1
|
Tan JHJ, Hallinan JTPD, Ang SW, Tan TH, Tan HIJ, Tan LTI, Sin QS, Lee R, Hey HWD, Chan YH, Liu KPG, Kumar N. Outcomes and Complications of Surgery for Symptomatic Spinal Metastases; a Comparison Between Patients Aged ≥ 70 and <70. Global Spine J 2023:21925682231209624. [PMID: 37880960 DOI: 10.1177/21925682231209624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Physicians may be deterred from operating on elderly patients due to fears of poorer outcomes and complications. We aimed to compare the outcomes of surgical treatment of spinal metastases patients aged ≥70-yrs and <70-yrs. MATERIALS AND METHODS This is a retrospective study of patients surgically treated for metastatic epidural spinal cord compression and spinal instability between January-2005 to December-2021. Follow-up was till death or minimum 1-year post-surgery. Outcomes included post-operative neurological status, ambulatory status, medical and surgical complications. Two Sample t-test/Mann Whitney U test were used for numerical variables and Pearson Chi-Squared or Fishers Exact test for categorical variables. Survival was presented with a Kaplan-Meier curve. P < .05 was significant. RESULTS We identified 412 patients of which 29 (7.1%) patients were excluded due to loss to follow-up and previous surgical treatment. 79 (20.6%) were ≥70-yrs. Age ≥70-yrs patients had poorer ECOG scores (P = .0017) and Charlson Comorbidity Index (P < .001). No significant difference in modified Tokuhashi score (P = .393) was observed with significantly more ≥ prostate (P < .001) and liver (P = .029) cancer in ≥70-yrs. Improved or maintained normal neurological function (P = .934), independent ambulatory status (P = .171), and survival at 6 months (P = .119) and 12 months (P = .659) was not significantly different between both groups. Medical (P = .528) or surgical (P = .466) complication rates and readmission rates (P = .800) were similar. CONCLUSION ≥70-yrs patients have comparable outcomes to <70-yr old patients with no significant increase in complication rates. Age should not be a determining factor in deciding surgical management of spinal metastases.
Collapse
Affiliation(s)
| | | | - Shi Wei Ang
- Yong Loo Lin School of Medicine, NUHS, Singapore
| | - Tuan Hao Tan
- Yong Loo Lin School of Medicine, NUHS, Singapore
| | | | | | | | - Renick Lee
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, Clinical Research Centre, 10 Medical Drive, Singapore
| | - Ka Po Gabriel Liu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
| |
Collapse
|
2
|
Zaborovskii N, Denisov A, Shapton J, Schlauch A, Ptashnikov D, Masevnin S, Smekalenkov O, Murakhovsky V, Mytyga P, Kondrashov D. Cross-cultural adaptation, reliability, and validity of the Russian version of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). J Neurosurg Spine 2023; 39:568-575. [PMID: 37439460 DOI: 10.3171/2023.5.spine23403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The most validated health-related quality-of-life (HRQOL) questionnaire specific to the metastatic spine cancer population is the Spine Oncology Study Group Outcomes Questionnaire version 2 (SOSGOQ2.0). The purpose of this study was to translate and validate a Russian version of the SOSGOQ2.0. METHODS The SOSGOQ2.0 was translated into Russian and cross-culturally adapted. In this study, 64 eligible patients completed the SOSGOQ2.0_RUS along with the EQ-5D 5 Level, SF-36 quality-of-life questionnaires, and visual analog scale for pain assessment scale (VAS). Internal consistency was measured using Cronbach's alpha, in which a score of 0.65 or higher is acceptable. Test-retest reliability was evaluated by examining the intraclass correlation coefficient (ICC). RESULTS Included in this study were 64 Russian-speaking patients (median age 59 years) with metastatic spine disease. The most common primary tumors were breast, kidney, and prostate cancers. The overall Cronbach's alpha was 0.87, indicating high internal consistency. The overall ICC for the SOSGOQ2.0_RUS was 0.88 (95% CI 0.81-0.93), indicating high reliability and consistency of the measure. The physical function, pain, and mental health domains of the SF-36 moderately correlated with the same domains of the SOSGOQ2.0_RUS, with correlation coefficients ranging from 0.65 to 0.71. CONCLUSIONS The SOSGOQ2.0_RUS is a reliable and valid questionnaire for assessing the HRQOL in patients with metastatic spinal tumors. The questionnaire showed high internal consistency, test-retest reliability, and good construct validity when compared with other established questionnaires.
