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Ulu MO, Akgun MY, Alizada O, Akcil EF, Kartum T, Hanci M. Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:247-255. [PMID: 36931930 DOI: 10.1016/j.neucie.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/04/2022] [Indexed: 03/17/2023]
Abstract
PURPOSE The surgical treatment of spinal metastases is mostly palliative in nature and focuses on improving the quality of life of patients. The posterior transpedicular surgical approach provides circumferential 360° decompression, allows reconstruction and stabilisation to be achieved in a single session and can be performed using an open, mini-open or minimally invasive approach. We present and discuss the surgical techniques and outcomes for patients with single-level metastatic spinal disease and in poor general condition who underwent surgery via the posterior-only transpedicular corpectomy approach and reconstruction with expandable corpectomy cages. METHODS Patients with a single level thoracolumbar metastatic disease (T3-L5) and a Karnofsky score of ≤70, who underwent a complete posterior transpedicular corpectomy with expandable cage reconstruction of the anterior spinal column were retrospectively reviewed. Patients' demographics, SINS, modified Tokuhashi scores as well as preoperative and postoperative ASIA scale, Karnofsky scores, VAS scores and vertebral height/Cobb angle values were analysed. RESULTS A total of 44 patients (24 M/20 F) (mean age 53.25±21.26 years) met the inclusion criteria. The modified Tokuhashi scores were as follows: score 0-8, 5 (11.4%) patients; score 9-11, 14 (31.8%) patients; and score 12-15, 25 (56.8%) patients. There were significant improvements in the postoperative VAS scores (mean 7.7-2.9), Karnofsky scores (mean 63.3-79.6) as well as the Cobb angles (18.6-12.8°) and vertebral height. Thirtyfive patients showed improved neurological function by at least one ASIA grade, whereas 9 showed no improvement during the postoperative period. CONCLUSIONS This technique, which has a low complication rate and a short recovery time, can help achieve satisfactory results even in patients with poor metabolic profiles and Karnofsky scores in the preoperative period. Further clinical studies with large patient groups are warranted to confirm the results of this study.
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Affiliation(s)
- Mustafa Onur Ulu
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Orkhan Alizada
- Department of Neurosurgery, Baskent University Hospital, Istanbul, Turkey
| | - Eren Fatma Akcil
- Department of Anesthesiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tufan Kartum
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Hanci
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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2
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Zijlstra H, Crawford AM, Striano BM, Pierik RJ, Tobert DG, Wolterbeek N, Delawi D, Terpstra WE, Kempen DHR, Verlaan JJ, Schwab JH. Neurological Outcomes and the Need for Retreatments Among Multiple Myeloma Patients With High-Grade Spinal Cord Compression: Radiotherapy vs Surgery. Global Spine J 2023:21925682231188816. [PMID: 37452005 DOI: 10.1177/21925682231188816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Up to 30% of Multiple Myeloma (MM) patients are expected to experience Epidural Spinal Cord Compression (ESCC) during the course of their disease. To prevent irreversible neurological damage, timely diagnosis and treatment are important. However, debate remains regarding the optimal treatment regimen. The aim of this study was to investigate the neurological outcomes and frequency of retreatments for MM patients undergoing isolated radiotherapy and surgical interventions for high-grade (grade 2-3) ESCC. METHODS This study included patients with MM and high-grade ESCC treated with isolated radiotherapy or surgery. Pre- and post-treatment American Spinal Injury Association (ASIA) impairment scale and retreatment rate were compared between the 2 groups. Adjusted multivariable logistic regression was utilized to examine differences in neurologic compromise, pain, and retreatments. RESULTS A total of 247 patients were included (Radiotherapy: n = 154; Surgery: n = 93). After radiotherapy, 82 patients (53%) achieved full neurologic function (ASIA E) at the end of follow-up. Of the surgically treated patients, 67 (64%) achieved full neurologic function. In adjusted analyses, patients treated with surgery were less likely to experience neurologic deterioration within 2 years (OR = .15; 95%CI .05-.44; P = .001) and had less pain (OR = .29; 95%CI .11-.74; P = .010). Surgical treatment was not associated with an increased risk of retreatments (OR = .64; 95%CI .28-1.47; P = .29) or death (HR = .62, 95%CI .28-1.38; P = .24). CONCLUSIONS After adjusting for baseline differences, surgically treated patients with high-grade ESCC showed better neurologic outcomes compared to patients treated with radiotherapy. There were no differences in risk of retreatment or death.
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Affiliation(s)
- Hester Zijlstra
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander M Crawford
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Brendan M Striano
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Robert-Jan Pierik
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Daniel G Tobert
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Nienke Wolterbeek
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Diyar Delawi
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Wim E Terpstra
- Department of Hematology/Oncology, OLVG, Amsterdam, The Netherlands
| | | | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
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3
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Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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4
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Oda Y, Takigawa T, Ito Y, Misawa H, Tetsunaga T, Uotani K, Ozaki T. Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:565. [PMID: 35629982 PMCID: PMC9143153 DOI: 10.3390/medicina58050565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction.
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Affiliation(s)
- Yoshiaki Oda
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan; (H.M.); (T.T.); (K.U.)
| | - Tomoyuki Takigawa
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, 1-3-1 Wakinohamakaigandori, Chuoku, Kobe City 651-0073, Japan; (T.T.); (Y.I.)
| | - Yasuo Ito
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, 1-3-1 Wakinohamakaigandori, Chuoku, Kobe City 651-0073, Japan; (T.T.); (Y.I.)
| | - Haruo Misawa
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan; (H.M.); (T.T.); (K.U.)
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan; (H.M.); (T.T.); (K.U.)
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan; (H.M.); (T.T.); (K.U.)
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan;
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Thio QCBS, Paulino Pereira NR, van Wulfften Palthe O, Sciubba DM, Bramer JAM, Schwab JH. Estimating survival and choosing treatment for spinal metastases: Do spine surgeons agree with each other? J Orthop 2021; 28:134-139. [PMID: 34924728 PMCID: PMC8665269 DOI: 10.1016/j.jor.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/05/2021] [Accepted: 11/17/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose This study aimed to investigate spine surgeons’ ability to estimate survival in patients with spinal metastases and whether survival estimates influence treatment recommendations. Methods 60 Spine surgeons were asked a survival estimate and treatment recommendation in 12 cases. Intraclass correlation coefficients and descriptive statistics were used to evaluate variability, accuracy and association of survival estimates with treatment recommendation. Results There was substantial variability in survival estimates amongst the spine surgeons. Survival was generally overestimated, and longer estimated survival seemed to lead to more invasive procedures. Conclusions Prognostic models to estimate survival may aid surgeons treating patients with spinal metastases.
