Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial

Patchell, Roy A.; Tibbs, Phillip A.; Regine, William F.; Payne, Richard; Saris, Stephen C.; Kryscio, Richard J.; Mohiuddin, Mohammed; Young, Byron

doi:10.1016/s0140-6736(05)66954-1

Cited by 2,025 publications

(1,452 citation statements)

References 17 publications

Supporting

Mentioning

1,362

Contrasting

Unclassified

Order By: Relevance

“…Assuming the overall medical condition of the patient is suitable to tolerate the proposed operation and the patient does not have a limited life expectancy (<3 months) (Fig. 1), patients may benefit significantly from surgery, as has been shown in a prospective, randomized clinical trial by Patchell et al [39]. Generally, surgical indications include: progressive neurological deficits due to significant bone or disc fragment in the spinal canal, mechanical instability, deformity, radiation resistant tumors or tumors that progress despite undergoing maximal radiation dosages, and medically intractable pain [29].…”

Section: Indications For Surgerymentioning

confidence: 94%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

View full text Add to dashboard Cite

Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre-and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory.Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

show abstract

Section: Indications For Surgerymentioning

confidence: 94%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

View full text Add to dashboard Cite

show abstract

“…More patients regained the ability to walk after treatment and retained the ability to walk for a longer period of time in the surgical group than in the radiotherapy alone group. 18 In addition, there was improved pain control in the surgical group with decreased opioid analgesic requirements. 18 The difference in the improved outcome appears to be related to age, with the benefits of surgery with radiation over radiation alone disappearing in patients over the age of 60 years.…”

Section: Metastatic Epidural Spinal Cord Compressionmentioning

confidence: 96%

“…18 In addition, there was improved pain control in the surgical group with decreased opioid analgesic requirements. 18 The difference in the improved outcome appears to be related to age, with the benefits of surgery with radiation over radiation alone disappearing in patients over the age of 60 years. 19 …”

Section: Metastatic Epidural Spinal Cord Compressionmentioning

confidence: 96%

“…A recent randomized trial by Patchell and colleagues 18 found that in patients who met certain criteria, surgical decompression followed by radiotherapy was superior to radiotherapy alone. The A recent randomized trial by Patchell and colleagues 18 found that in patients who met certain criteria, surgical decompression followed by radiotherapy was superior to radiotherapy alone.…”

Section: Metastatic Epidural Spinal Cord Compressionmentioning

confidence: 99%

“…The A recent randomized trial by Patchell and colleagues 18 found that in patients who met certain criteria, surgical decompression followed by radiotherapy was superior to radiotherapy alone. study included patients with a metastasis to a single area, which could include several contiguous vertebral segments, and importantly excluded patients with lymphoma, leukemia, multiple myeloma, and germ cell tumors.…”

Section: Metastatic Epidural Spinal Cord Compressionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical Treatment of Metastatic Spinal Tumors

Meyer¹,

Singh²,

Jenkins³

2010

Mount Sinai J Medicine

View full text Add to dashboard Cite

Spinal metastases represent a significant cause of morbidity in patients diagnosed with malignancies. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. The treatment paradigm for spinal metastases involves a cohesive multidisciplinary approach that allows treatment plans to be made in the context of a patient's overall condition. There have been significant advances in the surgical treatment of spinal metastases that can significantly improve a patient's quality of life. demonstrated that vertebral metastases are found in as many as 30% of patients with malignancies. 2 Spinal metastases are most commonly seen, in decreasing order of incidence, from primary lung, prostate, kidney, liver, gastric, and colon cancers in males and primary breast, lung, uterine, thyroid, and gastric cancers in females. 3 In addition, there is a significant contribution from hematogenous disorders such as lymphoma and multiple myeloma. Metastases to the spine can cause severe pain, paralysis, and impairment of activities of daily living. 4 Magnetic resonance imaging is the diagnostic modality of choice in the diagnosis of spinal metastases, with a sensitivity of 93% and a specificity of 97%. 5 Additional information regarding the extent of bone destruction and alignment can be obtained with computed tomography of the spine.We have found that a cohesive multidisciplinary approach to the treatment of metastases to the spine can improve outcomes as it brings the treating physicians together and allows plans to be made in the context of the patient's overall condition. The initial evaluation should involve a thorough history, including any prior history of malignancy. In some cases, symptoms related to spinal metastases are the first signs of malignancy, and a thorough metastatic workup, including standard X-rays, computed tomography of the chest, abdomen, and pelvis, positron emission tomography, and bone scans, is often necessary to identify the primary tumor. In addition, blood dyscrasias such as multiple myeloma and lymphoma need to be considered, and this requires further laboratory studies of the blood and possibly cerebrospinal fluid. Treatment paradigms involve close collaboration between the medical oncologist, radiation oncologist, and spine surgeon. The pathology of the primary tumor is important in determining the patient's life expectancy, sensitivity to adjuvant treatments, and likelihood of achieving systemic control.

show abstract

Myelopathies in Patients With Cancer

Graber¹,

Nolan²

2010

Arch Neurol

View full text Add to dashboard Cite

yelopathy is a devastating neurologic complication of cancer. The resulting pain, paralysis, and incontinence can turn a patient with cancer from a functioning individual to one who is confined to a chair or bed. Early diagnosis and appropriate therapy can prevent or ameliorate these symptoms and improve both duration of survival and quality of life. Accurate neurologic assessment of patients is crucial for early diagnosis and correct therapy. Myelopathy in patients with cancer is not rare. Epidural spinal cord compression (SCC) affects an estimated 5% of patients with cancer; other disorders such as intramedullary spinal cord metastases, adverse effects of therapy, and paraneoplastic spinal cord syndromes, although less common, are equally devastating. Because of space limitations, this review addresses the pathophysiology, clinical findings, diagnosis, and treatment of only some of the myelopathies that affect patients with cancer (Table 1). Because of new data, epidural SCC and paraneoplastic syndromes are emphasized.

show abstract

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial

Cited by 2,025 publications

References 17 publications

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Surgical Treatment of Metastatic Spinal Tumors

Myelopathies in Patients With Cancer

Contact Info

Product

Resources

About