Collapse
Affiliation(s)
- Nikita Zaborovskii
- 1Department of Orthopaedic Surgery, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
- 2Department of Orthopaedic Surgery, Saint Petersburg State University, St. Petersburg, Russia
| | - Anton Denisov
- 3Department of Orthopaedic Surgery, Traumatología Elgeadi/Hospital Quirónsalud Valle del Henares, Madrid, Spain
- 4Department of Orthopaedic Surgery, Traumatología Elgeadi/Hospital Quirónsalud San José, Madrid, Spain
- 5Department of Orthopaedic Surgery, Hospital 12 de Octubre Health Research Institute, Madrid, Spain
| | - John Shapton
- 6Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program/Saint Mary's Medical Center, San Francisco, California; and
| | - Adam Schlauch
- 6Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program/Saint Mary's Medical Center, San Francisco, California; and
| | - Dmitrii Ptashnikov
- 1Department of Orthopaedic Surgery, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
- 7Department of Orthopaedic Surgery, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Sergei Masevnin
- 1Department of Orthopaedic Surgery, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | - Oleg Smekalenkov
- 1Department of Orthopaedic Surgery, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | - Vladislav Murakhovsky
- 1Department of Orthopaedic Surgery, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | - Pavel Mytyga
- 1Department of Orthopaedic Surgery, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | - Dimitriy Kondrashov
- 6Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program/Saint Mary's Medical Center, San Francisco, California; and
| |
Collapse
|
3
|
Kumar N, Tan JH, Thomas AC, Tan JYH, Madhu S, Shen L, Lopez KG, Hey DHW, Liu G, Wong H. The Utility of 'Minimal Access and Separation Surgery' in the Management of Metastatic Spine Disease. Global Spine J 2023; 13:1793-1802. [PMID: 35227126 PMCID: PMC10556902 DOI: 10.1177/21925682211049803] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To compare outcomes of percutaneous pedicle screw fixation (PPSF) to open posterior stabilization (OPS) in spinal instability patients and minimal access separation surgery (MASS) to open posterior stabilization and decompression (OPSD) in metastatic spinal cord compression (MSCC) patients. METHODS We analysed patients who underwent surgery for thoracolumbar metastatic spine disease (MSD) from Jan 2011 to Oct 2017. Patients were divided into minimally invasive spine surgery (MISS) and open spine surgery (OSS) groups. Spinal instability patients were treated with PPSF/OPS with pedicle screws. MSCC patients were treated with MASS/OPSD. Outcomes measured included intraoperative blood loss, operative time, duration of hospital stay and ASIA-score improvement. Time to initiate radiotherapy and perioperative surgical/non-surgical complications was recorded. Propensity scoring adjustment analysis was utilised to address heterogenicity of histological tumour subtypes. RESULTS Of 200 eligible patients, 61 underwent MISS and 139 underwent OSS for MSD. There was no significant difference in baseline characteristics between MISS and OSS groups. In the MISS group, 28 (45.9%) patients were treated for spinal instability and 33 (54.1%) patients were treated for MSCC. In the OSS group, 15 (10.8%) patients were treated for spinal instability alone and 124 (89.2%) were treated for MSCC. Patients who underwent PPSF had significantly lower blood loss (95 mL vs 564 mL; P < .001) and surgical complication rates(P < .05) with shorter length of stay approaching significance (6 vs 19 days; P = .100) when compared to the OPS group. Patients who underwent MASS had significantly lower blood loss (602 mL vs 1008 mL) and shorter length of stay (10 vs 18 days; P = .098) vs the OPSD group. CONCLUSION This study demonstrates the benefits of PPSF and MASS over OPS and OPSD for the treatment of MSD with spinal instability and MSCC, respectively.