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Affiliation(s)
- Quirina C B S Thio
- Department of Orthopaedic Surgery, Amsterdam University Medical Center Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.,Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Nuno Rui Paulino Pereira
- Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Olivier van Wulfften Palthe
- Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital - the John Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Amsterdam University Medical Center Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - Joseph H Schwab
- Division of Orthopaedic Oncology, Department of Orthopaedics Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, Strouse IM, Dowell A, Kisana H, Khan N, Ravinsky R, Baaj AA. 10-Year Trends in the Surgical Management of Patients with Spinal Metastases: A Scoping Review. World Neurosurg 2021; 157:170-186.e3. [PMID: 34655822 DOI: 10.1016/j.wneu.2021.10.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spinal metastases are present in approximately 20% of patients with cancer, giving a risk for neurologic dysfunction and instability. In already frail patients, surgeons strive to improve quality of life. Our goal was to review a 10-year trend in the surgical management of spinal metastases. METHODS A scoping review was performed systematically using PubMed to assess trends in surgical treatment for spinal metastases. The search terms used were: metastas∗, "neoplasm metastasis"[Mesh], "Spine"[Mesh], spine, spinal, "vertebral column," "vertebral body," laser, robot, radiofrequency, screws, fixation, "separation surgery," corpectomy, vertebrectomy, spondylectomy, vertebroplasty, kyphoplasty, surgery, "open surgery," "mini open surgery," "minimally invasive surgery," endoscopy, thoracoscopy, corpectom∗, vertebrectom∗, spondylectom∗, "en bloc," and MIS. The variables of interest were neurologic improvement, tumor recurrence, reoperation, and overall survival. RESULTS A total of 2132 articles were found within the primary query. Fifty-six studies were selected for final review. The results were organized into main surgical practices: decompression, mechanical stabilization, and pain management. For separation surgery, clinical outcomes were overall 1-year survival, 40.7%-78.4%; recurrence rate, 4.3%-22%; reoperation, 5%; and complications, 5.4%-14%. For corpectomy, clinical outcomes were overall 1-year survival, 30%-92%; reoperation, 1.1%-50%; and recurrence rate, of 1.1%-28%. Complications and reoperations with spinal instrumentation were 0%-13.6% and 0%-15%, respectively. Cement augmentation achieved pain reduction rates of 56%-100%, neurologic improvement/stability 84%-100%, and complication rates 6%-56%. Laser achieved local tumor control rate of 71%-82% at 1 year follow-up, reoperation rate of 15%-31%, and complication rate of 5%-26%. CONCLUSIONS Minimally invasive techniques for decompression and stabilization seem to be the preferred method to surgically treat metastatic spine disease, with good outcomes. More research with high level of evidence is required to support the long-term outcomes of these approaches.
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Affiliation(s)
| | - María José Cavagnaro
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Mauricio J Avila
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Isabel M Strouse
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Aaron Dowell
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Haroon Kisana
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Naushaba Khan
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Robert Ravinsky
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Ali A Baaj
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Li J, Wei W, Xu F, Wang Y, Liu Y, Fu C. Clinical Therapy of Metastatic Spinal Tumors. Front Surg 2021; 8:626873. [PMID: 33937314 PMCID: PMC8084350 DOI: 10.3389/fsurg.2021.626873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Metastatic spinal tumors (MST) have high rates of morbidity and mortality. MST can destroy the vertebral body or compress the nerve roots, resulting in an increased risk of pathological fractures and intractable pain. Here, we elaborately reviewed the currently available therapeutic options for MST according to the following four aspects: surgical management, minimally invasive therapy (MIT), radiation therapy, and systemic therapy. In particular, these aspects were classified and introduced to show their developmental process, clinical effects, advantages, and current limitations. Furthermore, with the improvement of treatment concepts and techniques, we discovered the prevalent trend toward the use of radiation therapy and MIT in clinic therapies. Finally, the future directions of these treatment options were discussed. We hoped that along with future advances and study will lead to the improvement of living standard and present status of treatment in patients with MST.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China.,Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - Wenjie Wei
- Key Laboratory of Pathobiology, Ministry of Education, School of Basic Medical Sciences, Jilin University, Changchun, China
| | - Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yadong Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Changfeng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
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8
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Samala RV, Lagman RL, Steinmetz MP. Palliative Spine Surgery in a Patient with Advanced Cancer: A Case Report and Decision-Making Guide. J Palliat Med 2020; 24:793-796. [PMID: 33090943 DOI: 10.1089/jpm.2020.0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The spine is a frequent site of cancer metastasis leading to intractable pain, functional impairment, and poor quality of life. When analgesic regimens and nonpharmacological interventions fail, spine surgery may be indicated. For patients with advanced disease, the decision to operate can become a dilemma. A patient with colon cancer metastatic to his spine, who had undergone multiple procedures for back pain, was admitted to a palliative care unit, where pain persisted despite high-dose opioids and adjuvant analgesics. Owing to progressive disease, he was told of a prognosis of six months by his oncologist. He eventually underwent percutaneous pedicle screw fixation. Shortly after surgery, he settled on a regimen merely equivalent to 45 mg of morphine per day. The article explores the role of palliative spine surgery in managing intractable cancer-related back pain. The authors offer a guide when considering surgical procedures for patients with limited prognosis.
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Affiliation(s)
- Renato V Samala
- Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth L Lagman
- Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Steinmetz
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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9
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Bongers MER, Karhade AV, Villavieja J, Groot OQ, Bilsky MH, Laufer I, Schwab JH. Does the SORG algorithm generalize to a contemporary cohort of patients with spinal metastases on external validation? Spine J 2020; 20:1646-1652. [PMID: 32428674 DOI: 10.1016/j.spinee.2020.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The SORG machine-learning algorithms were previously developed for preoperative prediction of overall survival in spinal metastatic disease. On sub-group analysis of a previous external validation, these algorithms were found to have diminished performance on patients treated after 2010. PURPOSE The purpose of this study was to assess the performance of these algorithms on a large contemporary cohort of consecutive spinal metastatic disease patients. STUDY DESIGN/SETTING Retrospective study performed at a tertiary care referral center. PATIENT SAMPLE Patients of 18 years and older treated with surgery for metastatic spinal disease between 2014 and 2016. OUTCOME MEASURES Ninety-day and one-year mortality. METHODS Baseline patient and tumor characteristics of the validation cohort were compared to the development cohort using bivariate logistic regression. Performance of the SORG algorithms on external validation in the contemporary cohort was assessed with discrimination (c-statistic and receiver operating curve), calibration (calibration plot, intercept, and slope), overall performance (Brier score compared to the null-model Brier score), and decision curve analysis. RESULTS Overall, 200 patients were included with 90-day and 1-year mortality rates of 55 (27.6%) and 124 (62.9%), respectively. The contemporary external validation cohort and the developmental cohort differed significantly on primary tumor histology, presence of visceral metastases, American Spinal Injury Association impairment scale, and preoperative laboratory values. The SORG algorithms for 90-day and 1-year mortality retained good discriminative ability (c-statistic of 0.81 [95% confidence interval [CI], 0.74-0.87] and 0.84 [95% CI, 0.77-0.89]), overall performance, and decision curve analysis. The algorithm for 90-day mortality showed almost perfect calibration reflected in an overall calibration intercept of -0.07 (95% CI: -0.50, 0.35). The 1-year mortality algorithm underestimated mortality mainly for the lowest predicted probabilities with an overall intercept of 0.57 (95% CI: 0.18, 0.96). CONCLUSIONS The SORG algorithms for survival in spinal metastatic disease generalized well to a contemporary cohort of consecutively treated patients from an external institutional. Further validation in international cohorts and large, prospective multi-institutional trials is required to confirm or refute the findings presented here. The open-access algorithms are available here: https://sorg-apps.shinyapps.io/spinemetssurvival/.
