Comprehensive surgical treatment strategy for spinal metastases

Abstract

The management of patients with spinal metastases (SM) requires a multidisciplinary team of specialists involved in oncological care. Surgical management has evolved significantly over the recent years, which warrants reevaluation of its role in the oncological treatment concept. Any patient with a SM was screened for study inclusion. We report baseline characteristics, surgical procedures, complication rates, functional status and outcome of a large consecutive cohort undergoing surgical treatment according to an algorithm. 667 patients underwent 989 surgeries with a mean age of 65 years (min/max 20–94) between 2007 and 2018. The primary cancers mostly originated from the prostate (21.7%), breast (15.9%) and lung (10.0%). Surgical treatment consisted of dorsoventral stabilization in 69.5%, decompression without instrumentation in 12.5% and kyphoplasty in 18.0%. Overall survival reached 18.4 months (95% CI 9.8–26.9) and the median KPS increased by 10 within hospital stay. Surgical management of SMs should generally represent the first step of a conclusive treatment algorithm. The need to preserve long-term symptom control and biomechanical stability requires a surgical strategy currently not supported by level I evidence.

Two Single-Level Nonadjacent Corpectomies With Expandable Vertebral Body Replacements for Spinal Metastasis

“…Current treatment concepts of spinal metastases include stereotactic radiosurgery, conventional radiotherapy, and surgery 7 . According to Wagner et al, surgical management should generally represent the first step of a conclusive treatment algorithm, although it should be promoted by an interdisciplinary team 8 . Our patient underwent 28 cycles of radiotherapy after the first surgery and was free of symptoms until the progression of the disease.…”

Osteolytic vs. Osteoblastic Metastatic Lesion: Computational Modeling of the Mechanical Behavior in the Human Vertebra after Screws Fixation Procedure

“…In such cases, structural stabilization requires screw fixation [ 20 , 21 ] that consists of inserting different kinds of implants such as pedicle screws in the vertebra [ 20 , 22 ]. Following screw fixation, surgery complications can arise, e.g., construct failure, malposition of screws, neurologic deterioration, and deep and superficial wound infections [ 21 , 23 , 24 ]. Several retrospective studies have investigated complication rates after screw fixation for the treatment of spinal metastases, reporting between 15 and 47% of revisions.…”

CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy

“…Moreover, it was shown that spinal surgery, mainly spinal instrumentation with decompression, for metastatic epidural spinal cord compression (MESCC) significantly improves pain, neurologic function and health-related quality of life [ 2 , 3 ]. Consecutively, surgery for SM has gained a decisive role in modern interdisciplinary oncological treatment [ 4 , 5 , 6 ].…”

“…While SMs are the most frequent neoplasms of the spine, being found in about 15–35% of cancer patients [ 8 , 9 ] primary bone tumors of the spine are rare (less than 5% of spinal neoplasms) [ 10 ]. Treatment decisions are made interdisciplinary and individually, taking into account the patient’s symptoms, the degree of osteolytic instability, the degree of epidural compression, the radio- and chemosensitivity of the tumor and the overall prognosis [ 4 , 11 ].…”