Surgical results of metastatic spinal cord compression (MSCC) from non–small cell lung cancer (NSCLC): analysis of functional outcome, survival time, and complication

Park, Se-Jun; Lee, Chong-Suh; Chung, Sung-Soo

doi:10.1016/j.spinee.2015.11.005

Cited by 75 publications

(80 citation statements)

References 26 publications

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“…22 We found that 8 studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. 4,13,16,20,[29][30][31]33 However, we did not find any evidence of a surgical decision-making tool that uses postoperative ambulation as an outcome following decompression surgery for spinal metastases. Future studies are warranted to develop evidence-based decisionmaking tools that use postoperative ambulatory status as an outcome.…”

Section: Predictors Of Ambulatory Status/motor Functioncontrasting

confidence: 64%

“…2,3,5,7,15,18,19,21,25,28,[30][31][32]34,35,37,38,40,43 Of these, 16 studies were retrospective; 1 was a longitudinal observational study; 1 was a randomized, multiinstitutional, nonblinded trial; and 1 was a semiprospective study that included both retrospectively and prospectively collected data. Surgical interventions included decompression with and without instrumentation and radiotherapy.…”

Section: Predictors Of Survivalmentioning

confidence: 99%

“…Padalkar et al 28 studied 102 patients and found that metastases to internal organs (p < 0.001) and increased number of extraspinal bony metastases (p < 0.01) were significantly associated with worse odds of survival. In a longitudinal observational study, Park et al 31 used a multivariable analysis to find that time to neurological deficit (risk ratio [RR] 2.28, p = 0.02), postoperative chemotherapy (RR 6.58, p < 0.001), and postoperative Eastern Cooperative Oncology Group (ECOG) performance status (RR 2.73, p = 0.04) were independent predictors of increased survival time. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival.…”

Section: Predictors Of Survivalmentioning

confidence: 99%

“…1,3,4,13,[16][17][18][19][20]22,[29][30][31]33,38,39 Fifteen studies were retrospective, and one was a longitudinal observational study. Eleven studies 1,3,4,18,20,22,[29][30][31]33,39 reported outcomes following surgery alone, and 5 studies 13,16,17,19,38 reported the effects of decompression surgery with radiotherapy. Primary tumor sites included lung (15 studies), breast (13 studies), prostate (12 studies), gastrointestinal (8 studies), and renal (4 studies).…”

Section: Predictors Of Ambulatory Status or Motor Functionmentioning

confidence: 99%

“…4,13,16,20,[29][30][31]33 Chaichana et al 4 reported that preoperative ability to walk (RR 2.3 [95% CI 1.3-4.4], p < 0.01) was a positive predictor of postoperative ambulatory status, whereas pathological compression fracture of the vertebral body (RR 0.5 [95% CI 0.2-0.9], p < 0.01) was a negative predictor of postoperative ambulatory status. 4 Kondo et al 16 found that visceral metastases to vital organs (p < 0.01), primary renal tumors (p = 0.04), severe preoperative paralysis (p < 0.0001), and poor preoperative performance status (p < 0.0001) were significant negative predictors of postoperative ambulatory status among patients who received intraoperative radiotherapy combined with posterior decompression and stabilization.…”

Section: Predictors Of Ambulatory Status or Motor Functionmentioning

confidence: 99%

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Decompression surgery for spinal metastases: a systematic review

Bakar

Tanenbaum

Phan

et al. 2016

FOC

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OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that the type of treatment was not significantly associated with the rate of local control. The most commonly reported primary tumor types included lung cancer, prostate cancer, breast cancer, renal cancer, and gastrointestinal cancer. CONCLUSIONS This study reports a systematic review of the literature on decompression surgery for spinal metastases. The results of this study can help educate surgeons on the previously published predictors of outcomes following decompression surgery for metastatic spinal disease. However, the authors also identify significant gaps in the literature and the need for future studies investigating the optimal practice with regard to decompression surgery for spinal metastases.

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Section: Predictors Of Ambulatory Status/motor Functioncontrasting

confidence: 64%

Section: Predictors Of Survivalmentioning

confidence: 99%

Section: Predictors Of Survivalmentioning

confidence: 99%

Section: Predictors Of Ambulatory Status or Motor Functionmentioning

confidence: 99%

Section: Predictors Of Ambulatory Status or Motor Functionmentioning

confidence: 99%

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Decompression surgery for spinal metastases: a systematic review

Bakar

Tanenbaum

Phan

et al. 2016

FOC

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Ambulatory status after surgical and nonsurgical treatment for spinal metastasis

Schoenfeld

Losina

Ferrone

et al. 2019

Cancer

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Background Decisions for operative or nonoperative management remain challenging for patients with spinal metastases, especially when life expectancy and quality of life are not easily predicted. This study evaluated the effects of operative and nonoperative management on maintenance of ambulatory function and survival for patients treated for spinal metastases. Methods Propensity matching was used to yield an analytic sample in which operatively and nonoperatively treated patients were similar with respect to key baseline covariates. The study included patients treated for spinal metastases between 2005 and 2017 who were 40 to 80 years old, were independent ambulators at presentation, and had fewer than 5 medical comorbidities. It evaluated the influence of operative care and nonoperative care on ambulatory function 6 months after presentation as the primary outcome. Survival at 6 months and survival at 1 year were secondary outcomes. Results Nine hundred twenty‐nine individuals eligible for inclusion were identified, with 402 (201 operative patients and 201 nonoperative patients) retained after propensity score matching. Patients treated operatively had a lower likelihood than those treated nonoperatively of being nonambulatory 6 months after presentation (3% vs 16%; relative risk [RR], 0.16; 95% confidence interval [CI], 0.06‐0.46) as well as a reduced risk of 6‐month mortality (20% vs 29%; RR, 0.69; 95% CI, 0.49‐0.98). Conclusions These results indicate that in a group of patients with similar demographic and clinical characteristics, those treated operatively were less likely to lose ambulatory function 6 months after presentation than those managed nonoperatively. For patients with spinal metastases, our data can be incorporated into discussions about the treatments that align best with patients’ preferences regarding surgical risk, mortality, and ambulatory status.

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Classification and Radiological Assessment of CVJ Tumors

Freyschlag

Thomé

2019

Surgery of the Cranio-Vertebral Junction

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Surgical results of metastatic spinal cord compression (MSCC) from non–small cell lung cancer (NSCLC): analysis of functional outcome, survival time, and complication

Cited by 75 publications

References 26 publications

Decompression surgery for spinal metastases: a systematic review

Decompression surgery for spinal metastases: a systematic review

Ambulatory status after surgical and nonsurgical treatment for spinal metastasis

Classification and Radiological Assessment of CVJ Tumors

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