Spinal metastasis of bronchopulmonary cancer: Interest of a Spine surgery and prognostic scales value

2021 ◽  
Author(s):  
Mohameth Faye ◽  
Louncény Fatoumata Barry ◽  
Jean Marc Kaya ◽  
El Hadji Cheikh Ndiaye Sy ◽  
Moussa Diallo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Motor Deficit ◽  
Spinal Instability ◽  
Survival Prediction ◽  
Average Survival Time ◽  
Spinal Stabilization ◽  
Average Survival ◽  
Common Clinical Presentation

Abstract Backgroundlung cancer is the first mortality cause by cancer around the world. Bones metastasis occurrence is a common eventuality in case of lung cancer (40% at the diagnosis). In order to evaluate the indications and measure the effectiveness of surgery in the management of PBC spinal metastases, we report a series of 52 patients.MethodsDuring 6 years, from January 2009 to December 2014 at the Neurosurgery Unit of Marseille North Hospital (France), we studied retrospectively 52 patients records, who underwent a surgery for spinal metastasis of lung cancer. The study was only about patients which metastases were surgically treated. We used Stata software for the computation, and concerning the linear regression, all values under 0.1 were considered significant.Resultsthe average age was 63.6 years (39–80 years) with a sex ratio of 3. Non-small cell lung cancer was the most common, ie 36 cases (69.2%). Rachialgia associated to vertebral fracture with medullar compression was the most common clinical presentation (31 cases or 59.6%). SINS score (spinal instability neoplastic score) was equal or above 7 in 41 cases (78.9%). The general condition (Karnofski) was medium in 35 cases (67.4%). Survival prediction beyond 12 months was null according to Tokuhashi Index. The surgical indication was essentially palliative. Evolution was characterised by painful symptomatology regression in 44 cases (84.6%), stabilization of initially unstable lesion and motor deficit improvement in 48.3 % of cases. The average survival time following the surgery was 16 months.ConclusionOur results show the interest of surgery for pain relief and spinal stabilization in patient with spinal metastasis of lung cancer, and the relativity of predictive survival score.

scholarly journals Evaluation of predictive factors of vertebral compression fracture after conventional palliative radiotherapy for spinal metastasis from colorectal cancer

2018 ◽  
Vol 28 (3) ◽  
pp. 333-340 ◽  
Author(s):  
Jeongshim Lee ◽  
Woo Joong Rhee ◽  
Jee Suk Chang ◽  
Sei Kyung Chang ◽  
Woong Sub Koom
Keyword(s):  
Colorectal Cancer ◽  
Vertebral Compression Fracture ◽  
De Novo ◽  
Spinal Metastasis ◽  
Multivariable Analysis ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Palliative Radiotherapy ◽  
Spinal Instability ◽  
Spinal Segments

OBJECTIVEDelayed consequences of spinal radiotherapy (RT), including vertebral compression fracture (VCF), are critical complications. However, the predisposing factors that contribute to VCF after conventional RT are unclear. The aim of this study was to assess the incidence of VCF and to determine the predictors of VCF following conventional spinal RT specific to colorectal cancer (CRC).METHODSThe authors retrospectively reviewed 237 spinal segments (147 metastatic and 90 nonmetastatic) in 53 patients with CRC who underwent RT with a median total dose of 30 Gy in 10 fractions between January 2007 and December 2014. The primary end point was the development of a VCF following RT, either de novo VCF or the progression of a baseline VCF. VCFs were assessed using the spinal instability neoplastic score (SINS) criteria.RESULTSAmong all 237 spinal segments, 22 VCFs (9.3%) were observed following RT, including 13 de novo and 9 progressive fractures, and the median time to VCF was 4 months. All VCFs developed in metastatic spines. Among 147 metastatic spinal segments, 22 fractures were observed, with a 12-month cumulative incidence of VCF of 14.8%. Results of multivariable analysis indicated sex (p = 0.023) and SINS class II/III (p < 0.001) as risk factors related to development of a VCF in metastatic spinal segments. Among the SINS criteria, a lytic tumor and the presence of a baseline VCF were identified as predictors of VCF in metastatic spinal segments.CONCLUSIONSIn osteolytic or mixed lesions that were predominant in spinal metastases of CRC, the incidence of VCF was not negligible, even in patients treated with conventional spinal RT. This was especially evident in patients with spinal metastases with a SINS score ≥ 7. Presence of a baseline VCF after spinal RT is a predictor of VCF development and should be observed carefully.

scholarly journals Prognostic factors for overall survival in patients with spinal metastasis secondary to prostate cancer: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Zhong-yu Gao ◽  
Tao Zhang ◽  
Hui Zhang ◽  
Cheng-gang Pang ◽  
Wen-xue Jiang
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Spinal Metastasis ◽  
Meta Analysis ◽  
Performance Status ◽  
Spinal Metastases ◽  
Motor Deficit ◽  
Visceral Metastasis ◽  
Ambulatory Status ◽  
Meta Analyses

