Surgical Management of Symptomatic Spinal Metastases

Weigel, B.; Maghsudi, M.; Neumann, Claudia; Kretschmer, Robert; Müller, Franz; Nerlich, Michael

doi:10.1097/00007632-199911010-00012

Cited by 235 publications

(169 citation statements)

References 28 publications

Supporting

Mentioning

137

Contrasting

Unclassified

Order By: Relevance

“…Treatment of metastatic spinal lesions with vertebrectomy and stabilization has been shown to provide significant and sustained improvement in pain control (Table 8) [4,5,20,24,25,35,37,47,50,52]. Similar pain relief was achieved in our series, as evidenced by decreases in VAS and pain medication scale scores that lasted for at least 1 year.…”

Section: Indications For Surgerysupporting

confidence: 72%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

View full text Add to dashboard Cite

Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre-and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory.Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

show abstract

Section: Indications For Surgerysupporting

confidence: 72%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

View full text Add to dashboard Cite

show abstract

“…9,10,18 However, many differences in survival times were seen according to anatomic site of the primary carcinoma. Survival times after surgery were longest for the bone marrow, thyroid, and prostate.…”

Section: Discussionmentioning

confidence: 99%

“…Several series reporting pain-related outcomes have shown improvement ranging from 68% 21 to 90%, 2,10,19 as well as functional and neurologic improvement in 67% 22 and 100% 7 of patients. These rates of pain relief and neurologic improvement were similar to those in the current series.…”

Section: Discussionmentioning

confidence: 99%

“…10,22 Hosono et al 23 reported 22 local recurrences in 84 patients who had been managed with an anterior procedure. The risk of local recurrence increased with the duration of survival.…”

Section: Discussionmentioning

confidence: 99%

“…14 However, to our knowledge, most studies have dealt only with survival and postoperative neurologic status immediately after surgical treatment, with very few reports addressing long-term QOL after surgery for spinal metastases. 10,11 We believe that the overall preservation of QOL after surgery is even more important than postoperative improvement of QOL.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical outcome and survival after palliative surgery for spinal metastases

Hirabayashi

Ebara

Kinoshita

et al. 2003

Cancer

161

103

View full text Add to dashboard Cite

BACKGROUNDThe authors sought to identify treatment‐related factors that influenced survival after surgical treatment for metastatic spinal tumors and to evaluate the relationship between survival and postoperative ambulation time as a factor related to quality of life.METHODSThe medical records of 81 patients with metastatic spinal tumors who underwent palliative surgery at the study institution were assessed. Univariate analysis for factors influencing survival used the Kaplan–Meier log rank statistic and multivariate analysis used the Cox proportional hazards model. The Spearman correlation test was used to analyze the relationship between postoperative ambulation and survival time.RESULTSThe patients had a median age of 59.9 years and a median survival of 10.6 months after surgery. For patients, postoperative ambulatory median survival was 16.5 months and median ambulation time was 13.8 months. By univariate analysis, anatomic site of the primary tumor, postoperative ambulation, and combined adjuvant therapy (chemotherapy plus radiotherapy) were associated with prolonged survival (P < 0.05). Multivariate analysis identified primary site and postoperative ambulatory function as independent predictors of prolonged survival (P < 0.0001). Significant correlations were found between ambulation time and survival time of patients who were able to walk after surgery (P < 0.0001), even in patients with liver (P < 0.05) or lung carcinoma (P < 0.05).CONCLUSIONSThe anatomic site of primary carcinoma and postoperative ambulation were associated with longer survival after palliative surgery for metastatic spinal tumor. When ambulation is attained after surgery, it can be preserved until late in remaining life even when the primary tumor is unfavorable. Palliative surgery for spinal metastasis can improve the quality and quantity of life. Cancer 2003;97:476–84. © 2003 American Cancer Society.DOI 10.1002/cncr.11039

show abstract