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Affiliation(s)
- Michiel E R Bongers
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jemma Villavieja
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Olivier Q Groot
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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10
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Barzilai O, McLaughlin L, Lis E, Reiner AS, Bilsky MH, Laufer I. Utility of Cement Augmentation via Percutaneous Fenestrated Pedicle Screws for Stabilization of Cancer-Related Spinal Instability. Oper Neurosurg (Hagerstown) 2020; 16:593-599. [PMID: 30508168 DOI: 10.1093/ons/opy186] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer patients experience pathological fractures and the typical poor bone quality frequently complicates stabilization. Methods for overcoming screw failure include utilization of fenestrated screws that permit the injection of bone cement into the vertebral body to augment fixation. OBJECTIVE To evaluate the safety and efficacy of cement augmentation via fenestrated screws. METHODS A retrospective chart review of patients with neoplastic spinal instability who underwent percutaneous instrumented stabilization with cement augmentation using fenestrated pedicle screws. Patient demographic and treatment data and intraoperative and postoperative complications were evaluated by chart review and radiographic evaluation. Prospectively collected patient reported outcomes (PRO) were evaluated at short (2- <6 mo) and long term (6-12 mo). RESULTS Cement augmentation was performed in 216 fenestrated pedicle screws in 53 patients. Three patients required reoperation. One patient had an asymptomatic screw fracture at 6 mo postoperatively that did not require intervention. No cases of lucency around the pedicle screws, rod fractures, or cement extravasation into the spinal canal were observed. Eight cases of asymptomatic, radiographically-detected venous extravasation were found. Systemic complications included a pulmonary cement embolism, a lower extremity deep vein thrombosis, and a postoperative mortality secondary to pulmonary failure from widespread metastatic pulmonary infiltration. Significant improvement in PRO measures was found in short- and long-term analysis. CONCLUSION Cement augmentation of pedicle screws is an effective method to enhance the durability of spinal constructs in the cancer population. Risks include cement extravasation into draining blood vessels, but risk of clinically significant extravasation appears to be exceedingly low.
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Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lily McLaughlin
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
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11
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Chang SY, Mok S, Park SC, Kim H, Chang BS. Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review. Asian Spine J 2020; 14:513-525. [PMID: 32791769 PMCID: PMC7435309 DOI: 10.31616/asj.2020.0379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022] Open
Abstract
Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.
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Affiliation(s)
- Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sujung Mok
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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12
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How do vertebroplasty and kyphoplasty affect the quality of life of patients with multiple myeloma spinal metastasis? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1447-1451. [PMID: 32591912 DOI: 10.1007/s00590-020-02721-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by day. Increased life expectancy has increased the incidence of cancer, making metastases more observable. The aim of our study was to investigate how the quality of life is affected in the patient group with vertebral fracture due to spinal metastases of multiple myeloma and undergoing vertebroplasty and kyphoplasty. MATERIALS AND METHODS Forty-two patients with fracture due to spinal metastasis and adequate follow-up between the years of 2011 and 2018 were included in the study. Patients were listed according to their primary malignancy and metastases. The effect of vertebroplasty and kyphoplasty was investigated by evaluating preoperative and postoperative VAS and Oswestry Disability Index scores. All patients' radiographic kyphosis angle, compression ratio and wedging index were calculated before operation and after operation. RESULTS A total of 76 vertebrae were operated in 42 patients. Significant differences were found in the comparison of preoperative and postoperative quality of life according to VAS and Oswestry Disability Index scores in the patients undergoing vertebroplasty, kyphoplasty or both procedures after spinal metastases (VAS; p = 0.0001, ODI; p = 0.002/0.0001). There were statistically significant differences in preoperative local kyphosis angle, compression ratio and wedging index and post-op local kyphosis angle, compression ratio and wedging index (p = 0.001). CONCLUSION Vertebroplasty and kyphoplasty, minimally invasive procedures performed after spinal metastases, improve the quality of life of the patients.
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Abstract
STUDY DESIGN Literature review. OBJECTIVE To provide an overview of the recent advances in minimal access surgery (MAS) for spinal metastases. METHODS Literature review. RESULTS Experience gained from MAS in the trauma, degenerative and deformity settings has paved the road for MAS techniques for spinal cancer. Current MAS techniques for the treatment of spinal metastases include percutaneous instrumentation, mini-open approaches for decompression and tumor resection with or without tubular/expandable retractors and thoracoscopy/endoscopy. Cancer care requires a multidisciplinary effort and adherence to treatment algorithms facilitates decision making, ultimately improving patient outcomes. Specific algorithms exist to help guide decisions for MAS for extradural spinal metastases. One major paradigm shift has been the implementation of percutaneous stabilization for treatment of neoplastic spinal instability. Percutaneous stabilization can be enhanced with cement augmentation for increased durability and pain palliation. Unlike osteoporotic fractures, kyphoplasty and vertebroplasty are known to be effective therapies for symptomatic pathologic compression fractures as supported by high level evidence. The integration of systemic body radiation therapy for spinal metastases has eliminated the need for aggressive tumor resection allowing implementation of MAS epidural tumor decompression via tubular or expandable retractors and preliminary data exist regarding laser interstitial thermal therapy and radiofrequency ablation for tumor control. Neuronavigation and robotic systems offer increased precision, facilitating the role of MAS for spinal metastases. CONCLUSIONS MAS has a significant role in the treatment of spinal metastases. This review highlights the current utilization of minimally invasive surgical strategies for treatment of spinal metastases.
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Affiliation(s)
- Ori Barzilai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark H Bilsky
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Ilya Laufer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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14
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Disch AC, Kleber C, Redemann D, Druschel C, Liljenqvist U, Schaser KD. Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG). Eur J Surg Oncol 2019; 46:89-94. [PMID: 31506180 DOI: 10.1016/j.ejso.2019.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/03/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Questionnaire survey among the members of the German Spine Society (Deutsche Wirbelsäulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany. METHODS All DWG-members were contacted via the society's e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure. RESULTS 84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P ≤ 0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy. CONCLUSION In spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.
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Affiliation(s)
- A C Disch
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany.
| | - C Kleber
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
| | - D Redemann
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
| | - C Druschel
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
| | - U Liljenqvist
- Orthopaedic Department II, Spine Surgery, St. Franziskus Hospital Münster, Germany
| | - K D Schaser
- University Comprehensive Spine Center (UCSC), University Center for Orthopaedics and Traumatology, Carl Gustav Carus University Hospital at the TU Dresden, Germany
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15
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Mossa-Basha M, Gerszten PC, Myrehaug S, Mayr NA, Yuh WT, Jabehdar Maralani P, Sahgal A, Lo SS. Spinal metastasis: diagnosis, management and follow-up. Br J Radiol 2019; 92:20190211. [PMID: 31322920 DOI: 10.1259/bjr.20190211] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Spine metastatic disease is an increasingly common occurrence in cancer patients due to improved patient survival. Close proximity of the bony spinal column to the spinal cord limits many conventional treatments for metastatic disease. In the past decade, we have witnessed dramatic advancements in therapies, with improvements in surgical techniques and recent adoption of spine stereotactic radiotherapy techniques leading to improved patient outcomes. Multidisciplinary approaches to patient evaluation, treatment and follow-up are essential. Imaging plays an ever increasing role in disease detection, pre-treatment planning and assessment of patient outcomes. It is important for the radiologist to be familiar with imaging algorithms, best practices for surgery and/or radiotherapy and imaging findings in the post-treatment period that may indicate disease recurrence. In this review, we present a multidisciplinary discussion of spine metastases, with specific focus on pre-treatment imaging, planning, current treatment approaches, and post-treatment assessment.
