scholarly journals Prognostic value of the Tokuhashi scale when choosing a method of surgical treatment of metastatic lesions of the spine

2021 ◽  
Vol 13 (3) ◽  
pp. 63-75
Author(s):  
M. A. Kosimshoev ◽  
A. V. Evsyukov ◽  
Yu. E. Kubetskiy ◽  
E. K. Uzhakova ◽  
E. V. Amelina ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Life Expectancy ◽  
Cox Model ◽  
Prognostic Significance ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Study Objective ◽  
Spinal Lesion ◽  
Preoperative Examination

Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

scholarly journals Metastatic Spine Disease: Should Patients With Short Life Expectancy Be Denied Surgical Care? An International Retrospective Cohort Study

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 303-311 ◽  
Author(s):  
Nicolas Dea ◽  
Anne L Versteeg ◽  
Arjun Sahgal ◽  
Jorrit-Jan Verlaan ◽  
Raphaële Charest-Morin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Surgical Treatment ◽  
Life Expectancy ◽  
Performance Status ◽  
Spinal Metastases ◽  
Post Treatment ◽  
Baseline Performance ◽  
Significant Difference

Abstract BACKGROUND Despite our inability to accurately predict survival in many cancer patients, a life expectancy of at least 3 mo is historically necessary to be considered for surgical treatment of spinal metastases. OBJECTIVE To compare health-related quality of life (HRQOL) in patients surviving <3 mo after surgical treatment to patients surviving >3 mo to assess the validity of this inclusion criteria. METHODS Patients who underwent surgery for spinal metastases between August 2013 and May 2017 were retrospectively identified from an international cohort study. HRQOL was evaluated using generic and disease-specific outcome tools at baseline and at 6 and 12 wk postsurgery. The primary outcome was the HRQOL at 6 wk post-treatment measured by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). RESULTS A total of 253 patients were included: 40 patients died within the first 3 mo after surgery and 213 patients survived more than 3 mo. Patients surviving <3 mo after surgery presented with lower baseline performance status. Adjusted analyses for baseline performance status did not reveal a significant difference in HRQOL between both groups at 6 wk post-treatment. No significant difference in patient satisfaction at 6 wk with regard to their treatment could be detected between both groups. CONCLUSION When controlled for baseline performance status, quality of life 6 wk after surgery for spinal metastasis is independent of survival. To optimize improvement in HRQOL for this patient population, baseline performance status should take priority over expected survival in the surgical decision-making process.

Results of surgical treatment using minimally invasive methods in patients with endocrine ophthalmopathy

2018 ◽  
Vol 20 (3) ◽  
pp. 31-38
Author(s):  
O. V. Levchenko ◽  
A. A. Kalandari ◽  
N. Yu. Kutrovskaya ◽  
A. Yu. Grigoriev ◽  
O. N. Timofeeva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Minimum Degree ◽  
Functional Results ◽  
Study Objective ◽  
Computed Tomography Images ◽  
Endocrine Ophthalmopathy ◽  
Good Cosmetic ◽  
Neuronavigation System

The study objective is to analyze the results of surgical treatment of patients with endocrine ophthalmopathy using minimally invasive transorbital approaches and intraoperative frameless neuronavigation.Materials and methods. The study was based on the results of examination and surgical treatment of 9 patients with endocrine ophthalmopathy (17 orbits) in the period from 2015 to 2017. At the first stage the preoperative computed tomography images of the orbits was imported into the navigation software program, and then the area of the proposed resection of the orbit walls was marked. Further, in the operating room, the patient head position was registered in the navigation system. To perform bone decompression of the orbit and lipectomy, we used preseptal, transcaruncular and lateral retrocanthal approaches. These approaches are transconjunctival and do not leave postoperative scars. Upon completion of the orbitotomy, its accuracy and dimensions were determined by the intraoperative pointer of the neuronavigation system.Results. The postoperative period was uneventful. In all patients, according to clinical examination and computed tomography, good cosmetic and functional results were achieved. Only 1 patient developed a simblypharon after transconjunctival access, which required additional intervention to reconstruct the lower eyelid. There were no other complications of surgical treatment. The minimum degree of regression of exophthalmos was 3 mm, the maximum 7 mm. Diplopia completely regressed in 2 patients. The observation period was 6 months.Conclusion. Minimally invasive transorbital approaches allow the transconjunctival view of all orbital walls to perform decompression of the orbit and lipectomy without cutaneous incisions, to achieve good cosmetic and functional results. The intraoperative use of the neuronavigation system ensures the bone decompression of the orbit in full.

scholarly journals Surgical treatment of frontopolar artery aneurysm: a case report

2019 ◽  
Vol 21 (1) ◽  
pp. 60-65
Author(s):  
V. A. Lukyanchikov ◽  
I. V. Senko ◽  
M. M. Idalov ◽  
R. M. Umarov ◽  
M. M. Yusupova ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Stiff Neck ◽  
Focal Neurological Deficit ◽  
Study Objective ◽  
Grade 3 ◽  
The Right

