Strategy for the treatment of patients with spinal neoplasms

Kluger, P.; Korge, Andreas; Scharf, Hanns‐Peter

doi:10.1038/sj.sc.3100413

Cited by 20 publications

(6 citation statements)

References 14 publications

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“…Reasons are the general opinion that extensive rehabilitative efforts may either not be tolerated by the terminally ill patient or be futile because of the limited life span. While there are several studies that report the outcome of primary treatment and recommend an aggressive approach, [3][4][5][6][7][8] there is only limited information about postacute management. 20 consecutive patients confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

“…However, we expect that a combination of both functional and oncological parameters will give the best survival prognosis. Patients with metastatic disease of the spine are subject to extensive surgery, [3][4][5][6][7][8] sophisticated chemotherapy 11,12 or radiation protocols. 9,10 Consequently, SCI -once it is evident that neurological symptoms will not regressshould not be answered with rehabilitative nihilism.…”

Section: Discussionmentioning

confidence: 99%

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Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Parsch

Mikut²,

Abel

2003

Spinal Cord

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Study design: Retrospective study utilising clinical records and public administration databases. Objectives: This study was performed to analyse the clinical presentation and survival rate of individuals with spinal cord injury (SCI) due to spinal metastasis after primary treatment, and to evaluate the efficacy of rehabilitative efforts. Setting: Spinal Cord Injury Unit, University Hospital, Heidelberg. Methods: A total of 68 consecutive patients were included. Demographics, clinical data, tumour type, level and completeness of SCI, initial treatment, functional independence measure (FIM) and survival time were derived from hospital and public administration databases. Cox regression and fuzzy logic rule generation were used for statistical analysis. Results: Of the 68 patients, 66 patients died 11 months (median, interquartile range (IQR) 4-29 months) after the onset of neurological symptoms at an average age of 58 years. The functional independence measure (FIM) score describing the general clinical and functional status proved to be the most reliable prognostic factor of survival. Other more specific parameters (eg tumour type or level of lesion) did not have such an impact. In total, 51 patients completed the rehabilitation programme within 50 days (median, IQR 27-99 days). The FIM score improved from 62 at admission to 84 at discharge. Conclusion:The clinical and functional status is a valuable prognostic factor for survival. Since institutionalised rehabilitative efforts are effective, this group of patients should be accepted into such a program.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Parsch

Mikut²,

Abel

2003

Spinal Cord

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“…No surgery in group 1 with a very limited life expectancy, a dorsal approach in group 2, and a dorsoventral approach in group 3. 40,41 The revisions performed by Tokuhashi (written communication, June 2004) do not change the results of this study. However, a prospective study will ultimately determine the true value of this score.…”

Section: Discussionmentioning

confidence: 45%

The Tokuhashi Score: Significant Predictive Value for the Life Expectancy of Patients With Breast Cancer With Spinal Metastases

Ulmar¹,

Richter²,

Cakir³

et al. 2005

Spine

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Study Design. Retrospective study of 55 consecutive patients with spinal metastases secondary to breast cancer who underwent surgery.Objective. To evaluate the predictive value of the Tokuhashi score for life expectancy in patients with breast cancer with spinal metastases.Summary of Background Data. The score, composed of 6 parameters each rated from 0 to 2, has been proposed by Tokuhashi and colleagues for the prognostic assessment of patients with spinal metastases.Methods. A total of 55 patients surgically treated for vertebral metastases secondary to breast cancer were studied. The score was calculated for each patient and, according to Tokuhashi, the patients were divided into 3 groups with different life expectancy according to their total number of scoring points. In a second step, the grouping for prognosis was modified to get a better correlation of the predicted and definitive survival.Results. Applying the Tokuhashi score for the estimation of life expectancy of patients with breast cancer with vertebral metastases provided very reliable results. However, the original analysis by Tokuhashi showed a limited correlation between predicted and real survival for each prognostic group. Therefore, our patients were divided into modified prognostic groups regarding their total number of scoring points, leading to a higher significance of the predicted prognosis in each group (P Ͻ 0.0001), and a better correlation of the predicted and real survival.Conclusion. The modified Tokuhashi score assists in decision making based on reliable estimators of life expectancy in patients with spinal metastases secondary to breast cancer.

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“…Other authors have reported that up to 81% of patients with spinal neoplasm experienced neurological improvement following surgery combining anterior-posterior approaches (33,34). The prognosis for neurological recovery is adversely affected by the degree and duration of canal narrowing, demonstrating that patients may benefit from earlier decompression regardless of the selected surgical procedure (35).…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the surgical treatment results for multiple myeloma bone disease of the spine and the long bone/soft tissue

Shen

Ling-xiu

et al. 2018

Oncol Lett

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Abstract. The present retrospective study was designed to compare the pain relief, surgery duration, life quality, survival time and relative prognostic factors in multiple myeloma (MM) bone disease patients with different surgical sites. A total of 65 cases were enrolled and divided into two groups. Group A included patients with lesions located in the spine, while Group B included patients with lesions located in the long bone or soft tissue. Pain relief was measured by the visual analogue scale (VAS), neurological impairment was determined according to Frankel classification, and survival was assessed by the Kaplan-Meier method. Cox regression analysis was also used to estimate the effect of factors on the prediction of survival. The hospitalization time, preoperative duration of symptoms, method of surgery, complications, recurrence and survival time were evaluated and compared retrospectively. Pain relief and improvement of life quality were observed in all the patients in groups A and B. No significant differences were detected for the majority of parameters compared between groups A and B, with the exception of the surgery duration, as well as the postoperative VAS score at 1 and 6 months after surgery. The multivariate Cox regression analysis revealed several risk factors significantly associated with survival, including the preoperative VAS score, postoperative chemotherapy, prothrombin time activity (PTA), albumin, lactate dehydrogenase and urine protein level. In conclusion, surgical treatment was an effective therapeutic method in patients with MM. Postoperative analgesic use should be individualized according to the different surgical sites and postoperative periods. Furthermore, preoperative pain, PTA, albumin, urine protein level and postoperative chemotherapy are associated with prognosis.

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Strategy for the treatment of patients with spinal neoplasms

Cited by 20 publications

References 14 publications

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation

The Tokuhashi Score: Significant Predictive Value for the Life Expectancy of Patients With Breast Cancer With Spinal Metastases

Comparative analysis of the surgical treatment results for multiple myeloma bone disease of the spine and the long bone/soft tissue

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