Dynamics of Neurological Deficit After Surgical Decompression of Symptomatic Vertebral Metastases

Hessler, C; Burkhardt, Till; Raimund, Frank; Regelsberger, Jan; Vettorazzi, Eik; Madert, Juergen; Eggers, C.

doi:10.1097/brs.0b013e31819a825d

Cited by 23 publications

(16 citation statements)

References 30 publications

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“…Hessler et al, operated on 194 patients with neurologic deficits due to spinal metastases and evaluated pre-operative and post-operative Frankel scores that were measured five to seven days after surgery. 15 They reported a significant correlation between the pre-operative duration of symptoms and the post-operative neurologic outcome (p<0.01, Kendall-τ b = −0.331), and patients with symptom duration of <10 days and <3 days having higher probability of neurologic improvement compared to patients with >15 days symptom duration. The duration of symptoms did not appear to correlate with the probability of neurologic deterioration.…”

Section: Resultsmentioning

confidence: 96%

Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC

Laufer

Zuckerman

Bird

et al. 2016

Spine

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Study Design Systematic literature review and expert survey Objective Determination of factors associated with neurologic improvement in patients with neurologic deficits secondary to MESCC. Clear understanding of these factors will guide surgical decision making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration. Summary of Background Data Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, due to sparse data and complexity of these patients. Methods PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation. Results Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and prior irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation. Conclusions Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made in order to improve the probability of neurologic recovery.

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Section: Resultsmentioning

confidence: 96%

Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC

Laufer

Zuckerman

Bird

et al. 2016

Spine

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“…Chong et al [27] reported that 20% of their patients showed improvement of Frankel grade. One international multiple center study [21] showed that 64% of their cohort had improved or maintained their preoperative Frankel grade of Hessler et al [28] and found that 70% of their patients who underwent decompression within 24 hours achieved improved neurological function. The relative frequency of complications related to spinal metastatic surgery is high especially in the context of emergency surgeries.…”

Section: Other Surgical Outcomesmentioning

confidence: 97%

Improved patient selection by stratified surgical intervention: Aarhus Spinal Metastases Algorithm

Wang

Bünger

et al. 2015

The Spine Journal

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“…Patients with metastatic cancer are challenging to treat, because metastasis represents an advanced stage of the disease and, hence, is indicative of poor prognosis 1,2,3,9,18,19 .…”

Section: Discussionmentioning

confidence: 99%

“…Dorsal spinal decompression and stabilization are the most frequent surgical techniques used to treat metastatic disease of the thoracic and lumbar spine 1,2,3,4,5,6,7,8,9,10 . For patients with a solitary spinal metastasis without vertebral canal invasion and who are in good general health with a long life expectancy, tumor resection through en bloc spondylectomy/total vertebrectomy with primary stabilizing instrumentation has been suggested 9,10,11,12,13 . A recent paper reported that candidates for en bloc spondylectomy are not frequently encountered 14,15,16 .…”

Section: Discussionmentioning

confidence: 99%

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Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

Oliveira

Rotta

Botelho

2015

Arq. Neuro-Psiquiatr.

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The spine is the most common site for skeletal metastasis in patients with malignancy. Approximately half of all patients with an advanced malignancy have evidence of spinal involvement. Surgical treatment remains a source of debate, and prognostic factors need to be well established to allow an appropriate decision regarding treatment modalities 1,2,3,4,5 .Vertebral involvement in such patients is associated with worse morbidity and mortality rates, impairing prognosis. Quantification of vertebral involvement, vertebral canal invasion, neurological status, general health status, and malignancy prognosis determined by primary tumor histology are paramount factors for surgical planning and definition of therapeutic targets 6,7,8,9,10 .We conducted a survival analysis in a sample of patients with metastatic spinal disease to determine factors associated with survival. METHODThe study sample consisted of patients with vertebral metastases consecutively admitted from July 2010 to January ABSTRACTSpine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and therapeutic targets. We evaluated the impact of general clinical and neurological status, histologic type and surgery in survival. Method: The study sample consisted of consecutive patients admitted from July 2010 to January 2013 for treatment. Results: Sixty eight patients were evaluated. 23 were female and 45 were male. Main primary neoplasic sites were: breast, prostate, lung/pleura and linfoproliferative. Thirty three out of 68 received surgical treatment, 2 received percutaneous biopsy and 33 had nonsurgical treatment. Survival: Log Rank curves revealed no statistical significant difference according to histological type, surgical approach and Frankel Score. Karnofsky Score was statistically different. Conclusion: Histological type and clinical status were statistically associated with life expectancy in vertebral metastatic disease.Keywords: neoplasm metastasis, spinal diseases, prognosis. RESUMOA coluna vertebral é o sítio mais comum de metastases ósseas. A quantificação do acometimento vertebral, o status neurológico, status clínico e histologia do tumor primário são fatores importantes para planejamento cirúrgico e metas terapêuticas. Nós avaliamos o impacto do status clinico geral e neurológico, tipo histológico e cirurgia na sobrevida de pacientes com metástases espinhais. Método: A amostra consistiu de pacientes consecutivamente admitidos de Julho de 2010 a Janeiro de 2013. Resultados: Sessenta e oito pacientes foram avaliados. 23 eram mulheres e 45 eram homens. Os principais sítios primários foram mama, próstata, pulmão e linfoproliferativos. Trinta e três realizaram tratamento cirúrgico, 2 realizaram biópsia percutânea e 33 tiveram tratamento conservador e radioterapia. Conclusão: As curvas Log Rank não revelaram significância quanto à cirurgia e escore de Frankel, mas revelaram as...

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Dynamics of Neurological Deficit After Surgical Decompression of Symptomatic Vertebral Metastases

Abstract: Patients with neurologic deficit because of spinal bone metastases benefit from early operative intervention. Urgent surgery is indicated in patients with less than 3 days of neurologic deficit.

Cited by 23 publications

References 30 publications

Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC

Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC

Improved patient selection by stratified surgical intervention: Aarhus Spinal Metastases Algorithm

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

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