The study objective is to describe the results of surgical treatment of a patient with frontopolar artery aneurysm rupture. Materials and methods. A 22-year-old female patient in grave condition (Hunt and Hess grade 3, Glasgow coma score 14) was admitted to the Department of Neurosurgery on day 5 after hemorrhage. The patient presented with headache, nausea, weakness, and stiff neck. However, no hemodynamic, respiratory, motor, or sensitive disorders were observed. Computed tomography of the brain revealed a 35 cm3 intracerebral hemorrhage in the projection of the interhemispheric fissure and frontal lobes without transverse or axial dislocation. Computed tomography angiography demonstrated a distal aneurysm of the right frontopolar artery. Results. The patient underwent emergency osteoplastic craniotomy in the right pterional region followed by aneurysm excision and removal of intracerebral hemorrhage. The postoperative period was uneventful (Glasgow outcome score 5). The patient was discharged on day 14 postoperatively with no signs of focal neurological deficit. Conclusion. Thorough preoperative examination of patients with lobar hemorrhages prevents severe complications during surgery, such as uncontrolled intraoperative bleeding.

scholarly journals Multilevel radical resection in treatment of patients with spine tumors

2021 ◽  
Vol 13 (2) ◽  
pp. 11-17
Author(s):  
R. M. Kabardaev ◽  
E. R. Musaev ◽  
A. K. Valiev ◽  
K. A. Borzov ◽  
S. F. Kuznetsov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Malignant Tumors ◽  
Disease Free Survival ◽  
Functional Results ◽  
Radical Resection ◽  
Spinal Tumors ◽  
Benign Tumors ◽  
Study Objective ◽  
Surgical Interventions ◽  
National Medical

Introduction. Radical surgical resections in the treatment of malignant tumors of the spine have proven effective in improving both overall and disease-free survival of patients. Indications for such interventions are primary malignant tumors of the spine, primary benign tumors with aggressive growth, and solitary metastatic lesions in patients with a favorable oncological prognosis. Due to the anatomical features of the vertebral column, it is very difficult to perform radical resections. An even more difficult task is to perform such interventions for multilevel spinal lesions.The study objective is to evaluate the results of radical surgical treatment for multilevel tumor lesions of the spine.Materials and methods. From 2004 to 2019, in the department of spine surgery of the N.N. Blokhin National Medical Research Center of Oncology treated 36 patients with spinal tumors, who underwent multilevel radical resections. The analysis of this surgical treatment of patients with multilevel neoplastic lesions of the spine was carried out.Results. Performing radical surgical interventions on the spine makes it possible to reduce the frequency of local relapses, improve functional results and overall survival of patients. After performing multilevel resections, complications often occur.

Complications after Surgical Treatment of Spinal Metastases

2019 ◽  
Vol 21 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Piotr Szczerba
Keyword(s):  
Wound Healing ◽  
Surgical Treatment ◽  
Postoperative Radiotherapy ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Biochemical Tests ◽  
Orthopedic Oncology ◽  
Wound Healing Problems ◽  
Cerebrospinal Fluid Leaks ◽  
Treatment Of Wounds

Background. Metastases predominate among spinal tumors. The choice of the best treatment is always done on a case-by-case basis and is multi-faceted. Surgical treatment is increasingly being used and is often com­bined with postoperative radiotherapy. However, it is fraught with the risk of complications. Awareness of these risks and an ability to reduce their incidence is the key to obtaining good results. The aim of the study was to retrospectively assess complications in patients treated for spinal tumors in our Department of Orthopedic Oncology at the Hospital in Brzozów. Material and methods. Out of the 846 patients treated for spinal tumors in the years 2011-2016, 723 (85%) were operated on. The results of imaging and biochemical tests, documentation on the course of treatment, surgical protocols as well as patient records from the outpatient clinic were assessed. Results. In our series, complications occurred in 14% of the patients. They were divided into general-medical (2.7%), orthopedic and neurological (wound healing problems, dural injury, paresis) (11%), and mechanical (0.3%). Complications occurred most often after surgery using a posterior approach in the thoracic spine. In wound healing problems, good results were obtained after surgical treatment of wounds. Damage to the dura mater was repaired du­ring the original operation and cerebrospinal fluid leaks usually resolved spontaneously. Destabilized hardware was replaced during revision procedures. Conclusions. 1. The rate of complications in the present study was comparable to figures reported in the lite­rature. 2. Radiation therapy had a significant impact on the risk of wound healing complications. The most important risk factor is patients’ overall health status, age, previous radiotherapy and steroid therapy, and the presence of neu­rological deficits. 3. Mechanical complications occur mainly in the junctional segments of the spine. 4. Operative treat­ment of wound healing complications produces good results.”

scholarly journals Surgical treatment of patients with primary and metastatic spinal tumor with use of the O-Arm intraoperative portable computed tomography scanner

2019 ◽  
Vol 21 (4) ◽  
pp. 39-49
Author(s):  
A. A. Sufianov ◽  
V. I. Manashchuk ◽  
D. N. Nabiev ◽  
A. G. Shapkin ◽  
M. K. Zaytsev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Informed Consent ◽  
Conflict Of Interest ◽  
Navigation System ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Neurological Status ◽  
Spinal Tumors ◽  
Study Objective ◽  
Mass Lesions