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Affiliation(s)
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - William Tc Yuh
- Department of Radiology, University of Washington, Seattle, WA
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Jung JM, Chung CK, Kim CH, Yang SH. Minimally Invasive Surgery without Decompression for Hepatocellular Carcinoma Spinal Metastasis with Epidural Spinal Cord Compression Grade 2. J Korean Neurosurg Soc 2019; 62:467-475. [PMID: 30919607 PMCID: PMC6616991 DOI: 10.3340/jkns.2018.0199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022] Open
Abstract
Objective There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2.
Methods Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3–6 months of life expectancy, Tomita score ≥5, and Spinal Instability Neoplastic Score ≥7 were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009).
Results The MIS group had a significantly shorter operative time (94.2±48.2 minutes vs. 162.9±52.3 minutes, p=0.001), less blood loss (140.0±182.9 mL vs. 1534.4±1484.2 mL, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group (3.0±1.2 vs. 4.3±1.2, p=0.042). The MIS group had longer ambulation time (183±33 days vs. 166±36 days) and survival time (216±38 days vs. 204±43 days) than the open surgery group without significant difference (p=0.814 and 0.959, respectively).
Conclusion MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.
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Affiliation(s)
- Jong-Myung Jung
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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17
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Uei H, Tokuhashi Y. Therapeutic Impact of Percutaneous Pedicle Screw Fixation on Palliative Surgery for Metastatic Spine Tumors. Indian J Orthop 2019; 53:533-541. [PMID: 31303669 PMCID: PMC6590019 DOI: 10.4103/ortho.ijortho_474_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous pedicle screw (PPS) fixation has been introduced into palliative surgery for metastatic spine tumors; however, the therapeutic effects of PPS on the outcomes of multidisciplinary treatment for such tumors are unclear. Therefore, the therapeutic impact of PPS was investigated among patients with metastatic spine tumors and with revised Tokuhashi scores of ≤8. MATERIALS AND METHODS A total of 47 patients who underwent conventional palliative surgery (posterior decompression and stabilization, 33; posterior stabilization alone, 14) before the introduction of PPS and 38 patients who underwent PPS (posterior decompression and stabilization, 19; posterior stabilization alone, 19) were included. Surgical stress (operative time, blood loss, complications, etc.) and treatment outcomes (postoperative survival time, visual analog scale scores, Frankel classification, and the Barthel index at the final followup) were compared between the conventional and PPS groups. RESULTS The age of the indicated patients significantly increased after the introduction of PPS (P < 0.05). Regarding posterior decompression and stabilization, there were no significant intergroup differences in surgical stress or treatment outcomes. As for posterior stabilization alone, there were significant preoperative differences in various parameters between the conventional and PPS groups (P < 0.01) and also significant postoperative intergroup differences between surgical stress and treatment outcomes (P < 0.01). CONCLUSIONS For patients with early-stage metastatic spine tumors, the use of PPS-based posterior stabilization combined with multidisciplinary adjuvant therapy has changed the age range of the patients indicated for surgery and caused significant improvements in surgical stress, postoperative survival time, and Barthel index.
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Affiliation(s)
- Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan,Address for correspondence: Prof. Yasuaki Tokuhashi, Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo 173-8610, Japan. E-mail:
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18
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Afathi M, Mansouri N, Farah K, Benichoux V, Blondel B, Fuentes S. Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures. Asian Spine J 2018; 13:305-312. [PMID: 30481979 PMCID: PMC6454290 DOI: 10.31616/asj.2018.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective case series observational study. PURPOSE Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. OVERVIEW OF LITERATURE Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture. However, few papers describe the kyphosis reduction that can be achieved by combining percutaneous fixation and anterior vertebral reconstruction. METHODS We studied 35 patients seen between December 2013 and October 2016 who had at least one pathological spinal fracture and multiple vertebral metastases. The population's mean age was 67 years, and no patients included had preoperative neurological deficits. The patients underwent a minimally invasive surgery consisting of a percutaneous pedicular fixation with cement-enhanced screws and anterior reconstruction comprising kyphoplasty when possible or corpectomy in cases of excessive damage to the vertebral body. Back pain, traumatic local and regional kyphosis, and Beck's Index were collected pre- and postoperatively, and at 3-, 6-, and 12-month follow-ups. RESULTS Mean follow-up time was 13.4 months. Significant reductions in back pain (p<0.001) and local (p<0.001) and regional kyphosis (p=0.006) were found at the 6-month follow-up (alpha risk level <0.05). Beck's Index was also significantly increased, indicating good restoration of the anterior vertebral height. By the final follow-up, no screws had fallen/pulled out. There were no infectious or neurological complications. CONCLUSIONS Percutaneous cement-enhanced fixation for pathological fractures has proven a safe and efficient technique in our experience, enabling weak patients to rapidly become ambulatory again without complications. Further follow-up of the patients is necessary to assess the long-term effects of this technique and the continued quality of life of our patients.
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Affiliation(s)
- Mehdi Afathi
- Neurochirurgie C-Chirurgie du Rachis, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civiles de Lyon, Bron, France
| | - Nacer Mansouri
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Kaissar Farah
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Victor Benichoux
- Unité de Génétique et Physiologie de l'Audition, INSERM, Institut Pasteur, Sorbonne Université, Paris, France
| | - Benjamin Blondel
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Stéphane Fuentes
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
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19
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Park SB, Kim KJ, Han S, Oh S, Kim CH, Chung CK. Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine. J Korean Neurosurg Soc 2018; 61:415-423. [PMID: 29631384 PMCID: PMC5957313 DOI: 10.3340/jkns.2017.0505.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/13/2017] [Accepted: 09/06/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. METHODS We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. RESULTS There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). CONCLUSION When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.
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Affiliation(s)
- Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sanghyun Han
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
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20
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The Potential of Minimally Invasive Surgery to Treat Metastatic Spinal Disease versus Open Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 112:e859-e868. [DOI: 10.1016/j.wneu.2018.01.176] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/23/2018] [Indexed: 01/28/2023]
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21
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Barzilai O, Fisher CG, Bilsky MH. State of the Art Treatment of Spinal Metastatic Disease. Neurosurgery 2018; 82:757-769. [DOI: 10.1093/neuros/nyx567] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/23/2017] [Indexed: 12/25/2022] Open
Abstract
Abstract
Treatment paradigms for patients with spine metastases have evolved significantly over the past decade. Incorporating stereotactic radiosurgery into these paradigms has been particularly transformative, offering precise delivery of tumoricidal radiation doses with sparing of adjacent tissues. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional radiation. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive, techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care, improving both local control and patient survivals. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists, and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases, integrating these data into a decision framework, NOMS, which integrates the 4 sentinel decision points in metastatic spine tumors: Neurologic, Oncologic, Mechanical stability, and Systemic disease and medical co-morbidities.
