSCC.

RESULTS

The results of this systematic review identified the most frequently discussed QoL issues in the literature studying MSCC. This included direct symptoms of MSCC such as back pain, paralysis, limb weakness/numbness, and urinary/bowel incontinence. Indirect symptoms coming from radiotherapy treatment such as dysphagia, painful swallowing, mouth pain, dry mouth, diarrhea, fatigue, and nausea/vomiting were also noted. Other symptoms resulting from corticosteroid treatment included difficulty sleeping, blurring of vision, weight gain, and mood disturbance. Patients also experienced psychosocial issues such as anxiety, depression, emotional distress, low self-esteem, concerns about dependence on others, concerns about getting home, and fear about their prognosis and future.

CONCLUSION

This review highlights the QoL issues specific to patients with MSCC and QoL tools capturing these issues. Relevance of QoL issues identified in this systematic review must be prospectively validated by patients and healthcare professionals with experience in treating MSCC.

Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology

OBJECTIVE

Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual.

DESIGN

Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains.

DATA SOURCES

MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases.

RESULTS

301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual.

CONCLUSIONS

Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.

Quality of Life Changes After Surgery for Metastatic Spinal Disease: A Systematic Review and Meta-analysis

STUDY DESIGN

This was a systematic review and meta-analysis.

OBJECTIVE

A systematic review and meta-analysis was conducted to assess the quality of life (QoL) after open surgery for spinal metastases, and how surgery affects physical, social/family, emotional, and functional well-being.

SUMMARY OF BACKGROUND DATA

It remains questionable to what extent open surgery improves QoL for metastatic spinal disease, it would be interesting to quantify the magnitude and duration of QoL benefits-if any-after surgery for spinal metastases.

MATERIALS AND METHODS

Included were studies measuring QoL before and after nonpercutaneous, open surgery for spinal metastases for various indications including pain, spinal cord compression, instability, or tumor control. A random-effect model assessed standardized mean differences (SMDs) of summary QoL scores between baseline and 1, 3, 6, or 9-12 months after surgery.

RESULTS

The review yielded 10 studies for data extraction. The pooled QoL summary score improved from baseline to 1 month (SMD=1.09, P<0.001), to 3 months (SMD=1.28, P<0.001), to 6 months (SMD=1.21, P<0.001), and to 9-12 months (SMD=1.08, P=0.001). The surgery improved physical well-being during the first 3 months (SMD=0.94, P=0.022), improved emotional (SMD=1.19, P=0.004), and functional well-being (SMD=1.08, P=0.005) during the first 6 months, and only improved social/family well-being at month 6 (SMD=0.28, P=0.001).

CONCLUSIONS

The surgery improved QoL for patients with spinal metastases, and rapidly improved physical, emotional, and functional well-being; it had minimal effect on social/family well-being. However, choosing the optimal candidate for surgical intervention in the setting of spinal metastases remains paramount: otherwise postoperative morbidity and complications may outbalance the intended benefits of surgery. Future research should report clear definitions of selection criteria and surgical indication and provide stratified QoL results by indication and clinical characteristics such as primary tumor type, preoperative Karnofsky, and Bilsky scores to elucidate the optimal candidate for surgical intervention.

Characterizing Health-Related Quality of Life by Ambulatory Status in Patients with Spinal Metastases

STUDY DESIGN

Retrospective review of prospective longitudinal data.

OBJECTIVE

To determine health-related quality of life (HRQL) utilities associated with specific ambulatory states in patients with spinal metastases: independent, ambulatory with assistance, and nonambulatory.

SUMMARY OF BACKGROUND DATA

It is assumed that HRQL is aligned with ambulatory ability in patients with spinal metastases. Few studies have effectively considered these parameters while also accounting for clinical confounders.

METHODS

We used prospective longitudinal data from patients treated at one of three tertiary medical centers (2017-2019). HRQL was characterized using the Euroquol-5-dimension (EQ5D) inventory. We performed standardized estimations of HRQL stratified by ambulatory state using generalized linear modeling that accounted for patient age at presentation, biologic sex, follow-up duration, operative or nonoperative management, and repeated measures within the same participant.

RESULTS

We evaluated 675 completed EQ5D assessments, with 430 for independent ambulators, 205 for ambulators with assistance, and 40 for nonambulators. The average age of the cohort was 61.5. The most common primary cancer was lung (20%), followed by breast (18%). Forty-one percent of assessments were performed for participants treated surgically. Mortality occurred in 51% of the cohort. The standardized EQ5D utility for patients with spinal metastases and independent ambulatory function was 0.76 (95% confidence interval [CI] 0.74, 0.78). Among those ambulatory with assistance, the standardized EQ5D utility was 0.59 (95% CI 0.57, 0.61). For nonambulators, the standardized EQ5D utility was 0.14 (95% CI 0.09, 0.19).

