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Prost S, Bouthors C, Fuentes S, Charles YP, Court C, Mazel C, Blondel B, Bonnevialle P, Sailhan F. Influence of preoperative biological parameters on postoperative complications and survival in spinal bone metastasis. A multicenter prospective study. Orthop Traumatol Surg Res 2020; 106:1033-1038. [PMID: 32753354 DOI: 10.1016/j.otsr.2019.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/01/2019] [Accepted: 11/28/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Onset of spinal bone metastasis is a turning point in the progression of tumoral disease; although incidence is increasing, management is not standardized. Various prognostic scores are available, but advances in medical and surgical treatment have made them less well adapted, and sometimes discordant for a given patient. It would therefore be useful to develop new prognostic instruments. The aim of the present study was to identify biologic risk factors for onset of postoperative complications and death following spinal bone metastasis surgery. MATERIAL AND METHODS A prospective multicenter study included all patients operated on for spinal bone metastasis between November 2015 and May 2017. The main epidemiologic data and biologic data (CRP, albuminemia, calcemia) were collected preoperatively. Surgical strategy, death and/or postoperative complications were collected prospectively. RESULTS Five of the initial 264 patients died during the immediate postoperative course, and 107 within 6 months. At 1 year, 57 patients remained alive. Twenty-six (10%) were lost to follow-up. Preoperative albuminemia<35g/L (29% of patients), calcemia>2.6 nmol/L (8%) and CRP>10mg/L (47.5%) were associated with significantly elevated mortality. Only CRP elevation correlated with postoperative complications rate. CONCLUSION The study confirmed the prognostic value of 3 biologic parameters (CRP level, albuminemia, calcemia) for survival after spinal bone metastasis surgery. A hybrid score taking account of not only clinical but also biologic parameters should be developed to improve estimation of survival.
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Affiliation(s)
- Solène Prost
- CNRS, ISM, unité de chirurgie Rachidienne, Aix-Marseille Université, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique, CHU de Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Stéphane Fuentes
- CNRS, ISM, unité de chirurgie Rachidienne, Aix-Marseille Université, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Yann-Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Charles Court
- Service de chirurgie orthopédique, CHU de Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Christian Mazel
- Institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Benjamin Blondel
- CNRS, ISM, unité de chirurgie Rachidienne, Aix-Marseille Université, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital P.P. Riquet, place Baylac, 31052 Toulouse cedex, France
| | - Frédéric Sailhan
- Université Paris 5, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Clinique Arago, groupe Almaviva Santé, Paris, France
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- SOFCOT, 56, rue Boissonade, 75014 Paris, France
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Does surgical site infection influence neurological outcome and survival in patients undergoing surgery for metastatic spinal cord compression? 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 2018; 28:792-797. [PMID: 30368596 DOI: 10.1007/s00586-018-5797-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 09/23/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Most of the literature on infection after surgery for spinal metastases focuses on incidence and risk factors for surgical site infection (SSI). To the best of our knowledge, there is no report on the influence of infection on neurological outcome and survival in patients undergoing emergent surgery for metastatic spinal cord compression (MSCC). METHODS Our aim was to establish if SSIs adversely affected the neurological outcome and survival in patients with MSCC. We reviewed 318 consecutive patients admitted for surgical intervention for MSCC from October 2005 to October 2012. Morbidity (neurological outcome, length of hospital stay and additional procedures) and survival rates were analysed. RESULTS During this study period, the incidence of infection was 29/318 (9.1%). The median length of stay in hospital in the infected group was 25 days compared to 13 days in the non-infected group (p = 0.001). Twenty out of the 29 (69%) infected patients underwent an additional procedure (29 procedures in total) compared to 9/289 (3%) non-infected patients (p = 0.001). There was no statistical difference between the two groups with regard to neurological outcome (p = 0.37) but the survival rate was statistically different between the two groups [infected group: median survival 131 days (19-1558) vs. non-infected group: 258 days (5-2696; p = 0.03)]. CONCLUSION Surgical site infection increased the morbidity with considerably longer hospital stay and requirement for additional procedures. Although there was no difference in neurological outcome, the infected group of patients had a significantly shorter survival. These slides can be retrieved under Electronic Supplementary Material.
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Turel MK, Kerolus MG, O'Toole JE. Minimally invasive "separation surgery" plus adjuvant stereotactic radiotherapy in the management of spinal epidural metastases. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:119-126. [PMID: 28694595 PMCID: PMC5490345 DOI: 10.4103/jcvjs.jcvjs_13_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: This study aimed to describe the application of minimally invasive surgery (MIS) in separation surgery combined with postoperative stereotactic body radiation therapy (SBRT) in patients with symptomatic metastatic epidural spinal disease. Methods: Three techniques are described: (1) MIS posterior separation surgery alone, (2) MIS posterolateral separation surgery with percutaneous pedicle screw placement, and (3) MIS lateral corpectomy with percutaneous pedicle screw placement. Seven representative cases are presented in which the above techniques were applied and after which postoperative SBRT was performed. Results: The seven representative patients (3 male, 4 female) had a mean age of 54 years (range, 46–62 years). Two patients had a primary diagnosis of cholangiocarcinoma and in one patient each a diagnosis of breast, renal, lung adenocarcinoma, melanoma, and urothelial squamous cell carcinoma as their primary tumor. All patients had additional multiorgan disease apart from the metastatic spine involvement. Three patients underwent operations in the lumbar spine, two in the thoracic spine, and one in each of the thoraco-lumbar and lumbo-sacral spine. The average operating time was 149 ± 60.3 min (range, 90–240 min). The mean estimated blood loss was 188.8 cc. The mean length of stay in the hospital was 4 days (range, 3–7 days). There were no surgical complications. All patients received postoperative SBRT (typically 24 Gy in 3 fractions) at a mean of 43.2 days after surgery (range, 30–83). Conclusions: Early reports such as this suggest that MIS techniques can be successfully and safely applied in accomplishing “separation surgery” with adjuvant SBRT in the management of metastatic spinal disease. The potential advantages conferred by MIS techniques such as shortened hospital stay, decreased blood loss, reduced perioperative complications, and earlier initiation of adjuvant radiation are highly desirable in the treatment of this challenging patient population.
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Affiliation(s)
- Mazda K Turel
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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