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Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Charles G Fisher
- Division of Spine, Department of Orthopedics, University of British Columbia, and the Combined Neurosurgical and Orthopedic Spine Program at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Mark H Bilsky
- Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
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22
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Choi YH, Kwon SW, Moon JH, Kim CH, Chung CK, Park SB, Heo W. Lateral Lumbar Interbody Fusion and in Situ Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine. J Korean Neurosurg Soc 2017; 60:755-762. [PMID: 29142637 PMCID: PMC5678063 DOI: 10.3340/jkns.2017.0606.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/09/2017] [Accepted: 08/21/2017] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study is to describe the detailed surgical technique and short-term clinical and radiological outcomes of lateral lumbar interbody fusion (LLIF) and in situ lateral screw fixation using a conventional minimally invasive screw fixation system (MISF) for revision surgery to treat rostral lumbar adjacent segment disease. Methods The medical and radiological records were retrospectively reviewed. The surgery was indicated in 10 consecutive patients with rostral adjacent segment stenosis and instability. After the insertion of the interbody cage, lateral screws were inserted into the cranial and caudal vertebra using the MISF through the same LLIF trajectory. The radiological and clinical outcomes were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Results The median follow-up period was 13 months (range, 3–48 months). Transient sensory changes in the left anterior thigh occurred in 3 patients, and 1 patient experienced subjective weakness; however, these symptoms normalized within 1 week. Back and leg pain were significantly improved (p<0.05). In the radiological analysis, both the segmental angle at the operated segment and anterior disc height were significantly increased. At 6 months postoperatively, solid bony fusion was confirmed in 7 patients. Subsidence and mechanical failure did not occur in any patients. Conclusion This study demonstrates that LLIF and in situ lateral screw fixation may be an alternative surgical option for rostral lumbar adjacent segment disease.
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Affiliation(s)
- Young Hoon Choi
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jung Hyeon Moon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Won Heo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
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Kumar N, Malhotra R, Zaw A, Maharajan K, Naresh N, Kumar A, Vellayappan B. Evolution in treatment strategy for metastatic spine disease: Presently evolving modalities. Eur J Surg Oncol 2017; 43:1784-1801. [DOI: 10.1016/j.ejso.2017.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/07/2017] [Accepted: 05/05/2017] [Indexed: 01/01/2023] Open
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Paulino Pereira NR, Janssen SJ, Raskin KA, Hornicek FJ, Ferrone ML, Shin JH, Bramer JAM, van Dijk CN, Schwab JH. Most efficient questionnaires to measure quality of life, physical function, and pain in patients with metastatic spine disease: a cross-sectional prospective survey study. Spine J 2017; 17:953-961. [PMID: 28242336 DOI: 10.1016/j.spinee.2017.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/10/2017] [Accepted: 02/22/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Assessing quality of life, functional outcome, and pain has become important in assessing the effectiveness of treatment for metastatic spine disease. Many questionnaires are able to measure these outcomes; few are validated in patients with metastatic spine disease. As a result, there is no consensus on the ideal questionnaire to use in these patients. PURPOSE Our study aim was to assess whether certain questionnaires measuring quality of life, functional outcome, and pain (1) correlated with each other, (2) measured the construct they claim to measure, (3) had good coverage-floor and ceiling effects, (4) were reliable, and (5) whether there were differences in completion time between them. DESIGN This is a prospective cross-sectional survey study from three outpatient clinics (two orthopedic oncology clinics and one neurosurgery clinic) from two affiliated tertiary hospital care centers. PATIENT SAMPLE We included 100 consecutive patients with metastatic spine disease between July 2014 and February 2016. We excluded non-English-speaking patients. OUTCOME MEASURES The following questionnaires were given in random order: Oswestry Disability Index (ODI) or Neck Disability Index (NDI), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Intensity, EuroQol-5 Dimensions (EQ-5D), and the Spine Oncology Study Group Outcome Questionnaire (SOSG-OQ). METHODS We used exploratory factor analysis-correlating questionnaires with an underlying mathematically derived trait-to assess if questionnaires measured the same concept. Coverage was assessed by floor and ceiling effects, and reliability was assessed by standard error of measurement as a function of ability. Differences in completion times were tested using the Friedman test. RESULTS Questionnaires measured the construct they were developed for, as demonstrated with high correlations (>0.7) with the underlying trait. A floor effect was present in the PROMIS Pain Intensity (7.0%), ODI or NDI (4.0%), and the PROMIS Physical Function (1.0%) questionnaires. A ceiling effect was present in the EQ-5D questionnaire (6.0%). The SOSG-OQ had no floor or ceiling effect. The PROMIS Physical Function and PROMIS Pain Intensity proved to be the most reliable, whereas the EQ-5D was the least reliable. Completion time differed among questionnaires (p<.001) and was shortest for the PROMIS Pain Intensity (median 24 seconds) and PROMIS Physical Function (median 42 seconds). CONCLUSIONS In patients with metastatic spine disease, we recommend the SOSG-OQ for measuring quality of life, the PROMIS Physical Function for measuring physical function, and the PROMIS Pain Intensity for measuring pain.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Kevin A Raskin
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital-Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Cornelis Nicolaas van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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Tseng CL, Eppinga W, Charest-Morin R, Soliman H, Myrehaug S, Maralani PJ, Campbell M, Lee YK, Fisher C, Fehlings MG, Chang EL, Lo SS, Sahgal A. Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution. Global Spine J 2017; 7:179-197. [PMID: 28507888 PMCID: PMC5415159 DOI: 10.1177/2192568217694016] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN A broad narrative review. OBJECTIVES The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques. METHODS A comprehensive review of the literature was conducted on the techniques, outcomes, and developments in SBRT and surgery for spinal metastases. RESULTS The optimal management of patients with spinal metastases is complex and requires multidisciplinary assessment from an oncologic team that is familiar with the shifting paradigm as a consequence of evolving techniques in surgery and stereotactic radiation, as well as new developments in systemic agents. The Spinal Instability Neoplastic Score and the epidural spinal cord compression (Bilsky) grading system are useful tools that facilitate communication among oncologic team members and can direct management by providing a baseline assessment of risks prior to therapy. The combined multimodality approach with "separation surgery" followed by postoperative spine SBRT achieves thecal sac decompression, improves tumor control, and avoids complications that may be associated with more extensive surgery. CONCLUSION Spine SBRT is a highly effective treatment that is capable of delivering ablative doses to the target while sparing the critical organs-at-risk, chiefly the critical neural tissues, within a short and manageable schedule. At the same time, surgery occupies an important role in select patients, particularly with the expanding availability and expertise in minimally invasive techniques. With rapid adoption of spine SBRT in centers outside of the academic setting, it is imperative for the practicing oncologist to understand the relevance and application of these evolving concepts.