Collapse
Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Jiong H. Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Andrew C. Thomas
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Joel Y. H. Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith G. Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Dennis H. W. Hey
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Gabriel Liu
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - HeeKit Wong
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| |
Collapse
|
4
|
Hirase T, Taghlabi KM, Cruz-Garza JG, Faraji AH, Marco RAW, Saifi C. Preoperative Serum Albumin Level Predicts Length of Stay and Perioperative Adverse Events Following Vertebral Corpectomy and Posterior Stabilization for Metastatic Spine Disease. Global Spine J 2023:21925682231163814. [PMID: 36896896 DOI: 10.1177/21925682231163814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
STUDY DESIGN Retrospective review of a prospectively collected national database. OBJECTIVES To determine the association between preoperative serum albumin levels and perioperative adverse events (AEs) following vertebral corpectomy and posterior stabilization for metastatic spine disease. METHODS The 2010 to 2019 American College of Surgeons' National Surgical Quality Improvement (ACS-NSQIP) database was used to identify all patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Receiver operative characteristic (ROC) curve analysis was used to determine preoperative serum albumin cut-off values for predicting perioperative AEs. Low preoperative serum albumin was defined as serum albumin below this cut-off value. RESULTS A total of 301 patients were included in the study. ROC curve analysis demonstrated serum albumin < 3.25 g/dL as a cut-off value for predicting perioperative AEs. The low serum albumin group had a higher overall perioperative AEs (P = .041), longer post-operative LOS (P < .001), higher 30-day reoperation rate (P = .014), and a higher in-hospital mortality rate (P = .046). Multivariate analysis demonstrated that low preoperative serum albumin was associated with higher perioperative AEs. CONCLUSIONS Low serum albumin level is associated with higher perioperative AEs, longer postoperative LOS, and higher rates of 30-day reoperation and in-hospital mortality among patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Strategies to improve preoperative nutritional status in patients undergoing this procedure may improve these perioperative outcome measures within this surgical population. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Takashi Hirase
- Department of Orthopedic and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Khaled M Taghlabi
- Department of Neurosurgery, Houston MethodistHospital, Houston, TX, USA
| | | | - Amir H Faraji
- Department of Neurosurgery, Houston MethodistHospital, Houston, TX, USA
| | - Rex A W Marco
- Department of Orthopedic and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Comron Saifi
- Department of Orthopedic and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
5
|
Dial BL, Catanzano AA, Esposito V, Steele J, Fletcher A, Ryan SP, Kirkpatrick JP, Goodwin CR, Torok J, Hopkins T, Mendoza-Lattes S. Treatment Outcomes in Spinal Metastatic Disease With Indeterminate Stability. Global Spine J 2022; 12:373-380. [PMID: 32975442 PMCID: PMC9121158 DOI: 10.1177/2192568220956605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to compare outcomes between different treatment modalities for metastatic disease with indeterminate instability (Spinal Instability Neoplastic Score [SINS] 7-12). METHODS We retrospectively reviewed neurologically intact patients treated for spinal metastatic disease with a SINS of 7 to 12. The cohort was stratified by treatment approach: external beam radiation therapy alone (EBRT), surgery + EBRT (S+E), and cement augmentation + EBRT (K+E). Kaplan-Meier analysis was used to assess differences in length of survival (LOS) and ability to ambulate at time of death. Multivariate analysis was performed to assess adjusted LOS and ability to ambulate at time of death. RESULTS The cohort included 211 patients, S+E (n = 57), EBRT (n = 128), and K+E (n = 27). In the S+E group, the median LOS was 430 days, which was statistically longer than the median LOS for the EBRT group (121 days) and the K+E group (169 days). In the S+E group, 52 patients (91.2%) and in the K+E group 24 patients (92.3%) retained the ability to ambulate at their time of death compared to 99 patients (77.3%) of the EBRT patients (P = .01). The overall rate of revision treatment at the spinal level initially treated was 17.5%, S+E (15.8%), EBRT (20.3%), and K+E (7.7%). CONCLUSIONS The length of survival, ability to maintain ambulatory ability, and revision treatment rates were all improved following surgical management and radiation therapy compared to radiation therapy alone. The authors' conclusion from these results are that patients with indeterminate spinal instability should be discussed in a multidisciplinary setting for the need of spinal stabilization in addition to radiation therapy.