The study objective is to demonstrate our experience of employment of O-Arm intraoperative portable сomputed tomography scanner combined with navigation system Stealth Station Treon Plus (Medtronic Navigation) during decompressive-stabilizing surgeries for patients with primary and metastatic spinal tumors.Materials and methods. We have reviewed results of surgical treatment of 44 patients (24 males and 20 females, average age is 54.3 ± 1.8), who were hospitalized and operated in the department of spinal neurosurgery in Federal Centre of Neurosurgery (Tyumen). All surgeries were performed by one surgical team in the period of April 2011 to June 2017. All patients underwent full clinical examination according to diagnostic algorithm, including assessment of general condition, degree of bone and visceral dissemination, neurological status, quality of life, pain syndrome intensity. The most common cause of vertebral lesions was plasma cell myeloma (15 patients, 34.1 %), metastatic spinal lesions (12 patients, 27.3 %). Patients were subjected to posterior decompression and stabilization with total and subtotal excision of mass lesions. Assessment of degree of decompression and transpedicular fixation were carried out visually using O-Arm combined with navigation station.Results. In 6 to 12 months after surgery 79.5 % of patients demonstrated significant improvement of neurological status, specifically a decrease of conduction and sensory disorders. Degree of pain syndrome was reduced by 3.6 times. Using O-Arm combined with navigation station we placed screws adequately in 99.6 % of the cases. The main technical problem that occurred during the surgery was the failure of navigation system caused by: defect of reflective spheres, distant installation and shift of referential frame, aging of Jamshidi needle, malfunction of navigation camera, failure of data transfer from navigation station.Conclusion. The use of O-Arm combined with navigation station for decompressive and stabilizing surgeries in patients with spine and spinal cord tumors let us perform surgeries with 3D control and navigation, conduct surgeries in areas where it is hard to determine surgical landmarks, ensure precision of transpedicular screw implantation, accomplish total resection of mass lesions with minimal blood loss and less aggressive surgical intervention and properly decompress the spinal canal which, eventually, result in positive anatomical and functional characteristics, and contribute to good general outcome of surgical intervention.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

A novel prognostic model in elderly patients with acute myeloid leukemia: results of 909 patients entered into the prospective AML96 trial

Blood ◽  
2010 ◽  
Vol 116 (6) ◽  
pp. 971-978 ◽  
Author(s):  
Christoph Röllig ◽  
Christian Thiede ◽  
Martin Gramatzki ◽  
Walter Aulitzky ◽  
Heinrich Bodenstein ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Risk Model ◽  
Cox Model ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Intermediate Risk ◽  
Npm1 Mutation ◽  
Prognostic Groups ◽  
Acute Myeloid

Abstract We present an analysis of prognostic factors derived from a trial in patients with acute myeloid leukemia older than 60 years. The AML96 trial included 909 patients with a median age of 67 years (range, 61-87 years). Treatment included cytarabine-based induction therapy followed by 1 consolidation. The median follow-up time for all patients is 68 months (5.7 years). A total of 454 of all 909 patients reached a complete remission (50%). Five-year overall survival (OS) and disease-free survival were 9.7% and 14%, respectively. Multivariate analyses revealed that karyotype, age, NPM1 mutation status, white blood cell count, lactate dehydrogenase, and CD34 expression were of independent prognostic significance for OS. On the basis of the multivariate Cox model, an additive risk score was developed that allowed the subdivision of the largest group of patients with an intermediate-risk karyotype into 2 groups. We are, therefore, able to distinguish 4 prognostic groups: favorable risk, good intermediate risk, adverse intermediate risk, and high risk. The corresponding 3-year OS rates were 39.5%, 30%, 10.6%, and 3.3%, respectively. The risk model allows further stratification of patients with intermediate-risk karyotype into 2 prognostic groups with implications for the therapeutic strategy. This study was registered at www.clinicaltrials.gov as #NCT00180115.

Enthesopathy of the Bicipital Tuberosity of the Radius Treated Under Intraoperative Computed Tomography

2021 ◽  
Author(s):  
Ryosuke Ikeguchi ◽  
Takashi Noguchi ◽  
Maki Ando ◽  
Koichi Yoshimoto ◽  
Diachi Sakamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Surgical Resection ◽  
Tendon Rupture ◽  
Computed Tomography Scan ◽  
Forearm Rotation ◽  
Elbow Pain ◽  
Intraoperative Computed Tomography ◽  
Tomography Scan ◽  
Bicipital Tuberosity

Abstract There is no report of the application of intraoperative computed tomography to the extremities, and its usefulness is not mentioned. We present a case of a patient with the elbow pain and loss of the forearm rotation due to the prominent bicipital tuberosity of the radius, which was diagnosed as enthesopathy. Surgical treatment to excise the prominent part of the bicipital tuberosity of the radius was recommended. However, it is difficult to perform the appropriate excision of the abnormal prominent part because of complications such as bicipital tendon rupture. The patient was successfully treated by surgical resection under the control of intraoperative computed tomography. Intraoperative computed tomography scan is a useful tool to assess the remaining volume of the abnormal bones.

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