Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Opinions vary widely as to the role of surgery (from none to wide margin excision) in the management of spinal metastases. In this study the authors set out to ascertain if surgery improves the quality of remaining life in patients with spinal metastatic and tumor-related systemic disease.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors included 223 patients in this study who were referred by oncologists and physicians over a 2-year period. All underwent surgery. Surgery was classified according to extent of excision ranging from en bloc excision or debulking to palliative surgery. All patients had a histologically confirmed diagnosis of epithelial spinal metastasis, and an oncology specialist undertook appropriately indicated adjuvant therapy in almost half of the patients.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean patient age was 61 years. Excisional en bloc or debulking surgery was performed in 74%; the rest had (minimal) palliative decompression. All patients considered for surgery were included in the study. Patients presented with pain in 92% of cases, paraparesis in 24%, and abnormal urinary sphincter function in 22% (5% were incontinent). Breast, renal, lung, and prostate accounted for 65% of the cancers, and in 60% of patients there were widespread spinal metastases (Tomita Type 6 or 7).</jats:p> <jats:p>The incidence of perioperative death (within 30 days of surgery) was 5.8%. Postoperatively 71% of the entire group had improved pain control, 53% regained or maintained their independent mobility, and 39% regained urinary sphincter function. The median survival for the cohort was 352 days (11.7 months); those who underwent excision survived significantly longer than those in the palliative group (p = 0.003). As with survival results, functional improvement outcome was better in those who underwent excision.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Surgical treatment was effective in improving quality of life by providing better pain control, enabling patients to regain or maintain mobility, and offering improved sphincter control. Although not a treatment of the systemic cancer, surgery is feasible, has acceptably low mortality and morbidity rates, and for many will improve the quality of their remaining life.</jats:p></jats:sec>

Outcome of excisional surgeries for the patients with spinal metastases

“…In our study, the median postoperative survival time of the patients after en bloc or debulking surgeries was also very exciting, which was longer than 2 years. Although no significant difference was found in the comparison of survival time between the two procedures, the en bloc surgery showed a longer median survival time than the debulking surgery, which was also concluded by Ibrahim et al [11] through an international multicenter prospective observational study.…”

“…The treatment for spinal metastases is a synthesis of surgery, radiotherapy, chemotherapy, immune therapy, and other applicable conservative treatments. At the same time, surgical treatments have been evaluated to be important and effective in some recent studies [11,13,14]. Many new surgical concepts and procedures for management of the spine tumor have been greatly developed in recent years.…”

“…Laminectomy, the most frequently adopted traditional procedure in early time, has been proved to be mediocre in outcome and not more beneficial than radiotherapy alone [3,25]. Due to the improvement of the surgical techniques, more and more aggressive surgeries were adopted in spinal metastatic treatment [11,18,22]. Nowadays, the superiority of surgery in management of spinal metastases has been supported by a number of documentaries, in spite of the long-existing controversies [9,11,15].…”

Posterior transpedicular corpectomy for malignant cervical spine tumors

“…Spinal cord compression due to malignant vertebral body tumors of the cervical spine is often a cause of pain, loss of mobility, and neurological deficit. It leads to significant compromise of the quality of life in those patients [7].…”

“…Malignant spine tumors typically involve the vertebral body in 70% of cases and spare the posterior elements [3][4][5][6][7].…”