Collapse
Affiliation(s)
- Brian L. Dial
- Duke University Medical Center, Durham, NC, USA,Brian L. Dial, Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, USA.
| | | | | | - John Steele
- Duke University Medical Center, Durham, NC, USA
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Vidalis BM, Ngwudike SI, McCandless MG, Chohan MO. Negative Pressure Wound Therapy in Facilitating Wound Healing after Surgical Decompression for Metastatic Spine Disease. World Neurosurg 2021; 159:e407-e415. [PMID: 34954060 DOI: 10.1016/j.wneu.2021.12.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The risk of wound related complications, including surgical site infections (SSIs), in patients undergoing surgery for metastatic spine disease (MSD) is high. Consequently, patients requiring wound revision surgery face delay in resuming oncological care and incur additional hospitalization. Recent reports suggest that negative pressure wound therapy (NPWT) applied on a closed wound at the time of surgery, significantly reduces post-operative wound complications in degenerative spine disease and trauma setting. Here, we report a single institution experience with incisional NPWT in patients undergoing surgery for MSD. METHODS We compared rates of wound complications requiring surgical revision in a surgical cohort of patients with or without NPWT from 2015 to 2020. Adult patients with radiographic evidence of MSD with mechanical instability and/or accelerated neurological decline were included in the study. NPWT was applied on a closed wound in the operating room and continued for 5 days or until discharge, whichever occurred first. RESULTS A total of 42 patients were included: 28 with NPWT and 14 without. Patient demographics including underlying comorbidities were largely similar. NPWT patients had higher rates of prior radiation to the surgical site (36% vs. 0%, p = 0.017) and longer fusion constructs (6.7 vs. 3.9 levels, p < 0.001). Three patients (21%) from control group and none from NPWT group contracted SSI requiring wound washout (p = 0.032). CONCLUSIONS Our data suggests that SSI and wound dehiscence are significantly reduced with the addition of incisional NPWT in in this vulnerable population.
Collapse
Affiliation(s)
- Benjamin M Vidalis
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131
| | | | - Martin G McCandless
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS 39216
| | - Muhammad O Chohan
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131; Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS 39216.
| |
Collapse
|
7
|
Lyulin SV, Ivliev DS, Balaev PI, Borzunov DY, Ovsyankin AV, Miloserdov MA. [Surgical treatment results of metastatic spine disease with using minimally invasive technologies, including 3D video endoscopic technologies]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:49-57. [PMID: 34463450 DOI: 10.17116/neiro20218504149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
THE AIM OF THE STUDY Was to evaluate the results of surgical treatment of patients with metastatic lesions of the spine using 3-D video endoscopic technologies. MATERIAL AND METHODS We analysed the results of surgical treatment of 33 patients with metastatic lesions of the thoracic spine using a 3D video-assisted thoracoscopic intervention that was performed from November 2017 to December 2019. When examining patients, the following were used: X-ray of the spine, spiral computed tomography (CT), magnetic resonance imaging (MRI), as well as the SINS, Bilsky, Karnovsky, Tokuhashi, Frankel, SF-36 and VAS scales. RESULTS The actual life expectancy of the patients completely coincided with the predicted one according to the Tokuhashi scale. Regression of neurological disorders in the early postoperative period (before discharge from the hospital) was observed in 6% of patients (complete in 3%, partial in 3%). When evaluating the results of treatment 12 months after surgery, regression of neurological symptoms was observed in 19% of patients. At the same time, complete regression of neurological disorders occurred in 10%, partial in 9% of patients. When assessing the quality of life on the SF-36 scale, improvement was observed according to the most of the criteria. Also, in the postoperative period, there was a persistent decrease in the intensity of pain syndrome according to VAS compared with the preoperative level. CONCLUSION The use of 3-D video endoscopic technologies in the surgical treatment of patients with metastatic lesions of the spine made it possible to improve the quality of life of patients and reduce the number of complications.
