Estudo da aplicabilidade do escore de Tokuhashi modificado nos pacientes tratados cirurgicamente de metástases vertebrais

Abstract

Objective: To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain Rev Bras Ortop. 2011;46(4):424-30

Estudo epidemiológico de 55 pacientes portadores de doença vertebral metastática sintomática em Santo André - SP, Brasil

“…Segundo a literatura, as metástases vertebrais ocorrem mais frequentemente na região lombar, com 70% dos casos; em seguida na região torácica, com 20% e por fim, as lesões cervicais, que representam aproximadamente 10% dos casos de DVM 15,19,21,22 . Entretanto, as lesões torácicas são as mais sintomáticas, representando aproximadamente 70% dos casos, em virtude de um menor espaço disponível para a medula espinhal nesta região, uma vez que o canal vertebral é caracteristicamente mais estreito 1,22 .…”

“…A idade média dos pacientes observados no presente estudo variou de 28 a 85 anos, com média de 55,92 anos; houve 22 homens (40%) e 33 mulheres (60%). Segundo a literatura, sexo masculino e feminino são acometidos de maneira semelhante, com leve predomínio do sexo feminino em alguns relatos 4,13,15 entretanto não parece haver predomínio significativo de sexo nesta afecção. North et al 16 identificaram em uma população de 61 pacientes portadores de DVM a idade média de 52,4 anos; Ibrahim et al 14 Em estudo envolvendo 842 autópsias consecutivas de pacientes oncológicos sabidamente portadores de doença metastática, Ortiz Gomez 17 demonstrou que 65% dos casos de DVM ocorreram em decorrência de lesões primárias de mama, pulmão, mieloma múltiplo e linfomas.…”

Spinal Metastasis: Diagnosis, Treatment and Prognosis - Integrative Review From 2012 to 2017

“…19,22,27,[30][31][32]35 In addition to these scales, there are others that can be used in the evaluation of patients with spinal metastases, adding more detailed aspects and with a multidisciplinary view of the patient centered on functional capacity, functional independence/physical performance, on the presence of comorbidities, the quality of life and satisfaction, on the presence of depression and mood disorders, on functional activity to return to work, but, due to Brazilian sociocultural peculiarities, the results may not be fully applicable in their entirety. 19,25,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Another aspect to be mentioned is that a decision centered only on prognostic scales can often produce inhuman situations for the patients and their families, characterizing for them a feeling of abandonment and discredit. In one study, patients who scored between 0 and 8 on the modified Tokuhashi scale and who normally would not have been operated on because of poor prognosis, underwent surgery and had a longer survival than expected from the score, showing the benefit of investing in patients with worse prognoses.…”

“…In one study, patients who scored between 0 and 8 on the modified Tokuhashi scale and who normally would not have been operated on because of poor prognosis, underwent surgery and had a longer survival than expected from the score, showing the benefit of investing in patients with worse prognoses. 64 In this context, despite the numerous scales available to assist with therapeutic indications and their validity in determining the prognosis in treatment of spinal metastasis, a multidisciplinary team is essential to evaluate individual patient factors that go beyond the physical area, such as functional performance, neurological deficit, spinal instability, psychological and emotional state, involving their uniqueness, their values, and their beliefs. 66,67,[69][70][71] The thematic unit "types of treatment" in spinal metastases includes the minimally invasive and traditional categories, the former being predominantly cited.…”

Complications of Surgical Treatment of Spinal Metastases

“…7 Surgical treatment of spinal metastases is palliative, with the main goal of improving the patient's quality of life by reducing pain, maintaining or reducing the neurological deficit, and enabling activities of daily living. 8,9 Coluna/Columna. 2021;20(4):300-4 tumOr and medical OncOlOgy…”