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Affiliation(s)
- Chia-Lin Tseng
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada,Chia-Lin Tseng, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4 N 3M5.
| | - Wietse Eppinga
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Hany Soliman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Mikki Campbell
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Young K. Lee
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Charles Fisher
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Eric L. Chang
- University of Southern California, Los Angeles, CA, USA
| | | | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Paulino Pereira NR, Mclaughlin L, Janssen SJ, van Dijk CN, Bramer JAM, Laufer I, Bilsky MH, Schwab JH. The SORG nomogram accurately predicts 3- and 12-months survival for operable spine metastatic disease: External validation. J Surg Oncol 2017; 115:1019-1027. [DOI: 10.1002/jso.24620] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Lily Mclaughlin
- Department of Neurosurgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Stein J. Janssen
- Department of General Surgery; Onze Lieve Vrouwe Gasthuis; Amsterdam The Netherlands
| | - Cornelis N. van Dijk
- Department of Orthopaedic Surgery; Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Jos A. M. Bramer
- Department of Orthopaedic Surgery; Academic Medical Center-University of Amsterdam; Amsterdam The Netherlands
| | - Ilya Laufer
- Department of Neurosurgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Mark H. Bilsky
- Department of Neurosurgery; Memorial Sloan Kettering Cancer Center; New York New York
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
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27
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Bernard F, Lemée JM, Lucas O, Menei P. Postoperative quality-of-life assessment in patients with spine metastases treated with long-segment pedicle-screw fixation. J Neurosurg Spine 2017; 26:725-735. [PMID: 28338450 DOI: 10.3171/2016.9.spine16597] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In recent decades, progress in the medical management of cancer has been significant, resulting in considerable extension of survival for patients with metastatic disease. This has, in turn, led to increased attention to the optimal surgical management of bone lesions, including metastases to the spine. In addition, there has been a shift in focus toward improving quality of life and reducing hospital stay for these patients, and many minimally invasive techniques have been introduced with the aim of reducing the morbidity associated with more traditional open approaches. The goal of this study was to assess the efficacy of long-segment percutaneous pedicle screw stabilization for the treatment of instability associated with thoracolumbar spine metastases in neurologically intact patients. METHODS This study was a retrospective review of data from a prospective database. The authors analyzed cases in which long-segment percutaneous pedicle screw fixation was performed for the palliative treatment of thoracolumbar spinal instability due to spinal metastases in neurologically intact patients. All of the patients included in the study underwent surgery between January 2014 and May 2015 at the authors' institution. Postoperative radiation therapy was planned within 10 days following the stabilization in all cases. Clinical and radiological follow-up assessments were planned for 3 days, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery. Outcome was assessed by means of standard postoperative evaluation and oncological and spinal quality of life measures (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 [EORTC QLQ-C30] and Oswestry Disability Index [ODI], respectively). Moreover, 5 patients were given an activity monitoring device for recording the distance walked daily; preoperative and postoperative daily distances were compared. RESULTS Data from 17 cases were analyzed. There were no complications, and patients showed improvement in pain level and quality of life from the early postoperative period on. The mean ODI score was 62.7 (range 40-84) preoperatively, 35.4 (range 24-59) on postoperative Day 3, and 46.1 (range 30-76) at 3 weeks, 37.6 (range 25-59) at 6 weeks, 34.0 (range 24-59) at 3 months, 39.1 (range 22-64) at 6 months, and 30.0 (range 20-55) at 1 year after screw placement. The mean ODI was significantly improved in the first 45 days (p < 0.001). Improvement was also evident in scores for functional and symptomatic scales of the EORTC QLQ-C30. All patients underwent postoperative radiation therapy within 10 days (mean 7.5). All patients (n = 5) with an activity monitoring device showed improvement in daily walking distance. CONCLUSIONS Less-invasive palliative treatment for advanced spinal metastases is promising as part of a multidisciplinary approach to the care of patients with metastatic disease. The results of this study indicate that percutaneous surgery may allow for rapid improvement in quality of life and walking ability for patients with thoracolumbar instability due to spine metastases. Long-segment percutaneous screw fixation followed by early radiation therapy appears to be a safe and effective treatment option for providing solid and durable stability and improved quality of life for these patients.
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Hariri O, Takayanagi A, Miulli DE, Siddiqi J, Vrionis F. Minimally Invasive Surgical Techniques for Management of Painful Metastatic and Primary Spinal Tumors. Cureus 2017; 9:e1114. [PMID: 28446993 PMCID: PMC5403161 DOI: 10.7759/cureus.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with metastatic spinal disease are affected by disabling pain. The treatment of spinal metastases is focused on pain reduction and improvement in quality of life. Until recently, many patients with metastatic spinal disease did not qualify as surgical candidates due to the risks of surgery and length of recovery period. However, recent advances in minimally invasive surgery such as kyphoplasty and vertebroplasty allow patients to safely undergo surgery for pain relief with a short recovery period. The studies reviewed here suggest that vertebral augmentation is successful in reducing pain and disability scores in patients with painful metastases and multiple myeloma and are a safe modality to provide lasting pain relief. As the use of kyphoplasty and vertebroplasty for treatment of vertebral metastases is becoming more common, new combinations of cement augmentation with other techniques such as percutaneous pedicle screws and radiofrequency ablation are being explored. The implementation of kyphoplasty and vertebroplasty, in conjunction with other minimally invasive surgical techniques as well as nonsurgical modalities, may lead to the best palliative management of cancer patients with spinal metastases and help them ultimately achieve a better quality of life.
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Affiliation(s)
- Omid Hariri
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Dan E Miulli
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Javed Siddiqi
- Department of Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Frank Vrionis
- Department of Neurological Surgery, Marcus Neuroscience Institute, Boca Raton, Florida, United States
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Kim P, Kim SW. Bone Cement-Augmented Percutaneous Screw Fixation for Malignant Spinal Metastases: Is It Feasible? J Korean Neurosurg Soc 2017; 60:189-194. [PMID: 28264239 PMCID: PMC5365288 DOI: 10.3340/jkns.2016.0909.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/07/2016] [Accepted: 11/26/2016] [Indexed: 11/27/2022] Open
Abstract
Objective We evaluated the validity of bone cement-augmented percutaneous screw fixation for treating malignant spinal metastases. Methods Between 2011 and 2015, 14 patients (eight men and six women) who underwent bone cement-augmented percutaneous screw fixation for malignant spinal metastases were enrolled in this study. Their life expectancy was considered to be more than one month and less than one year, based on the revised Tokuhashi scoring system. Clinical findings including the back pain scale score, functional outcome, procedure related complications, and survival were assessed preoperatively, postoperatively, and then six months after the procedure. Results Twelve of the patients (86%) survived up to six months after the procedure. Three required mini-open decompressive laminectomy for severe epidural compression. Bone cement-augmented percutaneous screw fixation was performed one level above, one level below, and at the pathologic level itself. The mean operation time was 60 minutes (45–180) and blood loss was less than 100 mL. Prior to surgery, the mean pain score on the visual analogue scale was 8.8, while one month after the procedure, it had reduced to 3.0; this improvement was maintained until the six-month assessment in the surviving patients. All patients were able to sit within the first two days after surgery, and no patient experienced neurological deterioration at the one-month follow up after the surgery. No patient experienced screw loosening during the six months of follow-up. Asymptomatic cement leakage into the epidural space was observed in two patients, but no major complications were observed. Conclusion For selected patients with malignant spinal metastases, bone cement-augmented percutaneous screw fixation can provide significant pain relief and improve quality of life.
