A Natural History of Patients Treated Operatively and Nonoperatively for Spinal Metastases Over 2 Years Following Treatment

Abstract

Study Design. Prospective observational study. Objective. We present the natural history, including survival and function, among participants in the prospective observational study of spinal metastases treatment investigation. Summary of Background Data. Surgical treatment has been touted as a means to preserve functional independence, quality of life, and survival. Nearly all prior investigations have been limited by retrospective design and relatively short-periods of post-treatment surveillance.Methods. This natural history study was conducted using the records of patients who were enrolled in the prospective observational study of spinal metastases treatment study (2017)(2018)(2019). Eligible participants were 18 or older and presenting for treatment of spinal metastatic disease. Patients were followed at predetermined intervals (1, 3, 6, 12, and 24-mo) following treatment. We conducted cox proportional hazard regression analysis adjusting for confounders including age, biologic sex, number of comorbidities, type of metastatic lesion, neurologic symptoms at presentation, number of metastases involving the vertebral body, vertebral body collapse, New England Spinal Metastasis Score (NESMS) at presentation, and treatment strategy. Results. We included 202 patients. Twenty-three percent of the population had died by 3 months following treatment initiation, 51% by 1 year, and 70% at 2 years. There was no significant difference in survival between patients treated operatively and nonoperatively (P ¼ 0.16). No significant difference in HRQL between groups was appreciated beyond 3 months following treatment initiation. NESMS at presentation (scores of 0 [HR 5.61; 95% CI 2.83, 11.13] and 1 [HR 3.00; 95% CI 1.60, 5.63]) was significantly associated with mortality. Conclusion. We found that patients treated operatively and nonoperatively for spinal metastases benefitted from treatment in terms of HRQL. Two-year mortality for the cohort as a whole was 70%. When prognosticating survival, the NESMS appears to be an effective utility, particularly among patients with scores of 0 or 1.

Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor

“…A propensity score–matching analysis demonstrated patients with operative treatment showed a lower likelihood of being nonambulatory 6 months after presentation than patients with nonoperative treatment, as well as a lower risk of 6-month mortality 6 . A recent observational study indicated surgical intervention achieved a better improvement of QOL by 3 months after treatment than nonoperative treatment 7 . However, postoperative mortality and complication rates for spinal metastasis are much higher than that for general spinal surgery.…”

“…6 A recent observational study indicated surgical intervention achieved a better improvement of QOL by 3 months after treatment than nonoperative treatment. 7 However, postoperative mortality and complication rates for spinal metastasis are much higher than that for general spinal surgery. The 30-day mortality was 3% to 10% and the 90-day mortality was 10% to 30%.…”

Reply to the Letter to the Editor: Does Operative Management of Epidural Abscesses Increase Healthcare Expenditures up to 1 Year After Treatment?

“…The driving factors regarding decision for surgery in patients with a spinal epidural abscess should be guided by symptoms and objective findings at presentation, radiographic results, and anticipated risk for neurologic deterioration or loss of function [1,6]. As in patients with spinal metastases, the successful management of epidural abscess in a patient with intact function at baseline must focus on the preservation of neurological and ambulatory capacity.…”

Contextualizing Frailty in Contemporary Spine Practice

“…3 Its importance was further substantiated in investigations relying on large-scale data from the National Surgical Quality Improvement Program (NSQIP) 4 and subsequently incorporated in scoring utilities such as the New England Spinal Metastasis Score (NESMS). 5 Of course, the characterization of frailty now extends well beyond the simple determination of serum albumin, incorporating aspects of measured sarcopenia and tools like the Modified Adult Spinal Deformity Frailty Index (mASD-FI) and modified 5-item frailty index (mFI-5). Although many experienced clinicians have a general gestalt regarding who will benefit from a procedure and who will not, the fact remains that there is a need for more quantitative determinations regarding the impact of frailty in all its forms (physiologic, muscular, osseous, and combinations of the three) on outcomes following spine surgical interventions writ large.…”

“…Initiated in the context of predicting wound healing following lower extremity amputation,1 this concept was brought into the spine field in the 1990s through the studies of Klein et al 2 as well as Jevsevar and Karlin 3. Its importance was further substantiated in investigations relying on large-scale data from the National Surgical Quality Improvement Program (NSQIP)4 and subsequently incorporated in scoring utilities such as the New England Spinal Metastasis Score (NESMS) 5…”