Search Results (11)

Background. The aim of this study was to assess the surgical outcomes and survival of patients surgically treated for metastatic epidural spinal cord compression (MESCC), with a specific focus on identifying factors that influence overall survival and readmission-free survival. Methods. All patients who underwent surgery for spine metastases at our department in the period 2018–2022 were included in the study. Results. A total of 175 patients (n = 71 females, median age 67.15 years) were included. The most common primary tumors were lung carcinoma (n = 31), prostate carcinoma (n = 31), breast carcinoma (n = 28), multiple myeloma (n = 25), and renal cell carcinoma (n = 11). ECOG performance status was 0 (n = 7), 1 (n = 97), 2 (n = 27), 3 (n = 17), and 4 (n = 27). Pathological fractures were present in n = 108 patients. Decompression only was performed in n = 42, additional instrumentation in n = 133, and vertebral body replacement in n = 23. The most common complications were wound healing deficits and hardware failure. Preoperative motor deficits were present in n = 89 patients. Postoperatively, n = 122 improved, n = 43 was unchanged, and n = 10 deteriorated. Mean overall survival (OS) was 239.2 days, with a 30-day mortality rate of 18.3%. Favorable prognostic factors included Tomita score < 7, Frankel score A–C, ECOG 0–1, and Modified Tokuhashi score > 10 (p < 0.01). Factors affecting OS and readmission-free survival (RFS) included prognostic scores, adjuvant therapy, ASA classification, surgical complications, metastasis number, and postoperative improvement. Better prognostic scores, adjuvant therapy, and clinical improvement were associated with longer OS and RFS, while complications or deterioration resulted in worse outcomes. Conclusions. Patients undergoing decompression and/or stabilization for metastatic spinal tumors showed improved outcomes, with favorable prognosis linked to Tomita score < 7, Frankel score A–C, ECOG 0–1, and Modified Tokuhashi score > 10. Full article

Background/Objectives: Massive intraoperative blood loss (IBL) is one of the major complications in metastatic spinal tumor surgery (MSTS), and understanding the predictors of this risk is essential. This study aimed to determine the impact of the intratumoral flow void (IFV) observed on standard magnetic resonance imaging (MRI) and its association with IBL in palliative surgery for metastatic spinal tumors. Methods: This retrospective analysis included 88 palliative excisional surgeries performed at a single hospital between 2010 and 2024. Factors such as age, sex, body mass index, tumor location, histological tumor type, spinal instability neoplastic score, revised Tokuhashi score, preoperative radiation, presence of IFV, and IFV diameter were assessed in addition to surgical details such as the number of resected and instrumented vertebrae and surgical duration. Results: Of the 88 patients, 71 (80.7%) exhibited IFV, with a mean IFV diameter of 1.8 ± 1.3 mm. The univariate analysis identified a significant association between IBL and several factors, including the presence of IFV, IFV diameter, hypervascular tumor type, number of instrumented vertebrae, and surgical duration. The multivariate analysis indicated that IFV diameter had the highest standardized coefficient among the examined variables, suggesting its strong potential as a predictor of IBL. Conclusions: This is the first study to identify the IFV diameter as a critical and independent predictor of IBL in MSTS. IFV diameter, which can be easily assessed using standard MRI, should be considered in surgical planning to effectively manage bleeding. Full article

Targeted therapy has greatly improved the outlook for patients with spinal metastatic cancers. Scoring systems like the Tokuhashi or Tomita scores are commonly used to predict prognosis and inform surgical decisions, but they are outdated and fail to consider recent advancements. We aimed to investigate the current state of the literature and treatment options pertaining to advancements in targeted therapy compared to other forms of medical management for metastatic spinal tumors. This study represents the first comprehensive systematic review that encompasses the most common primary cancers that metastasize to the spine and evaluates the median overall survival (mOS) across five different medical treatment modalities as well as surgical intervention. Additionally, our study analyzes the tumor receptor status in conjunction with these treatments. A PubMed search was conducted, and according to the PRISMA guidelines, 28 articles out of 1834 met the inclusion criteria. The pooled data analysis highlighted the superior efficacy of targeted therapy, evidenced by a significant improvement in the mOS and lower hazard ratios in patients with lung and breast cancers who received targeted therapy compared to those who did not. Our study provides valuable insights into the recent advancements in the medical management of metastatic spinal tumors. Future indications include incorporating this literature into personalized treatment approaches for metastatic spinal tumors. Full article

