Outcome of excisional surgeries for the patients with spinal metastases

Li, Haomiao; Gasbarrini, A.; Cappuccio, Michele; Terzi, Silvia; Paderni, S; Mirabile, L.; Boriani, Stefano

doi:10.1007/s00586-009-1111-9

Cited by 46 publications

(40 citation statements)

References 20 publications

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“…Due to the large difference in the number of patients in our series who underwent the various surgical approaches [posterior (n = 105) vs. anterior (n = 3) vs. combined (n = 13)], we were not able to perform any meaningful statistics to make comparisons with our outcome variables. However, Li et al [19] showed that en bloc surgery (n = 32) could achieve a lower local recurrence rate than the debulking surgery (n = 99), but with similar survival, neurological salvage, and incidence of complications.…”

Section: Discussionmentioning

confidence: 99%

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

et al. 2012

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Purpose Metastatic spinal cord compression (MSCC) requires expeditious treatment. While there is no ambiguity in the literature about the urgency of care for patients with MSCC, the effect of timing of surgical intervention has not been investigated in detail. The objective of our study was to investigate whether or not the 'timing of surgery' is an important factor in survival and neurological outcome in patients with MSCC. Methods All patients with MSCC presenting to our unit from October 2005 to March 2010 were included in this study. Patients were divided into three groups-those who underwent surgery within 24 h (Group 1, n = 45), between 24 and 48 h (Group 2, n = 23) and after 48 h (Group 3, n = 53) from acute presentation of neurological symptoms. The outcome measures studied were neurological outcome (change in Frankel grade post-operatively), survival (survival rate and median survival in days), incidence of infection, length of stay and complications. Results Patients' age, gender, revised Tokuhashi score, level of spinal metastasis and primary tumour type were not significantly different between the three groups. Greatest improvement in neurology was observed in Group 1, although not significantly when compared against Group 2 (24-48 h; (p = 0.09). When comparisons of neurological outcome were performed for all patients having surgery within 48 h (Groups 1 and 2) versus after 48 h (Group 3), the Frankel grade improvement was significant (p = 0.048) favouring surgery within 48 h of presentation. There was a negative correlation (-0.17) between the delay in surgery and the immediate neurological improvement, suggesting less improvement in those who had delayed surgery. There was no difference in length of hospital stay, incidence of infection, post-operative complications or survival between the groups. Conclusions Our results show that surgery should be performed sooner rather than later. Furthermore, earlier surgical treatment within 48 h in patients with MSCC resulted in significantly better neurological outcome. However, the timing of surgery did not influence length of hospital stay, complication rate or patient survival.

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Section: Discussionmentioning

confidence: 99%

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

et al. 2012

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“…However, en bloc surgical resections are technically demanding, are associated with higher complication rates, and do not necessarily increase OS in patients with MSCC 1,3,4,13,18) . Our patients underwent palliative tumor removal using either posterior or 360° surgery, because all patients had Tokuhashi scores ranging from 0 to 11 were candidates for palliative surgery 18) .…”

Section: Comparison Of Surgical Methodsmentioning

confidence: 99%

Efficacy of Decompression and Fixation for Metastatic Spinal Cord Compression: Analysis of Factors Prognostic for Survival and Postoperative Ambulation

Park

Rhim

Jeon

2011

J Korean Neurosurg Soc

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We evaluated 103 consecutive patients (64 men, 39 women; mean age, 54.6 years; range, 25-75 years) with MSCC who presented with lower extremity weakness, with or without back pain, and underwent surgery between January 2001 and December 2008. The mean follow-up duration was 25.8 months (range, 1 to 129 months). Patients were classified by sex, primary tumor site, metastatic site, surgical level, Tokuhashi score, postoperative radiation therapy, postoperative chemotherapy, pre-and post-operative ambulation status, preoperative motor INTRODUCTIONMetastatic spinal cord compression (MSCC) eventually affects 5-10% of patients with cancer, and spinal instrumentation with direct decompressive surgery has become the standard treatment for metastatic lesions 1,2,5,7,9,17) . The goals of surgical intervention are to prolong patient survival and improve quality of life 4) . Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients 8,12,14,18,21,28) . Thus, proper patient selection and careful surgical planning are prerequisites for low complication rates, acceptable function, and improved overall prognosis 15,18) . Although technically demanding, en bloc surgical resections reduce the risk of tumor recurrence; however, they do not neces- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaObjective : The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. Methods : We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo-or radiation therapy, were analyzed retrospectively. Results : Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) (p=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; p=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; p=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; p=0.038) were prognostic of postoperative ambulation. Conclusion : We found that postoperative ambulation and preopera...

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“…That means en bloc resection would reduce the morbidity associated with local recurrence and revision surgery compared with curettage. However, the two procedures resulted in a similar survival outcome, neurological salvage, and incidence of complications [9]. Moreover, total spondylectomy is a procedure with strict principles that are difficult to fully achieve.…”

Section: Discussionmentioning

confidence: 98%

“…Therefore, we recommend preoperative embolization for every patient if possible. Surgical treatment of thyroid cancer has been found to be important and effective in several recent studies [2,3,5,8,9]. Operations for patients with thyroid cancer spinal metastases should be more aggressive, which is in contrast to more traditional opinions in the field.…”

Section: Discussionmentioning

confidence: 99%

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

Zhang

Yin

et al. 2012

Eur Spine J

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Purpose The aim of this study was to discuss the clinical presentation, imaging findings, treatments received, and outcome of therapies for patients with epidural spinal cord compression caused by thyroid spinal metastases, with the goal of emphasizing the importance of surgery in this setting and discussing therapeutic plan for treating these patients. Methods A total of 22 patients with spinal cord compression due to thyroid tumor spinal metastases who received surgery in our department were identified from 2004 to 2011. The series of 22 patients collected from our institution over the past 7 years was used to discuss treatment options for thyroid cancer spinal metastases on the basis of literature review and our own extensive experience. Results The mean age of the patients in this study was 57 years (range 37-78 years). The duration of the preoperative symptoms was 1-24 months, with an average of approximately 6 months. All patients attained improvement of at least one level of the Frankel classification after surgery. Two patients received more than one operation at our institution. Two patients died during follow-up, two patients had stable disease, and all other patients maintained a disease-free status during follow-up.Conclusions As thyroid tumor spinal metastases have a favorable prognosis, a radical therapeutic attitude should be considered in decision-making. Dorsal spinal decompression through curettage and stabilization can preserve or restore neurological function for most patients. For patients who have more than one metastatic lesion of the spine, surgeries can be sequentially performed based on the urgency of the case. In addition to treatment of primary disease, surgery and bisphosphonate treatment are the most important therapies for these patients.

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Outcome of excisional surgeries for the patients with spinal metastases

Cited by 46 publications

References 20 publications

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

Efficacy of Decompression and Fixation for Metastatic Spinal Cord Compression: Analysis of Factors Prognostic for Survival and Postoperative Ambulation

Surgery and survival outcomes of 22 patients with epidural spinal cord compression caused by thyroid tumor spinal metastases

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