Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Bourassa-Moreau, Étienne; Versteeg, Anne; Moskven, Eryck; Charest-Morin, Raphaële; Flexman, Alana M.; Ailon, Tamir; Dalkılıç, Türker; Fisher, Charles G.; Dea, Nicolas; Boyd, Michael; Paquette, Scott; Kwon, Brian K.; Dvorak, Marcel F.; Street, John

doi:10.1016/j.spinee.2019.08.012

Cited by 75 publications

(89 citation statements)

References 51 publications

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“…In case of disagreement, the two authors found an agreement by discussing their evaluations. 1, the 29 clinical studies included in this systematic review, can be divided into two groups of spinal diseases, 5 dealing with spinal tumors (primary or metastases) [28][29][30][31][32] and 24 dealing with other spine diseases, as adult spine deformity (ASD) [33][34][35][36][37][38][39], degenerative spine disease (DSD) [40][41][42], cervical deformity (CD) [43][44][45], lumbar spine diseases [46][47][48][49][50], diseases at different spine levels [51][52][53][54][55] [34][35][36]43], Spine Surgery Database of Adverse Events in 2009-2013 years [40], a multicenter database of 13 spine surgery centers across the USA in 2013-2018 years [44,45], Spinal center of a tertiary-care teaching hospital database in 2014-2017 years [50,56], Mount Sinai Electronic Scheduling system in 2013-2014 years [54] and not defined hospital database in which the research was carried in 2010-2015 [30], 2009-2016 [31], 2005-2015 [42], 2010-2013…”

Section: Assessment Of Methodological Qualitymentioning

confidence: 99%

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

et al. 2021

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Frailty is a condition characterized by a high vulnerability to low-power stressor. Frailty increases with age and is associated with higher complications and mortality. Several indexes have been used to quantify frailty. Spine diseases, both degenerative and oncologic, frequently require surgery which is related to complications and mortality. Aim of the present systematic review was to collect the most frequently used frailty indexes in clinics to predict surgical outcomes in patients affected by spine diseases, taking into account gender differences. Three databases were employed, and 29 retrospective clinical studies were included in this systematic review. The identified spine pathologies were primary and metastatic spine tumors, adult spine deformity (ASD), degenerative spine disease (DSD), cervical deformity (CD) and other pathologies that affected lumbar spine or multiple spine levels. Eleven indexes were identified: modified Frailty Index (mFI), Adult spinal deformity frailty index (ASD-FI), mFI-5, Metastatic Spinal Tumor Frailty Index (MSTFI), Fried criteria, Cervical deformity frailty index (CD-FI), Spinal tumor frailty index (STFI), Frailty Phenotype criteria (FP), Frailty Index (FI), FRAIL scale and Modified CD-FI (mCD-FI). All these indexes correlated well with minor and major postoperative complications, mortality and length of stay in hospital. Results on gender differences and frailty are still conflicting, although few studies show that women are more likely to develop frailty and more complications in the post-operative period than men. This systematic review could help the surgeon in the adoption of frailty indexes, before the operation, and in preventing complications in frail patients.

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Section: Assessment Of Methodological Qualitymentioning

confidence: 99%

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

et al. 2021

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“…For these patients, promoting recovery after surgery and returning to oncological treatment are major objectives. Various forms of MIT have been developed for the management of MST, including cement augmentation techniques, radiofrequency ablation (RFA), percutaneous cryoablation, and implantation of radiant seeds (5,29,38).…”

Section: Minimally Invasive Therapymentioning

confidence: 99%

Clinical Therapy of Metastatic Spinal Tumors

Wei

et al. 2021

Front. Surg.

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Metastatic spinal tumors (MST) have high rates of morbidity and mortality. MST can destroy the vertebral body or compress the nerve roots, resulting in an increased risk of pathological fractures and intractable pain. Here, we elaborately reviewed the currently available therapeutic options for MST according to the following four aspects: surgical management, minimally invasive therapy (MIT), radiation therapy, and systemic therapy. In particular, these aspects were classified and introduced to show their developmental process, clinical effects, advantages, and current limitations. Furthermore, with the improvement of treatment concepts and techniques, we discovered the prevalent trend toward the use of radiation therapy and MIT in clinic therapies. Finally, the future directions of these treatment options were discussed. We hoped that along with future advances and study will lead to the improvement of living standard and present status of treatment in patients with MST.

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“…Dual-energy X-ray absorptiometry (QDR 1000; Hologic) was used to measure BMD of the lumbar spine (L1-L4) in the posteroanterior projection, with the results expressed as the % young adult mean (YAM). To assess the degree of sarcopenia, the sum of the left and right psoas area on the axial image in the middle of the L3 vertebral body divided by the area of the L3 vertebral body was calculated using a Picture Archiving and Communication System [7]. All measurements were performed in triplicate by each of two observers blinded to data related to surgery, and the average value was used.…”

Section: Outcomes and Radiological Measurementsmentioning

confidence: 99%

Differences in clinical and imaging features of low lumbar osteoporotic vertebral collapse in patients with or without Parkinson’s disease: Rapid destructive progression and appearance of a cauda equina sign in Parkinson’s disease patients

Nakajima¹,

Kubota²,

Watanabe³

et al. 2020

Preprint

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BackgroundOsteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common with aging of society. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD) and a higher mechanical failure rate, compared with those with thoracolumbar junction collapse. The aim of this study was to identify differences in clinical and imaging features, and in outcomes of low lumbar OVC with or without PD and to discuss the appropriate treatment for lower lumbar OVC in patients with PD.MethodsThe subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. Clinical symptoms, morphological features of affected vertebrae, neurological status, surgical procedures, and complications were compared in patients with and without PD.ResultsThe main clinical symptoms were radicular leg pain in non-PD cases (68.8%) and a cauda equina sign in PD cases (72.7%). Rapid progression and destructive changes of OVC were seen in patients with PD at 24.5 ± 10.5 days after injury. The morphological features of OVC were flat-type in non-PD cases with old compression fracture at the thoracolumbar lesion, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar YAM, and severe sarcopenia, all of which can affect postoperative instrumentation-related complications. High postoperative complication rates may be due to vertebral fragility and longer fusion surgery. ConclusionsRapid progression and destructive changes of low lumbar OVC may occur in PD patients, and significantly more PD cases have a cauda equina sign and require urgent surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure, especially at an upper adjacent level. Given the progression of PD after surgery, invasive long-fusion surgery should be avoided for single low lumbar OVC. A surgical strategy considering the severities of PD and osteoporosis, and aggressive control of PD before and after surgery are important to prevent complications.

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Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Cited by 75 publications

References 51 publications

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

Clinical Therapy of Metastatic Spinal Tumors

Differences in clinical and imaging features of low lumbar osteoporotic vertebral collapse in patients with or without Parkinson’s disease: Rapid destructive progression and appearance of a cauda equina sign in Parkinson’s disease patients

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