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Affiliation(s)
- Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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Choi D, Bilsky M, Fehlings M, Fisher C, Gokaslan Z. Spine Oncology—Metastatic Spine Tumors. Neurosurgery 2017; 80:S131-S137. [DOI: 10.1093/neuros/nyw084] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/07/2016] [Indexed: 01/24/2023] Open
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Paulino Pereira NR, Langerhuizen DW, Janssen SJ, Hornicek FJ, Ferrone ML, Harris MB, Schwab JH. Are perioperative allogeneic blood transfusions associated with 90-days infection after operative treatment for bone metastases? J Surg Oncol 2016; 114:997-1003. [DOI: 10.1002/jso.24440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/05/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - David W.G. Langerhuizen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Stein J. Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Francis J. Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Marco L. Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Brigham and Women's Hospital-Harvard Medical School; Boston Massachusetts
| | - Mitchel B. Harris
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Brigham and Women's Hospital-Harvard Medical School; Boston Massachusetts
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
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32
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Paulino Pereira NR, Janssen SJ, van Dijk E, Harris MB, Hornicek FJ, Ferrone ML, Schwab JH. Development of a Prognostic Survival Algorithm for Patients with Metastatic Spine Disease. J Bone Joint Surg Am 2016; 98:1767-1776. [PMID: 27807108 DOI: 10.2106/jbjs.15.00975] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current prognostication models for survival estimation in patients with metastatic spine disease lack accuracy. Identifying new risk factors could improve existing models. We assessed factors associated with survival in patients surgically treated for spine metastases, created a classic scoring algorithm, nomogram, and boosting algorithm, and tested the predictive accuracy of the three created algorithms at estimating survival. METHODS We included 649 patients from two tertiary care referral centers in this retrospective study (2002 to 2014). A multivariate Cox model was used to identify factors independently associated with survival. We created a classic scoring system, a nomogram, and a boosting (i.e., machine learning) algorithm and calculated their accuracy by receiver operating characteristic analysis. RESULTS Older age (hazard ratio [HR], 1.01; p = 0.009), poor performance status (HR, 1.54; p = 0.001), primary cancer type (HR, 1.68; p < 0.001), >1 spine metastasis (HR, 1.32; p = 0.009), lung and/or liver metastasis (HR, 1.35; p = 0.005), brain metastasis (HR, 1.90; p < 0.001), any systemic therapy for cancer prior to a surgical procedure (e.g., chemotherapy, immunotherapy, hormone therapy) (HR, 1.65; p < 0.001), higher white blood-cell count (HR, 1.03; p = 0.002), and lower hemoglobin levels (HR, 0.92; p = 0.009) were independently associated with decreased survival. The boosting algorithm was best at predicting survival on the training data sets (p < 0.001); the nomogram was more reliable at estimating survival on the test data sets, with an accuracy of 0.75 (30 days), 0.73 (90 days), and 0.75 (365 days). CONCLUSIONS We identified risk factors associated with survival that should be considered in prognostication. Performance of the boosting algorithm and nomogram were comparable on the testing data sets. However, the nomogram is easier to apply and therefore more useful to aid surgical decision-making. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eva van Dijk
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis J Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Versteeg AL, Verlaan JJ, de Baat P, Jiya TU, Stadhouder A, Diekerhof CH, van Solinge GB, Oner FC. Complications After Percutaneous Pedicle Screw Fixation for the Treatment of Unstable Spinal Metastases. Ann Surg Oncol 2016; 23:2343-9. [PMID: 26965698 PMCID: PMC4889628 DOI: 10.1245/s10434-016-5156-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Complications after surgical stabilization for the treatment of unstable spinal metastases are common. Less invasive surgical (LIS) procedures are potentially associated with a lower risk of complications; however, little is known regarding the complications after LIS procedures for the treatment of spinal metastases. Our primary objective was to determine the characteristics and rate of complications after percutaneous pedicle screw fixation (PPSF) for the treatment of mechanically unstable spinal metastases. The secondary objective was to identify factors associated with the occurrence of complications and survival. METHODS A retrospective multicenter cohort study of patients who underwent PPSF between 2009 and 2014 for the treatment of unstable spinal metastases was performed. Patient data pertaining to demographics, diagnosis, treatment, neurologic function, complications, and survival were collected. RESULTS A total of 101 patients were identified, 45 men (45 %) and 56 women (55 %) with a mean age of 60.3 ± 11.2 years. The median operating time was 122 (range 57-325) minutes with a median blood loss of 100 ml (based on 41 subjects). Eighty-eight patients (87 %) ambulated within the first 3 days after surgery. An overall median survival of 11.0 (range 0-70) months was observed, with 79 % of the patients alive at 3 months after treatment. Eighteen patients experienced a total of 30 complications; nonsurgical complications were the most commonly encountered. Prolonged operating time was independently associated with an increased risk of complications. CONCLUSIONS A complication rate of 18 % was found after PPSF for unstable spinal metastases. Potential advantages of less invasive treatment are limited blood loss and high early ambulation rate.
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Affiliation(s)
- Anne L. Versteeg
- />Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Jorrit-Jan Verlaan
- />Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Paul de Baat
- />Department of Orthopedic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Tim U. Jiya
- />Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Agnita Stadhouder
- />Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Carel H. Diekerhof
- />Department of Orthopedic Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | | | - F. Cumhur Oner
- />Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
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Choi D, Fox Z, Albert T, Arts M, Balabaud L, Bunger C, Buchowski JM, Coppes MH, Depreitere B, Fehlings MG, Harrop J, Kawahara N, Martin-Benlloch JA, Massicotte EM, Mazel C, Oner FC, Peul W, Quraishi N, Tokuhashi Y, Tomita K, Verlaan JJ, Wang M, Crockard HA. Prediction of Quality of Life and Survival After Surgery for Symptomatic Spinal Metastases: A Multicenter Cohort Study to Determine Suitability for Surgical Treatment. Neurosurgery 2016. [PMID: 26204361 DOI: 10.1227/neu.0000000000000907] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Surgery for symptomatic spinal metastases aims to improve quality of life, pain, function, and stability. Complications in the postoperative period are not uncommon; therefore, it is important to select appropriate patients who are likely to benefit the greatest from surgery. Previous studies have focused on predicting survival rather than quality of life after surgery. OBJECTIVE To determine preoperative patient characteristics that predict postoperative quality of life and survival in patients who undergo surgery for spinal metastases. METHODS In a prospective cohort study of 922 patients with spinal metastases who underwent surgery, we performed preoperative and postoperative assessment of EuroQol EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning score, complication rates, and survival. RESULTS The primary tumor type, number of spinal metastases, and presence of visceral metastases were independent predictors of survival. Predictors of quality of life after surgery included preoperative EQ-5D (P = .002), Frankel score (P < .001), and Karnofsky Performance Status (P < .001). CONCLUSION Data from the largest prospective surgical series of patients with symptomatic spinal metastases revealed that tumor type, the number of spinal metastases, and the presence of visceral metastases are the most useful predictors of survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management.