Collapse
Affiliation(s)
- S V Lyulin
- Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
| | - D S Ivliev
- Federal Center of Traumatology, Orthopedics and Endoprosthetics of the Ministry of Health of the Russian Federation, Smolensk, Russia
- Smolensk State Medical University of the Ministry of Health of the Russian Federation, Smolensk, Russia
| | - P I Balaev
- Kurgan Regional Oncological Center, Kurgan, Russia
| | - D Yu Borzunov
- Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
| | - A V Ovsyankin
- Federal Center of Traumatology, Orthopedics and Endoprosthetics of the Ministry of Health of the Russian Federation, Smolensk, Russia
- Smolensk State Medical University of the Ministry of Health of the Russian Federation, Smolensk, Russia
| | - M A Miloserdov
- Smolensk State Medical University of the Ministry of Health of the Russian Federation, Smolensk, Russia
| |
Collapse
|
8
|
Sullivan PZ, Albayar A, Ramayya AG, McShane B, Marcotte P, Malhotra NR, Ali ZS, Chen HI, Janjua MB, Saifi C, Schuster J, Grady MS, Jones J, Ozturk AK. Association of spinal instability due to metastatic disease with increased mortality and a proposed clinical pathway for treatment. J Neurosurg Spine 2020; 32:950-957. [PMID: 32059185 DOI: 10.3171/2019.11.spine19775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multidisciplinary treatment including medical oncology, radiation oncology, and surgical consultation is necessary to provide comprehensive therapy for patients with spinal metastases. The goal of this study was to review the use of radiation therapy and/or surgical intervention and their impact on patient outcomes. METHODS In this retrospective series, the authors identified at their institution those patients with spinal metastases who had received radiation therapy alone or had undergone surgery with or without radiation therapy within a 6-year period. Data on patient age, chemotherapy, surgical procedure, radiation therapy, Karnofsky Performance Status (KPS), primary tumor pathology, Spinal Instability Neoplastic Score (SINS), and survival after treatment were collected from the patient electronic medical records. N - 1 chi-square testing was used for comparisons of proportions. The Student t-test was used for comparisons of means. A p value < 0.05 was considered statistically significant. A survival analysis was completed using a multivariate Cox proportional hazards model. RESULTS Two hundred thirty patients with spinal metastases were identified, 109 of whom had undergone surgery with or without radiation therapy. Among the 104 patients for whom the surgical details were reviewed, 34 (33%) had a history of preoperative radiation to the surgical site but ultimately required surgical intervention. In this surgical group, a significantly increased frequency of death within 30 days was noted for the SINS unstable patients (23.5%) as compared to that for the SINS stable patients (2.3%; p < 0.001). The SINS was a significant predictor of time to death among surgical patients (HR 1.11, p = 0.037). Preoperative KPS was not independently associated with decreased survival (p > 0.5) on univariate analysis. One hundred twenty-six patients met the criteria for inclusion in the radiation-only analysis. Ninety-eight of these patients (78%) met the criteria for potential instability (PI) at the time of treatment, according to the SINS system. Five patients (5%) with PI in the radiation therapy group had a documented neurosurgical or orthopedic surgery consultation prior to radiation therapy. CONCLUSIONS At the authors' institution, patients with gross mechanical instability per the SINS system had an increased rate of 30-day postoperative mortality, which remained significant when controlling for other factors. Surgical consultation for metastatic spine patients receiving radiation oncology consultation with PI is low. The authors describe an institutional pathway to encourage multidisciplinary treatment from the initial encounter in the emergency department to expedite surgical evaluation and collaboration.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - M Burhan Janjua
- 3Orthopedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania; and
| | - Comron Saifi
- 4Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas
| | | | | | | | | |
Collapse
|
9
|
