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

Wang, Miao; Bünger, Cody; Li, Haisheng; Sun, Ming; Helmig, Peter; Borhani-Khomani, Gilava; Wu, Chunsen; Hansen, Ebbe Stender; Choi, David; Hoey, Kristian

doi:10.1016/j.spinee.2015.03.012

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…Laminectomy alone may compromise the stability of the spine in an individual who already has reduced functional capacity from a systemic disease. Subsequent radiotherapy can further compromise the soft tissues, including muscle, leading to myopathy and late kyphosis at the site of decompression. Pedicle screw constructs placed across the decompression site allow stabilization and can prevent late deformity.…”

Section: Radiologymentioning

confidence: 99%

Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team

Curtin

Piggott

Murphy

et al. 2017

Orthopaedic Surgery

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Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.

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Section: Radiologymentioning

confidence: 99%

Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team

Curtin

Piggott

Murphy

et al. 2017

Orthopaedic Surgery

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“…Given the short life-expectancy associated with widely metastatic prostate and other cancers, often open surgical fusion for relief of mechanical pain from pathologic fractures is forgone due to concerns about prolonged post-operative recovery times [14]. Based on the landmark study by Patchell et al [15], a minimum of three months of life-expectancy is widely considered necessary to derive benefit from a spinal decompression and stabilization procedure [16-18]. However, as demonstrated in this report, navigated, percutaneously placed, fenestrated pedicle screws with cement augmentation and internal fixation may represent a low morbidity, rapid recovery procedure to add to the surgeon’s armamentarium to provide significant stabilization and pain relief to patients in this population previously not considered to be surgical candidates.…”

Section: Discussionmentioning

confidence: 99%

Image-guided Percutaneous Polymethylmethacrylate-augmented Spondylodesis for Painful Metastasis in the Veteran Population

Sussman

Pendharkar

et al. 2019

Cureus

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The treatment of painful spinal metastases in patients with limited life-expectancy, significant perioperative risks, and poor bone quality poses a surgical challenge. Recent advances in minimal-access spine surgery allow for the surgical treatment of patients previously considered not to be operative candidates. The addition of fenestrated screws for cement augmentation to existing image-guided percutaneous pedicle screw fixation can enhance efficiency, decrease risk of hardware complications, and improve back pain in this patient population. The patient is a 70-year-old man with severe axial back pain due to metastatic prostate cancer and L5 pathologic fractures not amenable to kyphoplasty. In the setting of a 6-12-month life-expectancy, the primary goal of surgery was relief of back pain associated with instability with minimal operative morbidity and post-operative recovery time. This was achieved with an internal fixation construct including percutaneously placed cement-augmented fenestrated pedicle screws at L4 and S1. The patient was discharged to home on post-operative day 1 with substantial improvement of his low back pain. Image-guided, percutaneous placement of fenestrated, cement-augmented pedicle screws is an emerging treatment for back pain associated with metastasis. Fenestrated screws allow for integrated cement augmentation. The minimal associated blood loss and recovery time make this approach an option even for patients with limited life-expectancy. This is the first report of utilization of this technique for the veteran population.

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“…[8][9][10][11] Moreover, more detailed decision algorithms have been suggested to decide whether more aggressive surgical resection is appropriate. 12,13 Therefore, recurrent spinal cord compression from loss of local control could be considered a shortcoming of the initial choice of surgical technique or approach. While it is thought that radical en bloc resections may reduce the incidence of loss of local control, 9 such interventions are associated with higher surgical risks.…”

Section: Introductionmentioning

confidence: 99%