CONCLUSION

Patients with spinal metastases and independent ambulatory function have an HRQL similar to patients with primary cancers and no spinal involvement. Loss of ambulatory ability leads to a 22% decrease in HRQL for ambulation with assistance and an 82% reduction among nonambulators. Given prior studies demonstrate superior maintenance of ambulatory function with surgery for spinal metastases, our results support surgical consideration to the extent that it is clinically warranted.Level of Evidence: 3.

Survival, discharge destination, and referral for rehabilitation after metastatic spinal cord compression surgery

STUDY DESIGN

A retrospective review of medical records.

OBJECTIVE

The objective of this study was to examine probability of survival after 90- and 180-days after surgery, to document the rehabilitation needs, patients discharge destination, and whether discharge destination, re-admission, and probability of survival among patients with metastatic spinal cord compression (MSCC) were associated with potential risk factors.

SETTING

Copenhagen University Hospital, Rigshospitalet that serves a population of 2.8 million people from the Eastern part of Denmark, Faroe Islands, and Greenland.

METHODS

Adult (≥18 years) patients with MSCC undergoing surgery in 2017-2018 were included. Descriptive statistics were used to investigate the probability of survival after 90- and 180-days, rehabilitation needs documented in the patient's medical record, and discharge destination. Univariate logistic regression analyses were used to examine the associations between a priory defined potential risk factors for mortality and readmission.

RESULTS

Seventy-four medical records were included in final analysis. The probability of survival after 90- and 180-days post-surgery were 78% and 57%, respectively. Higher age was the only defined variable that was significantly associated with higher mortality. Ninety-three percent of the patient's medical records described rehabilitation potential, but only 44.6% of the patients were discharged with a rehabilitation plan. Seventy-three percent of the patients were discharged to their home. None had a specialized rehabilitation plan.

CONCLUSION

Almost all patients diagnosed with MSCC have a rehabilitation potential described in their medical records. However, only half of these patients are discharged with a rehabilitation plan indicating an unmet potential for rehabilitation.

Predictors of overall survival in non-small-cell lung cancer patients with metastatic spinal cord compression treated with short-course radiotherapy

Metastatic spinal cord compression (MSCC) is a condition that impacts directly on the patient's prognosis.

OBJECTIVE

The study purpose was to identify predictors of overall survival in non-small-cell lung cancer (NSCLC) patients with MSCC.

METHODS

A cohort study involving NSCLC patients enrolled between 2008 and 2017 was performed. Sixty-four patients treated with short-course radiotherapy were included. Clinical and socio-demographic data were extracted from medical records. Data were analysed using survival analysis and Cox proportional hazard regression analysis.

RESULTS

The median survival time was 2.5 months (95% CI: 1.6-3.5). Patients >60 years had shorter survival than younger patients (HR 1.85; 95% CI 1.06-3.24; p = 0.02), and patients with performance status (PS) >2 had shorter survival than those with PS≤2 (HR 1.93; 95% CI 1.12-3.33; p = 0.01).

CONCLUSION

This study found worse PS and higher age are independent predictors of overall survival in NSCLC patients with MSCC treated with short-course radiotherapy after adjusting the potential confounding factors (PS, age and target therapy).

Metastatic Spine Disease: Should Patients With Short Life Expectancy Be Denied Surgical Care? An International Retrospective Cohort Study

BACKGROUND

Despite our inability to accurately predict survival in many cancer patients, a life expectancy of at least 3 mo is historically necessary to be considered for surgical treatment of spinal metastases.

OBJECTIVE

To compare health-related quality of life (HRQOL) in patients surviving <3 mo after surgical treatment to patients surviving >3 mo to assess the validity of this inclusion criteria.

METHODS

Patients who underwent surgery for spinal metastases between August 2013 and May 2017 were retrospectively identified from an international cohort study. HRQOL was evaluated using generic and disease-specific outcome tools at baseline and at 6 and 12 wk postsurgery. The primary outcome was the HRQOL at 6 wk post-treatment measured by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ).

RESULTS

A total of 253 patients were included: 40 patients died within the first 3 mo after surgery and 213 patients survived more than 3 mo. Patients surviving <3 mo after surgery presented with lower baseline performance status. Adjusted analyses for baseline performance status did not reveal a significant difference in HRQOL between both groups at 6 wk post-treatment. No significant difference in patient satisfaction at 6 wk with regard to their treatment could be detected between both groups.