Moses ZB, Lee TC, Huang KT, Guenette JP, Chi JH. MRI-guided cryoablation for metastatic spine disease: intermediate-term clinical outcomes in 14 consecutive patients. J Neurosurg Spine 2020; 32:676-681. [PMID: 31952035 DOI: 10.3171/2019.11.spine19808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimal access ablative techniques have emerged as a less invasive option for spinal metastatic disease reduction and separation from neural tissue. Compared with heat-based ablation modalities, percutaneous image-guided cryoablation allows for more distinct visualization of treatment margins. The authors report on a series of patients undergoing MRI-guided cryoablation as a feasible method for treating spinal metastatic disease. METHODS A total of 14 patients with metastatic spine disease undergoing MR-monitored cryoablation were prospectively enrolled. Procedures were performed in an advanced imaging operating suite with the use of both CT and MRI to gain access to the spinal canal and monitor real-time cryoablation. RESULTS The average age was 54.5 years (range 35-81 years). The mean preoperative Karnofsky Performance Status score was 79.3 (range 35-90). The average radiographic follow-up was 7.1 months (range 25-772 days), and the average clinical follow-up was 9.8 months (range 7-943 days). In 10 patients with epidural disease, 7 patients underwent postprocedural imaging, and of these 71% (5/7) had stable or reduced radiographic disease burden. Bone regrowth was observed in 63% (5/8) of patients with bone ablation during the treatment who had postoperative imaging. Pre- and postoperative visual analog scale scores were obtained, and a significant reduction in these scores was found following ablation. There were no complications. CONCLUSIONS MR-guided cryoablation is a minimally invasive treatment option for metastatic spine disease. In patients with epidural disease, the majority experienced tumor reduction or arrest at follow-up. In addition, pain was significantly improved following ablation. The average hospital stay was short, and the procedure was safe in a range of patients who are otherwise not ideal candidates for standard treatment.
Collapse
Affiliation(s)
| | - Thomas C Lee
- 2Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jeffrey P Guenette
- 2Division of Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | |
Collapse
|
10
|
Majeed H, Kumar S, Bommireddy R, Klezl Z, Calthorpe D. Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease. Ann R Coll Surg Engl 2012; 94:28-33. [PMID: 22524919 PMCID: PMC3954183 DOI: 10.1308/003588412x13171221498424] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Management of metastatic spinal disease has changed significantly over the last few years. Different prognostic scores are used in clinical practice for predicting survival. The aim of this study was to assess the accuracy of prognostic scores and the role of delayed presentation in predicting the outcome in patients with metastatic spine disease. METHODS Retrospectively, four years of data were collected (2007-2010). Medical records review included type of tumour, duration of symptoms, expected survival and functional status. The Karnofsky performance score was used for functional assessment. Modified Tokuhashi and Tomita scores were used for survival prediction. RESULTS A total of 55 patients who underwent surgical stabilisation were reviewed. The mean age was 63 years (range: 32-87 years). The main primary sources of tumours included myeloma, breast cancer, lymphoma, lung cancer, renal cell cancer and prostate cancer. Of the cases studied, 29 patients had posterior instrumented stabilisation alone, 10 patients had an anterior procedure alone and 16 patients (with an expected survival of more than one year) had both anterior and posterior procedures performed. Twenty-three patients presented with spinal cord compression. The mean follow-up duration was 9 months (range: 1-39 months). Patients who were treated within one week of referral survived longer than anticipated. Patients were divided into three groups based on their expected survival. Actual survival was better in all three groups after surgery. Discrepancies in scores were prominent in patients with myeloma, breast and prostate cancers. Functional outcome was better in patients under 65 years of age. CONCLUSIONS The prognostic scoring systems are not uniformly effective in all types of primary tumours. However, they are useful in decision making for surgical intervention, taking other factors into account, in particular the age of the patient, the type and stage of the primary tumour and general health.
Collapse
|