Management – spinal metastases

Nater, Anick; Sahgal, Arjun; Fehlings, Michael G.

doi:10.1016/b978-0-12-811161-1.00016-5

Cited by 39 publications

(35 citation statements)

References 112 publications

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“…Current improvements in oncologic care will yield prolonged survival that demands recurrent considerations for instrumented stabilization and risks of revision [10]. Here we characterized the heterogeneous and complex clinical histories of patients with extended follow-up and determine that pseudarthrosis remains a prominent risk, as 27% were with radiographic evidence of lucency.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Rate and Clinical Impact of Pseudarthrosis in Spine Radiosurgery for Metastatic Spinal Disease

Zhang

Appelboom

Ratliff

et al. 2018

Cureus

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PurposePseudarthrosis within the spine tumor population is increased from perioperative radiation and complex stabilization for invasive and recurrent pathology. We report the radiographic and clinical rates of pseudarthrosis following multiple courses of instrumented fusion and perioperative stereotactic radiosurgery (SRS).MethodsWe performed a single institution review of 418 patients treated with non-isocentric SRS for spine between October 2002 and January 2013, identifying those with spinal instrumentation and greater than six months of follow-up. Surgical history, radiation planning, and radiographic outcomes were documented.ResultsEleven patients who met criteria for inclusion underwent 21 sessions of spinal SRS and 16 instrumented operations. Radiographic follow-up was 48.9 months; 3/11 (27%) were with radiographic hardware failure, and one (9%) separate case ultimately warranted externalization due to tumor recurrence. SRS was administered to treat progression of disease in 12/21 (57%) procedures, and residual lesions in 7/11 (64%) procedures. Following first and second SRS, 8/11 (73%) and 2/7 (29%) patients were with symptomatic improvement, respectively.ConclusionRisk of pseudarthrosis following SRS for patients with oncologic spinal lesions will become increasingly apparent with the optimized management of and survival from spinal pathologies. We highlight how the need for local control outpaces the risk of instrumentation failure.

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Section: Discussionmentioning

confidence: 99%

Radiographic Rate and Clinical Impact of Pseudarthrosis in Spine Radiosurgery for Metastatic Spinal Disease

Zhang

Appelboom

Ratliff

et al. 2018

Cureus

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“…( 15 ) graded the vascularity of the metastases, by visual evaluation of the intensity of tumor blush, as: no hypervascularity (equal to or less than adjacent vertebrae without tumor involvement), moderate hypervascularity, and pronounced hypervascularity. Lesions were assigned a vascularity grade ( 1 – 3 ) according to tumor blush in the study by Meng et al. ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…Cancers of various origins metastasize frequently to bone, and the spine is the most common location of bone metastases ( 1 , 2 ). To relieve pain, improve neurological function, and maintain spinal stability and local tumor control, surgical intervention is necessary for certain spinal metastases ( 1 , 3 , 4 ). However, such surgery carries a high risk of extreme intraoperative blood loss (IBL), especially for highly vascularized tumors ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

et al. 2021

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BackgroundThe role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial.MethodsA systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types.ResultsIn total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = −0.51, 95% confidence interval [CI]: −1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = −0.25, 95% CI: −1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = −0.93, 95% CI: −1.55 to −.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups.ConclusionsOnly tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.

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“…Owing to a worldwide increase in the incidence of cancer and a longer life expectancy of patients with metastatic cancer, the incidence of symptomatic vertebral metastases has risen [4]. Although surgical treatment of spinal metastases remains controversial, Tangpatanasombat et al reported that patients with spinal metastases benefit from palliative surgery, with significant pain relief and neurological recovery [5].…”

Section: Discussionmentioning

confidence: 99%

Successful Neurological Recovery with Multimodality Therapy without Surgery for Spinal Metastases from Advanced Gastric Cancer

Kinoshita

Kamoda

Ishii

et al. 2020

Case Reports in Orthopedics

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Advanced gastric cancer with bone metastasis has a very poor prognosis with short median survival. To the best of our knowledge, no reports in literature have described extensive recovery of paralysis with multimodality treatment without surgery in these cases. This report describes the case of a 52-year-old severely paralyzed female patient with spinal metastasis from advanced gastric cancer. She was inoperable, owing to a large thrombus in the inferior vena cava; alternative multimodality treatments, including chemotherapy and radiotherapy, were administered. The paralysis and the bladder and rectal dysfunction improved considerably. In addition, the performance status (PS) and Frankel grade also improved dramatically, from 4 to 1 and grade B to D, respectively. At 1 year after initiation of treatment, she is ambulatory. Patients with poor PS are often offered palliative therapy. However, this case demonstrates that poor PS solely due to paralysis from spinal metastasis may necessitate multimodality treatment instead of palliative care.

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Management – spinal metastases

Cited by 39 publications

References 112 publications

Radiographic Rate and Clinical Impact of Pseudarthrosis in Spine Radiosurgery for Metastatic Spinal Disease

Radiographic Rate and Clinical Impact of Pseudarthrosis in Spine Radiosurgery for Metastatic Spinal Disease

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

Successful Neurological Recovery with Multimodality Therapy without Surgery for Spinal Metastases from Advanced Gastric Cancer

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