CONCLUSION

When controlled for baseline performance status, quality of life 6 wk after surgery for spinal metastasis is independent of survival. To optimize improvement in HRQOL for this patient population, baseline performance status should take priority over expected survival in the surgical decision-making process.

A pilot study of stereotactic boost for malignant epidural spinal cord compression: clinical significance and initial dosimetric evaluation

Purpose

Metastatic epidural spinal cord compression (MESCC) is a devastating complication of advanced malignancy, which can result in neurologic complications and significant deterioration in overall function and quality of life. Most patients are not candidates for optimal surgical decompression and as a result, receive urgent 3D conformal radiotherapy (3DCRT) to prevent or attempt to reverse neurologic progression. Multiple trials indicate that response and ambulatory rates after 3DCRT are inferior to surgery. The advent of stereotactic body radiation therapy (SBRT) has created a method with which a “radiosurgical decompression” boost may facilitate improve outcomes for MESCC patients.

Methods

We are conducting a pilot study to investigate SBRT boost after urgent 3D CRT for patients with MESCC. The aim of the study is to establish feasibility of this two-phase treatment regimen, and secondarily to characterize post-treatment ambulation status, motor response, pain control, quality of life and survival.

Discussion

We describe the study protocol and present a case report of one patient. A quality assurance review was conducted after the first seven patients, and resultant dose-constraints were revised to improve safety and feasibility of planning through more conservative organ at risk constraints. There have been no severe adverse events (grade 3–5) to date. We have illustrated clinical and dosimetric data of an example case, where a patient regained full strength and ambulatory capacity.

Conclusions

Our study aims to determine if SBRT is a feasible option in addition to standard 3DCRT for MESCC patients, with the goal to consider future randomized trials if successful. Having a robust quality assurance process in this study ensures translatability going forward if future trials with multicenter and increased patient representation are to be considered.

Trial registration

clinicaltrials.gov; registration no. NCT03529708; https://clinicaltrials.gov/ct2/show/NCT03529708; First posted May 18, 2018.

Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression

OBJECTIVE

Metastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes.

METHODS

The authors performed a retrospective chart review and collected data for patients who had neurological symptoms resulting from radiologically and histologically confirmed MSCC and were treated with surgical decompression during the last 12 years.

RESULTS

A total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months. Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%). The median estimated blood loss was 500 mL and the average length of hospital stay was 10.3 days. About 18% of patients had postoperative complications and the mean follow-up was 7 months. The mean pre- and postoperative ECOG (Eastern Cooperative Oncology Group) performance status grades were 3.2 and 2.4, respectively. At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status. The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1-2, 2-3, 3-4, or 4-5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively. Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome.

CONCLUSIONS

The mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.

Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease: A Retrospective Study of 315 Patients in Sweden

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.

SUMMARY OF BACKGROUND DATA

Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.

METHODS

Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.

RESULTS

The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6-14.2) and median 5.9 months (confidence interval 4.5-7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.

CONCLUSION

Predictive scores underestimate survival for the patients which might affect important clinical decisions.

LEVEL OF EVIDENCE

3.

Thoracic Vertebral Hemangioma with Spinal Cord Compression: Multidisciplinary Surgical Treatment and Follow-up of Six Patients

OBJECTIVE

To provide useful insights of multidisciplinary surgical treatment for vertebral hemangioma with spinal cord compression.

METHODS

From 2009 to 2014, data on six patients who were diagnosed with cord compression vertebral hemangioma were reviewed and analyzed retrospectively. There were five women and one man with a mean age of 48.6 years (range, 26-68 years). All the patients were treated by multidisciplinary approach, including use of gelfoam, pedicle screw instrumentation, vertebroplasty, and decompression laminectomy. Neurological status and Frankel grades were documented, CT scan and MRI were performed after surgery.

RESULTS

The follow-up period ranged from 8 to 54 months. Mean blood loss was around 367 mL, and the mean surgical time was 2.30 h. All patients had uneventful intraoperative and postoperative courses and reported symptomatic and neurological relief to varying degrees, at an average follow-up period of 23 months. Bone cement distribution was disseminated homogeneously over the affected vertebra and no leakage was observed. All the patients had a complete restoration to Frankel grade E. The postoperative and follow-up imaging showed that the implant was in perfect position, and no recurrence occurred in all patients.

CONCLUSION

The vertebral hemangioma with cord compression is a challenge to surgeons for therapeutic improvement, and an active involvement of several disciplines as well as performance of multidisciplinary surgical treatment can be crucial in achieving favorable results.