Lung cancer is the second most frequently diagnosed cancer in the world, and surgery is an integral part of the treatment for spinal metastases. The aims of this retrospective study were to assess the overall survival of surgically treated patients affected by lung cancer spinal metastases and identify any factors related to a better survival rate. We recruited 56 consecutive patients (34 male and 22 female) surgically treated for metastatic lung cancer in the spine from 2009 to 2019. Surgical indications were based on a previously published and validated flow chart following a multidisciplinary evaluation. We assessed the localization of vertebral metastases, the presence of other bone or visceral metastases, neurological status according to the Frankel score, ambulatory autonomy, and general status, measured with the Karnofsky performance scale. The expected prognosis was retrospectively assessed according to the revised Tokuhashi score. The median survival was 8.1 months, with over a third of patients surviving more than 1 year. We observed a global improvement in all clinical parameters after surgical treatment. The Tokuhashi predictive score did not correlate with survival after surgery. The results of this study suggest that the surgical treatment of symptomatic spinal metastases from lung cancer can improve quality of life, even in patients with a shorter life expectancy, by controlling pain and improving autonomy. Full article

(1) Background: Whether clinical management of spinal metastatic disease (SMD) matches evidence-based recommendations is largely unknown. (2) Patients and Methods: A questionnaire was distributed through Spanish Medical Societies, exploring routine practice, interpretation of the SINS and ESCC scores and agreement with items in the Tokuhashi and SINS scales, and NICE guideline recommendations. Questionnaires were completed voluntarily and anonymously, without compensation. (3) Results: Eighty specialists participated in the study. A protocol for patients with SMD existed in 33.7% of the hospitals, a specific multidisciplinary board in 33.7%, 40% of radiological reports included the ESCC score, and a prognostic scoring method was used in 73.7%. While 77.5% of the participants were familiar with SINS, only 60% used it. The different SINS and ESCC scores were interpreted correctly by 57.5–70.0% and 30.0–37.5% of the participants, respectively. Over 70% agreed with the items included in the SINS and Tokuhashi scores and with the recommendations from the NICE guideline. Differences were found across private/public sectors, hospital complexity, number of years of experience, number of patients with SMD seen annually and especially across specialties. (4) Conclusions: Most specialists know and agree with features defining the gold standard treatment for patients with SCC, but many do not apply them. Full article

Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient’s condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors. Full article

This study aimed to analyze the survival and functional outcome after surgery in spinal metastasis patients with a short life expectancy and to compare the baseline characteristics based on 3-month survival. A total of 492 surgical treatment cases with a preoperative revised Tokuhashi score ≤ 8were reviewed. Median survival was calculated and Kaplan–Meier analysis was used to analyze the survival rates at 6 months, 1 year, and 2 years postoperatively. The surgical period was divided into three time frames to examine the time trends. For the functional outcome, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was analyzed. This study categorized subjects based on 3-month survival and compared the baseline characteristics. The median overall survival was 10.6 months. The 2013–2020 period showed a significantly better median survival than the other two periods (p < 0.001). Lung and kidney cancers showed a significant survival improvement in 2013–2020 (p < 0.001). Patients with ECOG-PS ≤ 2 increased from 37.4% preoperatively to 63.7% postoperatively (p < 0.001). There were significantly more cases of preoperative favorable performance status, slow and moderate growth cancers, and chemotherapy after surgery in the survival ≥3 months group. Depending on the type of primary cancer, surgery can be considered even in spinal metastasis patients with a short life expectancy, particularly those with a good performance status. Full article

Clear cell renal cell carcinoma (ccRCC) usually spreads in the spinal region causing instability or spinal cord compression leading to neurological deficits. Therefore, surgical treatment is required for improving the outcome of patients. The aim of this study is to identify which prognostic factors could affect overall survival in patients affected by ccRCC. Methods: Retrospective cohort study of patients with ccRCC spinal metastases, surgically treated from November 2009 to April 2019. Demographic and clinical data were collected. The Kaplan–Meier method was used to estimate overall survival, and the log-rank test was used to evaluate differences in survival among potentially prognostic factors. Results: A total of 69 patients were surgically treated and followed up for a median period of 65 months. The average age at the time of surgery was 62.6 years old. The median overall survival (OS) was 34.7 months (95% CI 20.8–51.9) and 5-year OS was 31.2% (95% CI 19.2–44.1). A high Tokuhashi score (p = 0.0217), the presence of visceral metastases (p < 0.001), other bone metastases (p = 0.02012) and the kind of surgical treatment (p = 0.0395) are the main prognostic factors that influence the OS. Moreover, 3-year progression-free survival (PFS) was analyzed: the median PFS was 53.1 months and the % 3-year PFS was 62.9% (45.2–76.3). In the multivariate analysis, only pre-operative radiation therapy had a significant impact on 3-year PFS (95% CI 0.929–12.994, p = 0.0643). Conclusion: The results of this study suggest that the absence of visceral metastases and an aggressive surgery as en-bloc, when feasible, could prolong the survival rate and improve quality of life for patients. Full article

