The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases

Cofano, Fabio; Perna, Giuseppe Di; Zenga, Francesco; Ducati, Alessandro; Baldassarre, Bianca Maria; Ajello, Marco; Marengo, Nicola; Ceroni, Luca; Lanotte, Michele; Garbossa, Diego

doi:10.1016/j.clineuro.2020.105896

Cited by 20 publications

(13 citation statements)

References 30 publications

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“…According to these new concepts, MESCC treatment should need could not ignore anymore the need for a multidisciplinary management involving spine surgeons, radiation oncologists and oncologists [16] , [26] , [27] , [28] , [29] . The aim of this review is to describe the State of the Art about the concept of SS in its surgical and clinical aspects, while examining the medical evidence published on this topic.…”

Section: Introductionmentioning

confidence: 99%

“…The only limit of SRS is represented by the need to create a safe distance between the tumor and the spinal cord, which is indeed the aim of SS in high grade ESCC [16] , [22] , [47] , [48] , [49] , [50] . Recently, Cofano et al proposed the Neurologic Stability Epidural compression (NSE) score with the aim to translate all these concepts in a practical score evaluating the need for surgery in patients with MESCC, according to the latest evidence and assessing ASA, performance status, neurological status, spine stability and ESCC [28] . In the setting of a more comprehensive approach with SRS as a new and relevant treatment option, SS has carved out a key role in MESCC treatment, creating the adequate conditions for radiations [2] , [6] , [7] , [12] , [20] , [22] , [26] .…”

Section: Introductionmentioning

confidence: 99%

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Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Perna

Cofano

Mantovani

et al. 2020

Journal of Bone Oncology

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Highlights Separation surgery is a new concept for metastatic spinal cord compression treatment. Stereotactic radiosurgery increased local control, overcoming radio-resistance’s idea. The surgery goal shifted towards creating targets for radiations avoiding cord damages. Minimal invasive strategies could allow quick return to systemic therapies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Perna

Cofano

Mantovani

et al. 2020

Journal of Bone Oncology

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show abstract

“…The restoration of a proper clinical status in a metastatic patient is mandatory to maintain a proper quality of life while avoiding to reduce the overall survival [4] . The treatment of symptomatic spinal cord compression still remains mainly a surgical issue, at first, since surgery is able to rescue quickly the spinal cord when necessary [26] , [27] , [28] , [29] . Nevertheless, evidence addressing neurological outcomes following different type of surgical decompression are lacking so far.…”

Section: Discussionmentioning

confidence: 99%

Neurological outcomes after surgery for spinal metastases in symptomatic patients: Does the type of decompression play a role? A comparison between different strategies in a 10-year experience

Cofano

Perna

Alberti

et al. 2021

Journal of Bone Oncology

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Highlights The achievement of a proper circumferential decompression of the sac instead of simple posterior bilateral laminectomy has been progressively highlighted. Since the majority of spinal cord compression involves firstly the ventral part of the sac, circumferential and anterior decompression are associated with better neurological outcomes at discharge and at follow-up, and should be achieved in case of circumferential or anterior/anterolateral compression. Post-operative improvement and/or maintenance of ambulation resulted to be a significative protective factor at last follow-up.

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“…1,2 Treatment of MSCC is dependent upon global performance status, expected survival, neurological and mechanical factors of the patients. [3][4][5] Spinal cord injury caused by MSCC is a major challenge for spinal surgeons. The timing of surgery is considered to be a key factor affecting neurological recovery.…”

Section: Introductionmentioning

confidence: 99%

Effect of the Timing of Surgery on Neurological Recovery for Patients with Incomplete Paraplegia Caused by Metastatic Spinal Cord Compression

Cui¹,

Shi²,

Li³

et al. 2021

TCRM

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Objective This study aimed to investigate the effect of timing of surgery on neurological recovery for patients with metastatic spinal cord compression (MSCC). Methods According to the timing of surgery, 75 patients with incomplete paraplegia caused by MSCC were assigned to 3 groups: within 3 days (group A), between 4 days and 7 days (group B), and after 7 days (group C). T -test, one-way ANOVA, Mann–Whitney U -test, and Chi-square test were used to evaluate the difference in the improvement of American Spinal Injury Association Impairment Scale (AIS) and ambulatory status, the incidence of perioperative complications, surgical site infection, and the length of hospital stay between 3 groups. Results Patients with incomplete paraplegia treated in our department had an average of 17.4±1.8 days delayed and most occurred before hospitalization (4.0±0.4 vs 13.2±1.8, P<0.001). There was no significant difference in the AIS improvement between patients with different pre-op AIS. The timing of surgery was significantly correlated with AIS improvement (correlation coefficient=−0.257, P=0.019). Sub-analysis showed that patients who underwent surgery within 7 days (group A and group B) had significantly better AIS improvement compared with group C (improved at least 1 grade, P=0.043; improved more than 1 grade, P=0.039) and the surgery timing was more important for patients with AIS B and C. The timing of surgery was significantly correlated with the length of hospital stay (correlation coefficient=0.335, P=0.003). Patients of group C had the longest length of hospital stay (P=0.002). The incidence of perioperative complications and surgical site infection did not differ significantly between the 3 groups. Conclusion Delay surgery was common in incomplete paraplegia patients with MSCC. Patients with AIS B and C who underwent surgery within 7 days had better AIS improvement.

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The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases

Cited by 20 publications

References 30 publications

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

Neurological outcomes after surgery for spinal metastases in symptomatic patients: Does the type of decompression play a role? A comparison between different strategies in a 10-year experience

Effect of the Timing of Surgery on Neurological Recovery for Patients with Incomplete Paraplegia Caused by Metastatic Spinal Cord Compression

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