Current Paradigms for Metastatic Spinal Disease: An Evidence-Based Review

Kaloostian, Paul E.; Yurter, Alp; Zadnik, Patricia L.; Sciubba, Daniel M.; Gokaslan, Ziya L.

doi:10.1245/s10434-013-3324-8

Cited by 98 publications

(80 citation statements)

References 161 publications

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“…1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, 48,52,65,74,86,93,98 and prior studies have identified anatomical location, tumor size, tumor histology, extent of resection, surgical approaches, age, functional status, comorbidities, preoperative medication (steroid use, morphine), longer operative time, insurance status, early postoperative complications, and adjuvant chemotherapy and radiotherapy as factors associated with postoperative morbidity and mortality. 1,[18][19][20][21][22][23][24]39,41,42,44,48,51,52,56,58,66,69,78,92,99 Nevertheless, many of these previous publications were retrospective, institutional studies, 10,11,55,60,65,87,…”

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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“…A total of 5-14% of cancer patients develop spinal metastasis with cord compression (9). Lung, breast, prostate, renal and gastrointestinal tumors are all prone to progress to or present with spinal metastasis (10).…”

Section: Discussionmentioning

confidence: 99%

Unusual lower back pain with monocytosis: A case report

Huang

et al. 2016

Oncology Letters

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Abstract. There are numerous causes of lower back pain. In the oncological setting, spine metastasis from a solid tumor is the most common. However, hematological disorders should also be taken into consideration. The current study presents a case of chronic myelomonocytic leukemia with the initial presentation of chronic lower back pain, followed by symptoms that included urinary retention, stool incontinence and left gum swelling, in a patient who was eventually diagnosed with granulocytic sarcoma (GS) over the sacral region. GS is a rare presentation of a tumor consisting of extramedullary leukemic infiltrations, which develop at different sites and cause different symptoms. Prompt and correct diagnosis of this type of disease may be crucial to improve the survival outcome by the early initiation of adequate treatment.

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“…In patients with vertebral compression fracture, the differential diagnosis between neoplastic and benign osteoporotic fractures is important to provide proper early therapeutic intervention and improve prognosis and quality of life (1). As pathologic confirmation for the differential diagnosis is not always feasible due to advanced age and general condition, the usual practice is generally based on the clinical information and findings of spine magnetic resonance imaging (MRI) (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

“…As pathologic confirmation for the differential diagnosis is not always feasible due to advanced age and general condition, the usual practice is generally based on the clinical information and findings of spine magnetic resonance imaging (MRI) (1)(2)(3). In conventional MRI sequences, such as T1-or T2-weighted images, morphologic features like the degree and pattern of bone marrow replacement, multiplicity of lesions, presence of paravertebral soft tissue masses, infiltration of posterior elements of the vertebrae, and presence of a fracture line are commonly evaluated for the differential diagnosis (1)(2)(3)(4)(5)(6)(7)(8). However, accurate differential diagnosis between these fractures can be challenging since there are overlapping morphological features and frequent mimickers (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%