Background Context: The role of radiotherapy versus surgery in treating acute metastatic spinal cord compression (AMSCC) has changed over the years. Purpose: Our study evaluates neurological and functional outcomes following urgent surgery and radiotherapy (USFR) versus urgent radiotherapy alone in treating AMSCC. Study Design/Setting: A retrospective cohort of 54 patients with AMSCC with variable neurological deficits. Overall, 32 patients were treated with USFR, and 22 received urgent radiotherapy alone. Outcome Measures: Neurological status regarding the Asia and Frankel scores, continence and ambulation, and Kranofsky’s functional score and patient life span comprised the outcome measures. Methods: This was a retrospective EMR study. Results: USFR and radiotherapy cohorts were similar in age, gender, tumor origin, and the number of spinal metastases. The most common cause of AMSCC was carcinoma of the breast (24.1%), followed by carcinoma of the lung (16.7%) and multiple myeloma (13%). Neurological status at AMSCC presentation was similar between cohorts regarding Asia and Frankel scores, continence and ambulation, and Kranofsky’s functional score. Following USFR, 59.3% of the patients had a motor strength improvement, 31.3% regained sphincter function, and 34.4% regained ambulation, while 90% of the patients treated by radiotherapy did not show any improvement. One patient under radiotherapy lost sphincter function. The treatment received did not affect the patient’s survival. A subanalysis of patients with a short life expectancy, by Tomita and Tokuhashi scores, showed missed prediction in 29.4% of cases. Conclusion: The study supports the beneficial effect of UFSR compared to urgent radiotherapy alone in treating AMSCC in all subgroups. Early surgery improved function, motor strength, sphincter control, and ambulation without affecting life span. Prognostic scores failed to predict life span in almost one-third of the patients, requiring further investigation. Full article

Introduction: Predicting survival time for patients with spinal metastases is important in treatment choice. Generally speaking, six months is a landmark cutoff point. Revised Tokuhashi score (RTS), the most widely used scoring system, lost its accuracy in predicting 6-month survival, gradually. Therefore, a more precise scoring system is urgently needed. Objective: The aim of this study is to create a new scoring system with a higher accuracy in predicting 6-month survival based on the previously used RTS. Methods: Data of 171 patients were examined to determine factors that affect prognosis (reference group), and the remaining (validation group) were examined to validate the reliability of a new score, adjusted Tokuhashi score (ATS). We compared their discriminatory abilities of the prediction models using area under receiver operating characteristic curve (AUC). Results: Target therapy and the Z score of BMI (Z-BMI), which adjusted to the patients’ sex and age, were additional independent prognostic factors. Patients with target therapy use are awarded 4 points. The Z score of BMI could be added directly to yield ATS. The AUCs were 0.760 for ATS and 0.636 for RTS in the validation group. Conclusion: Appropriate target therapy use can prolong patients’ survival. Z-BMI which might reflect nutritional status is another important influencing factor. With the optimization, surgeons could choose a more individualized treatment for patients. Full article

Prediction of prognosis is a key factor in therapeutic decision making due to recent the development of therapeutic options for spinal metastases. The aim of the study was to examine predictive scoring systems and identify prognostic factors for 6–month mortality after palliative surgery. The participants were 75 patients with spinal metastases who underwent palliative surgery and had a minimum follow–up period of 1 year. Associations of actual survival with categories based on the revised Tokuhashi score and new Katagiri score were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors for 6–month mortality after palliative surgery. The median actual survival period was longer than those predicted using the scoring systems. However, 21.3% of patients died of cancers within 6 months after surgery. A higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for 6–month mortality. There was no association of mortality with primary site, severity of sarcopenia, or other biomarkers. These results suggest that careful consideration is needed to determine whether palliative surgery is the best option for patients with a high preoperative CRP/albumin ratio and/or absence of postoperative adjuvant therapy, regardless of predictions made from scoring systems. Full article