Less invasive palliative surgery for spinal metastases

Kim, Chi Heon; Chung, Chun Kee; Sohn, Seil; Lee, Sungjoon; Park, Sung Bae

doi:10.1002/jso.23418

Cited by 47 publications

(26 citation statements)

References 27 publications

(66 reference statements)

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“…When considering whether to operate on patients with spine metastatic disease, one must balance the benefits of surgery (decreasing pain, preserving neurologic impairment, and prolonging survival) against the drawbacks (a prolonged hospital admission, chance of complications and reoperations, and potential premature death) . Many algorithms prognosticate survival for these patients, although one cannot predict individual survival times from these algorithms, and some are merely utilized for surgical planning .…”

Section: Introductionmentioning

confidence: 99%

The SORG nomogram accurately predicts 3‐ and 12‐months survival for operable spine metastatic disease: External validation

Pereira

McLaughlin

Janssen

et al. 2017

Journal of Surgical Oncology

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Section: Introductionmentioning

confidence: 99%

The SORG nomogram accurately predicts 3‐ and 12‐months survival for operable spine metastatic disease: External validation

Pereira

McLaughlin

Janssen

et al. 2017

Journal of Surgical Oncology

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“…Immobilization in bed can lead to complications, including orthostatic pneumonia, pressure sores, urinary tract infection, thromboembolism, and joint contractures. 14,15 The treatment of spinal metastases is usually palliative, aiming to provide pain relief, maintenance or recovery of neurological function, local durable tumor control, spinal stability, and improved quality of life, 7,35 although in rare cases, patients who present with isolated spinal metastases at an early stage may be treated with radical resection. The treatment for patients with spinal instability due to metastatic disease often involves nonoperative palliative care due to the serious prognosis associated with their condition.…”

Section: Discussionmentioning

confidence: 99%

“…The mean preoperative ODI score was 62.7 (range 40-84); the mean ODI scores obtained 3 days, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery were 35 (range 20-55), respectively. ODI significantly improved during the 45 days immediately after surgery (p < 0.001) ( Fig.…”

Section: Pain and Functional Outcomesmentioning

confidence: 96%

Postoperative quality-of-life assessment in patients with spine metastases treated with long-segment pedicle-screw fixation

Bernard¹,

Lemée²,

Lucas³

et al. 2017

SPI

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OBJECTIVEIn recent decades, progress in the medical management of cancer has been significant, resulting in considerable extension of survival for patients with metastatic disease. This has, in turn, led to increased attention to the optimal surgical management of bone lesions, including metastases to the spine. In addition, there has been a shift in focus toward improving quality of life and reducing hospital stay for these patients, and many minimally invasive techniques have been introduced with the aim of reducing the morbidity associated with more traditional open approaches. The goal of this study was to assess the efficacy of long-segment percutaneous pedicle screw stabilization for the treatment of instability associated with thoracolumbar spine metastases in neurologically intact patients.METHODSThis study was a retrospective review of data from a prospective database. The authors analyzed cases in which long-segment percutaneous pedicle screw fixation was performed for the palliative treatment of thoracolumbar spinal instability due to spinal metastases in neurologically intact patients. All of the patients included in the study underwent surgery between January 2014 and May 2015 at the authors' institution. Postoperative radiation therapy was planned within 10 days following the stabilization in all cases. Clinical and radiological follow-up assessments were planned for 3 days, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery. Outcome was assessed by means of standard postoperative evaluation and oncological and spinal quality of life measures (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 [EORTC QLQ-C30] and Oswestry Disability Index [ODI], respectively). Moreover, 5 patients were given an activity monitoring device for recording the distance walked daily; preoperative and postoperative daily distances were compared.RESULTSData from 17 cases were analyzed. There were no complications, and patients showed improvement in pain level and quality of life from the early postoperative period on. The mean ODI score was 62.7 (range 40–84) preoperatively, 35.4 (range 24–59) on postoperative Day 3, and 46.1 (range 30–76) at 3 weeks, 37.6 (range 25–59) at 6 weeks, 34.0 (range 24–59) at 3 months, 39.1 (range 22–64) at 6 months, and 30.0 (range 20–55) at 1 year after screw placement. The mean ODI was significantly improved in the first 45 days (p < 0.001). Improvement was also evident in scores for functional and symptomatic scales of the EORTC QLQ-C30. All patients underwent postoperative radiation therapy within 10 days (mean 7.5). All patients (n = 5) with an activity monitoring device showed improvement in daily walking distance.CONCLUSIONSLess-invasive palliative treatment for advanced spinal metastases is promising as part of a multidisciplinary approach to the care of patients with metastatic disease. The results of this study indicate that percutaneous surgery may allow for rapid improvement in quality of life and walking ability for patients with thoracolumbar instability due to spine metastases. Long-segment percutaneous screw fixation followed by early radiation therapy appears to be a safe and effective treatment option for providing solid and durable stability and improved quality of life for these patients.

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“…In patients with spinal metastasis, Kim et al7) reported on less invasive palliative surgery using percutaneous screw fixation with vertebroplasty in 16 patients. The pain intensity and functional status were significantly improved without evident cement leakage causing spinal cord compression.…”

Section: Discussionmentioning

confidence: 99%

Bone Cement-Augmented Percutaneous Screw Fixation for Malignant Spinal Metastases : Is It Feasible?

Kim

2017

J Korean Neurosurg Soc

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ObjectiveWe evaluated the validity of bone cement-augmented percutaneous screw fixation for treating malignant spinal metastases.MethodsBetween 2011 and 2015, 14 patients (eight men and six women) who underwent bone cement-augmented percutaneous screw fixation for malignant spinal metastases were enrolled in this study. Their life expectancy was considered to be more than one month and less than one year, based on the revised Tokuhashi scoring system. Clinical findings including the back pain scale score, functional outcome, procedure related complications, and survival were assessed preoperatively, postoperatively, and then six months after the procedure.ResultsTwelve of the patients (86%) survived up to six months after the procedure. Three required mini-open decompressive laminectomy for severe epidural compression. Bone cement-augmented percutaneous screw fixation was performed one level above, one level below, and at the pathologic level itself. The mean operation time was 60 minutes (45–180) and blood loss was less than 100 mL. Prior to surgery, the mean pain score on the visual analogue scale was 8.8, while one month after the procedure, it had reduced to 3.0; this improvement was maintained until the six-month assessment in the surviving patients. All patients were able to sit within the first two days after surgery, and no patient experienced neurological deterioration at the one-month follow up after the surgery. No patient experienced screw loosening during the six months of follow-up. Asymptomatic cement leakage into the epidural space was observed in two patients, but no major complications were observed.ConclusionFor selected patients with malignant spinal metastases, bone cement-augmented percutaneous screw fixation can provide significant pain relief and improve quality of life.

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Less invasive palliative surgery for spinal metastases

Abstract: Using a multidisciplinary approach, quality of life can be improved for fragile patients with spinal metastasis.

Cited by 47 publications

References 27 publications

The SORG nomogram accurately predicts 3‐ and 12‐months survival for operable spine metastatic disease: External validation

The SORG nomogram accurately predicts 3‐ and 12‐months survival for operable spine metastatic disease: External validation

Postoperative quality-of-life assessment in patients with spine metastases treated with long-segment pedicle-screw fixation

Bone Cement-Augmented Percutaneous Screw Fixation for Malignant Spinal Metastases : Is It Feasible?

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