Clinical Results of Minimally Invasive Spine Stabilization for the Management of Metastatic Spinal Tumors Based on the Epidural Spinal Cord Compression Scale

Hong

et al. 2021

J Korean Neurosurg Soc

Spinal metastases can present with varying degrees of mechanical instability. The Spinal Instability Neoplastic Score (SINS) was developed as a tool to assess spinal neoplastic-related instability while helping to guide referrals among oncology specialists. Some previous papers suggested that the SINS was accurate and reliable, while others disagreed with this opinion. We performed a systematic review regarding the SINS to evaluate its accuracy and precision in predicting vertebral compression fractures (VCFs). The 21 included studies investigated a total of 2118 patients. Thirteen studies dealt with the accuracy of SINS to predict postradiotherapy VCFs, and eight dealt with the precision. Among 13 studies, 11 agreed that the SINS categories showed statistically significant accuracy in predicting VCF. Among eight studies, body collapse was effective for predicting VCFs in six studies, and alignment and bone lesion in two studies. Location has no statistical significance in predicting VCFs in any of the eight studies. The precision of SINS categories was substantial to excellent in six of eight studies. Among the six components of the SINS, the majority of the included studies reported that location showed near perfect agreement; body collapse, alignment, and posterolateral involvement showed moderate agreement; and bone lesion showed fair agreement. Bone lesion showed significant accuracy in predicting VCFs in half of eight studies, but displayed fair reliability in five of seven studies. Although location was indicated as having near perfect reliability, the component showed no accuracy for predicting VCFs in any of the studies and deleting or modifying the item needs to be considered. The SINS system may be accurate and reliable in predicting the occurrence of postradiotherapy VCFs for spinal metastasis. Some components seem to be substantially weak and need to be revised.

Section: Discussionmentioning

confidence: 99%

Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis

Hong

et al. 2021

J Korean Neurosurg Soc

“…A meta-analysis of nonrandomized cohorts showed that surgery was 1.3 times more likely to maintain ambulation and twice as likely to restore ambulation. [ 3 28 29 ] We did not take into account the modality of surgical treatment or the location of metastasis, but only the performance of decompression of the vertebral canal and surgical stabilization. Metastasis location, surgical approach, or method of reconstruction of the affected vertebral body was not considered.…”

Section: Discussionmentioning

confidence: 99%

“…The reports of separation surgery and less invasive surgery associated with stereotactic radiotherapy can provide the reported results of surgery associated with radiotherapy with less morbidity and complications. [ 28 29 ] Unfortunately, we cannot afford reported drugs that are effective in treating spinal metastasis conservatively or associated with surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and survival of spinal metastasis with epidural compression

Candido

Peria

Pinheiro

et al. 2021

J Craniovert Jun Spine

Objective: The goal of the study was to retrospectively evaluate the demographics, clinical manifestation, outcomes, treatment result, and survival of patients with spinal metastasis with epidural metastasis who underwent surgical treatment. Materials and Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression who underwent surgical treatment between 2009 and 2015 was performed. The recorded parameters selected for the study were general demographic data (gender, age, and educational level) and clinical data (primary tumor, performance status according to Karnofsky score, neurological status according to Frankel scale, pain, surgical treatment outcomes, and patient survival). Results: The mean age of the patients was 55.28 ± 15.79 years, and spinal metastasis was more frequent in males (61.7%). The two most frequent tumors were malignant breast cancer (26.21%) and prostate cancer (22.33%). Preoperative pain was presented in 96 (94.12%) patients and improvement was observed in 44 (47.31%) patients. Symptoms of spinal cord compression were the initial clinical manifestation of the primary tumor in 35 (33.98%) patients. Neurological deficit was observed in 66 (64.07%) patients, and improvement was observed in 43 (41.74%) patients. Improvement of functional outcome and pain was observed in 34 (37.38%) patients. The mean survival was 12.26 months. Longer survival (mean 19.13 months) was observed in patients who showed improvement in their ability to walk or kept it preserved (Frankel D or E). Conclusions: Surgical treatment of spinal metastasis can improve pain and functional activities. Longer survival was observed in patients that keep or recovery the walking ability.

Ukr. ž. med. bìol. sportu

“…Токухаси и соавт. рекомендовал эксцизионную операцию для пациентов с хорошим прогнозом (оценка Токухаси 12-15), паллиативную операцию для большинства пациентов со средним прогнозом (оценка 9-11) и консервативное лечение для пациентов с оценкой 8 или менее баллов [8,45,46,47]. Они проспективно применили свою систему подсчета баллов к 118 пациентам, чтобы помочь определить хирургическую стратегию, и обнаружили хорошую корреляцию между прогностическим показателем и фактической выживаемостью (r = 0,57, значительный P <0,0001), с коэффициентом согласованности между прогнозируемой и фактической выживаемостью 86,4.…”

Section: рис 3 классификация Weinsteinunclassified

Review of Classifications and Scoring Systems for Metastatic Spine Tumors Used in Surgical Treatment

Korzh¹,

Kutsenko²,

Perfiliev³

et al. 2020

It is known that metastases in the spine are detected in more than 70% of cancer patients, and in 10% of such patients, compression of nerve structures and severe neurological disorders develop. The role of surgery for metastatic tumors of the spine is in the focus of attention, since the operation can improve mechanical stability, decompress nerve structures and reduce the intensity of pain. However, what role the operation plays in increasing life expectancy and how to correctly assess the results of treatment remains controversial and the opinions of specialists are controversial, since the assessment is often made by oncologists, but it is the surgeon who more fully evaluates the potential risks and benefits of surgical interventions. Therefore, it is important for surgeons to understand what prognostic factors affect the quality and duration of life. This article presents the most cited classifications and assessments before 2009, as well as all classifications and assessments obtained after 2010 regarding metastatic lesions of the spine, as well as classifications used to develop treatment tactics obtained from the electronic databases PubMed, MEDLINE, articles, monographs, abstracts, dissertations and other sources of scientific and medical information. 57 main publications with II and III levels of evidence were selected, 6 classifications and 24 rating scales were considered. In order to construct the necessary tactics of the surgical strategy, the classification / assessment methods were divided into anatomical classification / assessment methods, neurological symptom / instability assessment methods, and assessment systems for predicting life expectancy. The study showed that in the surgical treatment of metastatic tumors of the spine, it is important to use the same rating scales and classifications to select indications and assess the results of surgical treatment, as well as to achieve meaningful comparisons between published series. Conclusion. The classifications and rating scales used for metastatic lesions of the spine do not fully reflect the type of surgical treatment: there is no algorithm for restoring the support ability of the spine, which is very important for this category of patients