Surgical outcomes and risk factors for poor outcomes in patients with cervical spine metastasis: a prospective study

Kanda, Yutaro; Kakutani, Kenichiro; Sakai, Yoshitada; Zhang, Zhongying; Yurube, Takashi; Miyazaki, Shingo; Kakiuchi, Yuji; Takeoka, Yoshiki; Tsujimoto, Ryu; Miyazaki, Kunihiko; Ohnishi, Hiroki; Hoshino, Yuichi; Takada, Toru; Kuroda, Ryosuke

doi:10.1186/s13018-021-02562-8

Cited by 8 publications

(10 citation statements)

References 28 publications

(53 reference statements)

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“…Spinal cord decompression via tumor laminectomy renders the affected segments of the spine less stable, promoting sagittal malalignment such as post-laminectomy kyphosis that is associated not only with pain, but also with neurological deterioration. This particularly holds true for junctional segments, where often not only posterior, but also anterior column stabilization may be warranted [24,25].…”

Section: Instrumentation For Spinal Stabilization In Patients With Ac...mentioning

confidence: 99%

Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome

Meyer

Wagner

Raufer

et al. 2022

Cancers

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Background: Patients with metastatic spinal cord compression (MSCC) may experience long-term functional impairment. It has been established that surgical decompression improves neurological outcomes, but the effect of early surgery remains uncertain. Our objective was to evaluate the impact of early versus late surgery for acute MSCC due to spinal metastases (SM). Methods: We retrospectively reviewed a consecutive cohort of all patients undergoing surgery for SMs at our institution. We determined the prevalence of acute MSCC; the time between acute neurological deterioration as well as between admission and surgery (standard procedure: decompression and instrumentation); and neurological impairment graded by the ASIA scale upon presentation and discharge. Results: We screened 693 patients with surgery for spinal metastasis; 140 patients (21.7%) had acute MSCC, defined as neurological impairment corresponding to ASIA grade D or lower, acquired within 72 h before admission. Non-MSCC patients had surgery for SM-related cauda equina syndrome, radiculopathy and/or spinal instability. Most common locations of the SM in acute MSCC were the thoracic (77.9%) and cervical (10.7%) spine. Per standard of care, acute MSCC patients underwent surgery including decompression and instrumentation, and the median time from admission to surgery was 16 h (interquartile range 10–22 h). Within the group of patients with acute MSCC, those who underwent early surgery (i.e., before the median 16 h) had a significantly higher rate of ASIA improvement by at least one grade at discharge (26.5%) compared to those who had late surgery after 16 h (10.1%; p = 0.024). Except for a significantly higher sepsis rate in the late surgery group, complication rates did not differ between the late and early surgery subgroups. Conclusions: We report data on the largest cohort of patients with MSCC to date. Early surgery is pivotal in acute MSCC, substantially increasing the chance for neurological improvement without increasing complication rates. We found no significant impact when surgery was performed later than 24 h after admission. These findings will provide the framework for a much-needed prospective study. Until then, the treatment strategy should entail the earliest possible surgical intervention.

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Section: Instrumentation For Spinal Stabilization In Patients With Ac...mentioning

confidence: 99%

Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome

Meyer

Wagner

Raufer

et al. 2022

Cancers

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“…The CTJ is a biomechanically challenging region for spinal surgery and one of the major risk factors for poor surgical outcomes in MCSTs [ 8 , 10 - 13 ]. Interestingly, although the 5.5-mm rod group had significantly more lesions located at the CTJ—a region more unstable than C3–6—with a higher mean SINS than the 3.5-mm rod group, the postoperative collapse rate was significantly lower in the 5.5-mm rod group than in the 3.5-mm rod group [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The cervicothoracic junction (CTJ), where approximately 10% of all spinal metastases occur, is the most challenging anatomical transitional area for treating spinal pathologies [ 8 , 10 - 13 ]. Although controversial, the consensus of surgical treatment has consistently improved biomechanical stability [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Cervical Pedicle Screw Is Enhanced When Used With 5.5-mm Rods for Metastatic Cervical Spinal Tumor Surgery

Park,

Lee,

Lee

et al. 2024

Neurospine

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Objective: The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5-mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5-mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5-mm rods.Methods: This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses.Results: Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5-mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5-mm rod group. Neck pain reduction was significantly better in the 5.5-mm rod group.Conclusion: CPS with 5.5-mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5-mm rods to enhance surgical outcomes.

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“…As an advanced stage of cancer, metastatic spinal disease is often characterized by severe back pain, infection, neurological sequelae, and ambulatory disability (8), which are particularly challenging for surgeons. Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Quality of Life and Mental Health Status Among Cancer Patients With Metastatic Spinal Disease

Liu

Cao

Shi

et al. 2022

Front. Public Health

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This study aimed to investigate the quality of life and mental health status and further to identify relevant risk factors among advanced cancer patients with spine metastases. This study prospectively included and analyzed 103 advanced cancer patients with spine metastases. Patient's basic information, lifestyles, comorbidities, tumor characteristics, therapeutic strategies, economic conditions, quality of life, anxiety, and depression were collected. Patient's quality of life was assessed using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Subgroup analysis was performed based on different age groups, and a multivariate analysis was performed to test the ability of 20 potential risk factors to predict quality of life, anxiety, and depression. The mean total FACT-G score was only 61.38 ± 21.26. Of all included patients, 52.43% had skeptical or identified anxiety and 53.40% suffered from skeptical or identified depression. Patients had an age of 60 or more and <70 years had the lowest FACT-G score (54.91 ± 19.22), highest HADS anxiety score (10.25 ± 4.22), and highest HADS depression score (10.13 ± 4.94). After adjusting all other potential risk factors, age was still significantly associated with quality of life (OR = 0.57, 95%CI: 0.38–0.86, p < 0.01) and depression (OR = 1.55, 95%CI: 1.00–2.42, p = 0.05) and almost significantly associated with anxiety (OR = 1.52, 95%CI: 0.94–2.43, p = 0.08). Besides, preference to eating vegetables, time since knowing cancer diagnosis, surgical treatment at primary cancer, hormone endocrine therapy, and economic burden due to cancer treatments were found to be significantly associated with the quality of life. A number of comorbidities and economic burden due to cancer treatments were significantly associated with anxiety. Advanced cancer patients with spine metastases suffer from poor quality of life and severe anxiety and depression, especially among patients with an age of 60 or more and <70 years. Early mental health care and effective measures should be conducted to advanced cancer patients with spine metastases, and more attention should be paid to take care of patients with an age of 60 or more and <70 years in terms of their quality of life and mental health status.

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Surgical outcomes and risk factors for poor outcomes in patients with cervical spine metastasis: a prospective study

Cited by 8 publications

References 28 publications

Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome

Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome

The Efficacy of Cervical Pedicle Screw Is Enhanced When Used With 5.5-mm Rods for Metastatic Cervical Spinal Tumor Surgery

Quality of Life and Mental Health Status Among Cancer Patients With Metastatic Spinal Disease

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