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Tsagozis P, Bauer HCF. Outcome of Surgical Treatment for Spinal Cord Compression in Patients With Hematological Malignancy. Int J Spine Surg 2019; 13:186-191. [PMID: 31131219 DOI: 10.14444/6025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background We investigated the outcome of surgical treatment of patients with radiosensitive hematological malignancies presenting with spinal cord compression. Methods Retrospective review of 50 patients who had treatment between 1993 and 2012. Results The neurological outcome was favorable in 35 patients, stable in 12, whereas 3 patients deteriorated. Decompression within 48 hours from referral was associated with a superior neurological recovery (P = .001). Complications were noted in 11 patients, and 6 of these underwent secondary surgery. Early (30-day) mortality was 8%. Radiotherapy was associated with increased incidence of complications (χ2 = 0.009). Patients who had low blood hemoglobin preoperatively as well as those who remained totally bedridden postoperatively had an inferior overall survival rate (P < .001). Conclusion Patients with cord compression from hematological malignancy benefit from early surgical decompression. There is an inherent high risk for complications, which increases further if radiotherapy is given. Patients failing to ambulate after surgery have a poor prognosis.
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Affiliation(s)
- Panagiotis Tsagozis
- Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik C F Bauer
- Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Liu Y, Yang M, Li B, Xu K, Gao X, Li J, Wei H, Huang Q, Xu W, Xiao J. Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer. 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 2019; 28:1491-1501. [DOI: 10.1007/s00586-019-05879-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/06/2019] [Indexed: 01/05/2023]
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Abstract
Due to a worldwide increase of cancer incidence and a longer life expectancy of patients with metastatic cancer, a rise in the incidence of symptomatic vertebral metastases has been observed. Metastatic spinal disease is one of the most dreaded complications of cancer as it is not only associated with severe pain, but also with paralysis, sensory loss, sexual dysfunction, urinary and fecal incontinency when the neurologic elements are compressed. Rapid diagnosis and treatment have been shown to improve both the quality and length of remaining life. This chapter on vertebral metastases with epidural disease and intramedullary spinal metastases will be discussed in terms of epidemiology, pathophysiology, demographics, clinical presentation, diagnosis, and management. With respect to treatment options, our review will summarize the evolution of conventional palliative radiation to modern stereotactic body radiotherapy for spinal metastases and the surgical evolution from traditional open procedures to minimally invasive spine surgery. Lastly, we will review the most common clinical prediction and decision rules, framework and algorithms, and guidelines that have been developed to guide treatment decision making.
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Tsagozis P, Bauer HCF. Spinal metastasis with neurologic deficits. Acta Orthop 2018; 89:229-233. [PMID: 29231771 PMCID: PMC5901523 DOI: 10.1080/17453674.2017.1412193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - A significant number of patients with spinal metastases are treated non-surgically, but may need surgical treatment at a later stage due to progression of symptoms. Therefore, we investigated the need for late surgical decompression in patients with spinal metastasis who were initially deemed as non-surgical candidates, as well as the outcome of late surgery. Patients and methods - 116 patients who were referred to the orthopedic oncology department between 2002 and 2011 due to spinal metastasis with neurologic symptoms were deemed to be non-surgical candidates. The primary reason was minor neurologic deficits in 40 patients (M) and short survival (S) in 76 patients. Results - 8 patients underwent a late operation due to progression of the neurologic symptoms, all of them belonged to group M. M-patients with a modified Bauer score of less than 2 had both an inferior survival as well as a higher risk for late surgery. Postoperative improvement in neurologic function was noted in 5/8 operated patients, whilst 2 patients had stationary symptoms and 1 deteriorated. Interpretation - The need for late surgery arises in a minority of patients with spinal metastasis primarily treated non-surgically, and only in patients with minor neurologic compromise rather than poor general condition. An established prognostic score (modified Bauer) can be used to guide decision-making. Late surgical decompression is effective in restoring the neurologic status.
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Affiliation(s)
- Panagiotis Tsagozis
- Section of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden,Correspondence:
| | - Henrik C F Bauer
- Section of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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Nater A, Tetreault LL, Davis AM, Sahgal AA, Kulkarni AV, Fehlings MG. Key Preoperative Clinical Factors Predicting Outcome in Surgically Treated Patients with Metastatic Epidural Spinal Cord Compression: Results from a Survey of 438 AOSpine International Members. World Neurosurg 2016; 93:436-448.e15. [DOI: 10.1016/j.wneu.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
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Arana E, Kovacs FM, Royuela A, Asenjo B, Pérez-Ramírez Ú, Zamora J. Spine Instability Neoplastic Score: agreement across different medical and surgical specialties. Spine J 2016; 16:591-9. [PMID: 26471708 DOI: 10.1016/j.spinee.2015.10.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/27/2015] [Accepted: 10/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. PURPOSE This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. STUDY DESIGN Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. PATIENT SAMPLE Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. OUTCOME MEASURES Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board. METHODS Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. RESULTS Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category. CONCLUSIONS Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.
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Affiliation(s)
- Estanislao Arana
- Department of Radiology, Valencian Oncology Institute Foundation, C/ Beltrán Báguena, 19, 46009 Valencia, Spain; Research Institute in Health Services Foundation, C/ San Vicente,112, 3, 46007 Valencia, Spain; Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
| | - Francisco M Kovacs
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Scientific Department, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain
| | - Ana Royuela
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain
| | - Beatriz Asenjo
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Department of Radiology, Hospital Regional Universitario Carlos Haya, Avda Carlos Haya s/n, 29010 Málaga, Spain
| | - Úrsula Pérez-Ramírez
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, CPI Building (8E), F access, 1st floor, Cami de Vera, s/n, 46022 Valencia, Spain
| | - Javier Zamora
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain; Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS, UK
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Arana E, Kovacs FM, Royuela A, Asenjo B, Pérez-Ramírez U, Zamora J, Abraira V, Alcázar L, Alonso A, Álvarez L, Álvarez MA, Amengual G, Antuña A, Aparici F, Bagó J, Barriga A, Barrios M, Bas P, Begara J, Bravo-Rodríguez F, Cabrera A, Casillas C, Catalán G, Conde AJ, Peñas RDL, Díaz L, Dualde D, Estremera A, Fenollosa J, Fernández C, Fernández E, Fernández-Baillo N, Ferrer P, Fuster S, Galarraga MI, García-Villar C, García-Ferrer L, García MI, García-Duque S, Garde J, González A, González R, Hernández-Fernández A, Hernando O, Hernanz R, Hervás A, Holgado E, Juan MJ, Lavernia J, Lazo A, Lersundi A, López E, Magallón R, Majem M, Martín A, Martín MI, Martínez J, Montoya J, Moreno P, Navarro A, Noguerón E, Mendivil AOD, Palomino JC, Paniagua JC, Pereira D, Pérez-Romasanta LA, Pérez R, Piñera ÁR, Piñero P, Plata-Bello J, Poblete J, Ramírez J, Rivas D, Roldán H, Ruiz F, Sánchez JM, Sancho S, Sarasíbar H, Sepúlveda JM, Silvestre A, Sobrino B, Tomé-Bermejo F, Tovar I, Vallejo MDC, Vanaclocha V, Villanueva A, Zamarro J, Zazpe I. Agreement in the assessment of metastatic spine disease using scoring systems. Radiother Oncol 2015; 115:135-40. [DOI: 10.1016/j.radonc.2015.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/13/2015] [Accepted: 03/15/2015] [Indexed: 11/25/2022]
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