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Affiliation(s)
- David Choi
- *Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom; ‡Departments of Neurosurgery and Orthopedic Surgery, Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania; §Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, the Netherlands; ¶Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France; ‖Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark; #Departments of Orthopedic and Neurological Surgery, Washington University, St. Louis, Missouri; **Department of Neurosurgery, Groningen, the Netherlands; ‡‡Division of Neurosurgery, University Hospital Leuven, Leuven, Belgium; §§Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; ¶¶Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan; ‖‖Spinal Unit, Hospital Universitario Dr Peset, Valencia, Spain; ##Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; ***Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands; ‡‡‡Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, United Kingdom; §§§Department of Orthopaedic Surgery, Nihon University School of Medicine, Japan; ¶¶¶Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan; ‖‖‖Department of Neurosurgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
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Cho JH, Ha JK, Hwang CJ, Lee DH, Lee CS. Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The Efficacy of Each Treatment Modality. Clin Orthop Surg 2015; 7:476-82. [PMID: 26640631 PMCID: PMC4667116 DOI: 10.4055/cios.2015.7.4.476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/23/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Metastatic pathological fractures of the spine are a major problem for cancer patients; however, there is no consensus on treatment strategy. The purpose of this study was to evaluate various treatment options by analyzing their patterns for metastatic pathological fractures of the spine. METHODS In this study, 54 patients (male:female = 36:18) who were diagnosed with metastatic pathological fractures of spine were recruited. Demographic data, origin of cancer, type of treatment, and results were obtained from electronic medical records. Treatment options were divided into radiotherapy (RT), vertebroplasty (VP) or kyphoplasty (KP), operation (OP), and other treatments. Treatment results were defined as aggravation, no response, fair response, good response, and unknown. The survival time after detection of pathologic fractures was analyzed with the Kaplan-Meier method. RESULTS The mean age of the patients was 62.3 years. Hepatocellular carcinoma was the most common cancer of primary origin (n = 9), followed by multiple myeloma (n = 8). RT was the most common primary choice of treatment (n = 29, 53.7%), followed by OP (n = 13, 24.1%), and VP or KP (n = 10, 18.5%). Only 13 of 29 RT cases and 7 of 13 OP cases demonstrated a fair or good response. The mean survival time following detection of pathological spinal fractures was 11.1 months for 29 patients, who died during the study period. CONCLUSIONS RT was the most common primary choice of treatment for metastatic pathological fractures of the spine. However, the response rate was suboptimal. Although OP should be considered for the relief of mechanical back pain or neurologic symptoms, care should be taken in determining the surgical indication. VP or KP could be considered for short-term control of localized pain, although the number of cases was too small to confirm the conclusion. It is difficult to determine the superiority of the treatment modalities, hence, a common guideline for the diagnosis and treatment of metastatic pathological fractures of the spine is required.
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Affiliation(s)
- Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Ki Ha
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zoccali C, Skoch J, Walter CM, Torabi M, Borgstrom M, Baaj AA. The Tokuhashi score: effectiveness and pitfalls. 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; 25:673-8. [PMID: 26626082 DOI: 10.1007/s00586-015-4339-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced. METHODS A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival. RESULTS Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00%; for patients expected to survive less than 6 months (group I), it was 64.10%; 6-12 months (group II), 55.32%; and more than 12 months (group III), 77.21%. A progressive decrease in accuracy over time was statistically significant in groups I and II. CONCLUSIONS The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.
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Affiliation(s)
- Carmine Zoccali
- Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Jesse Skoch
- Division of Neurosurgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.,Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Christina M Walter
- Division of Neurosurgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA
| | - Mohammad Torabi
- Research Computing Group of University Information Technology Services, University of Arizona, 1077 N. Highland, Tucson, AZ, 85721, USA
| | - Mark Borgstrom
- Research Computing Group of University Information Technology Services, University of Arizona, 1077 N. Highland, Tucson, AZ, 85721, USA
| | - Ali A Baaj
- Division of Neurosurgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.,Weill Cornell Brain and Spine Center, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY, 10065, USA
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Bellato RT, Teixeira WGJ, Torelli AG, Cristante AF, Barros Filho TEPD, Camargo OPD. Late failure of posterior fixation without bone fusion for vertebral metastases. ACTA ORTOPEDICA BRASILEIRA 2015; 23:303-6. [PMID: 27057142 PMCID: PMC4775506 DOI: 10.1590/1413-785220152306151402] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE : To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patients METHODS : This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformities RESULTS : One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgery CONCLUSION : The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study.
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Park HY, Lee SH, Park SJ, Kim ES, Lee CS, Eoh W. Minimally invasive option using percutaneous pedicle screw for instability of metastasis involving thoracolumbar and lumbar spine : a case series in a single center. J Korean Neurosurg Soc 2015; 57:100-7. [PMID: 25733990 PMCID: PMC4345186 DOI: 10.3340/jkns.2015.57.2.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/21/2014] [Accepted: 08/13/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To report a minimally invasive treatment option using percutaneous pedicle screw fixation with adjuvant treatment for metastatic thoraco-lumbar and lumbar spinal tumors. Methods This is a retrospective study of charts of patients with spinal metastases. All were older than 18 years of age and were considered to have more than 3 months of life expectancy. The patients had single or two level lesions, and compression fracture or impending fracture. Exclusion criterion was metastasis showing severe epidural compression with definite neurological symptoms. Usually spinal segments from one level above to below pathology were stabilized. Visual analog scale (VAS) score for pain assessment and Frankel scale for neurological deficit were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results Twelve patients (nine men, three women; median age 54.29 years) underwent surgery. All patients presented with back pain with/without radicular pain. There were no early complications and perioperative mortalities. Following surgery, a significant difference between average pre- and post-operative VAS scores was found (p=0.003). Overall, 91.8% of patients (11/12) experienced improvement in their ECOG score post-operatively. The mean ambulation time was 196.9 days [95% confidence interval (CI), 86.2-307.6 days; median, 97 days]. During follow-up, nine patients died and the mean overall survival time in enrolled twelve patients was 249.9 days (95% CI, 145.3-354.4 days; median, 176 days). Conclusion Minimally invasive treatment using percutaneous pedicle screw fixation with adjuvant treatment is a good alternative treatment option for potential instability of the thoraco-lumbar and lumbar spinal metastasis.
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Affiliation(s)
- Ho-Young Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong-Suh Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Papanastassiou ID, Filis AK, Gerochristou MA, Vrionis FD. Controversial issues in kyphoplasty and vertebroplasty in malignant vertebral fractures. Cancer Control 2015; 21:151-7. [PMID: 24667402 DOI: 10.1177/107327481402100208] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures. METHODS A critical review of the medical literature was performed and controversial issues were analyzed. RESULTS Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized. CONCLUSIONS In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure. Address.
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Evaluation of prognostic scoring systems for spinal metastases in 196 patients treated during 2005–2010. 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 2014; 24:2133-41. [DOI: 10.1007/s00586-014-3482-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
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Gerszten PC. Spine Metastases: From Radiotherapy, Surgery, to Radiosurgery. Neurosurgery 2014; 61 Suppl 1:16-25. [DOI: 10.1227/neu.0000000000000375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Peter C. Gerszten
- Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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