Abstract Background: To guide the selection of treatments for spinal metastases, the expected survival time is one of the most important determinants. Few scoring systems are fully applicable for spinal metastasis secondary to prostate cancer (PCa). This study aimed to identify the independent factors to predict the overall survival (OS) of patients with spinal metastases from PCa.Methods: The PubMed, Embase and CENTRAL were retrieved by two reviewers independently, to identify studies analyzed the prognostic effect of different factors in spinal metastasis from PCa. A systematic review and quantitative meta-analysis was conducted with hazard ratio (HR) and 95% confidence interval (95%CI) as the effect size.Results: A total of 12 retrospective cohort studies (1566 patients) were eligible for qualitative synthesis and 10 for quantitative meta-analyses. The OS was significantly influenced by performance status, visceral metastasis, ambulatory status and time from PCa diagnosis in more than half of the available studies. The meta-analyses demonstrated that OS was significantly influenced by visceral metastasis (HR=2.24, 95%CI:1.53-3.27, p<0.001), pre-treatment ambulatory status (HR=2.64, 95%CI:1.82-3.83, p<0.001), KPS (HR=4.45, 95%CI:2.01-9.85, p<0.001), ECOG (HR=2.96, 95%CI:2.02-4.35, p<0.001), extraspinal bone metastasis (HR=2.04, 95%CI:1.13-3.68, p=0.018), time developing motor deficit (HR=1.57, 95%CI:1.30-1.88, p<0.001) and time from PCa diagnosis (HR=1.37, 95%CI:1.17-1.59, p<0.001).Conclusions: Visceral metastasis, ambulatory status, extraspinal bone metastasis, performance status, time developing motor deficit and time interval from primary tumor diagnosis were significantly associated with the OS for spinal metastasis from PCa. When selecting the treatment modality, clinicians should fully consider the patients’ systematic status based on all potential prognostic factors.Level of Evidence: Ⅰ Meta-analysis

scholarly journals A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis

2020 ◽  
Vol 32 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Jeff Ehresman ◽  
Andrew Schilling ◽  
Zach Pennington ◽  
Chengcheng Gui ◽  
Xuguang Chen ◽  
...  
Keyword(s):  
Bone Quality ◽  
Signal Intensity ◽  
Scoring System ◽  
Spinal Metastasis ◽  
Multivariable Analysis ◽  
Spinal Metastases ◽  
Vertebral Compression Fractures ◽  
Spinal Instability ◽  
The Novel ◽  
Compression Fractures

OBJECTIVEVertebral compression fractures (VCFs) in patients with spinal metastasis can lead to destabilization and often carry a high risk profile. It is therefore important to have tools that enable providers to predict the occurrence of new VCFs. The most widely used tool for bone quality assessment, dual-energy x-ray absorptiometry (DXA), is not often available at a patient’s initial presentation and has limited sensitivity. While the Spinal Instability Neoplastic Score (SINS) has been associated with VCFs, it does not take patients’ baseline bone quality into consideration. To address this, the authors sought to develop an MRI-based scoring system to estimate trabecular vertebral bone quality (VBQ) and to assess this system’s ability to predict the occurrence of new VCFs in patients with spinal metastasis.METHODSCases of adult patients with a diagnosis of spinal metastasis, who had undergone stereotactic body radiation therapy (SBRT) to the spine or neurosurgical intervention at a single institution between 2012 and 2019, were retrospectively reviewed. The novel VBQ score was calculated for each patient by dividing the median signal intensity of the L1–4 vertebral bodies by the signal intensity of cerebrospinal fluid (CSF). Multivariable logistic regression analysis was used to identify associations of demographic, clinical, and radiological data with new VCFs.RESULTSAmong the 105 patients included in this study, 56 patients received a diagnosis of a new VCF and 49 did not. On univariable analysis, the factors associated with new VCFs were smoking status, steroid use longer than 3 months, the SINS, and the novel scoring system—the VBQ score. On multivariable analysis, only the SINS and VBQ score were significant predictors of new VCFs and, when combined, had a predictive accuracy of 89%.CONCLUSIONSAs a measure of bone quality, the novel VBQ score significantly predicted the occurrence of new VCFs in patients with spinal metastases independent of the SINS. This suggests that baseline bone quality is a crucial factor that requires assessment when evaluating these patients’ conditions and that the VBQ score is a novel and simple MRI-based measure to accomplish this.

The neurosurgical management of spinal metastases causing cord and cauda equina compression

1978 ◽  
Vol 49 (6) ◽  
pp. 839-843 ◽  
Author(s):  
Kenneth E. Livingston ◽  
Richard G. Perrin
Keyword(s):  
Cauda Equina ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Content Type ◽  
Spinal Stabilization ◽  
Prominent Symptom ◽  
Average Survival ◽  
Cauda Equina Compression ◽  
Effective Pain Relief

✓ The authors report a series of 100 consecutive patients with spinal metastases causing cord or cauda equina compression, who were treated with surgical decompression. Of these, 30% (all women) had breast cancer. The most common primary neoplasm in man was prostatic carcinoma. Pain was the earliest and most prominent symptom, followed by weakness. Bladder dysfunction was recorded in 40 patients. The thoracic region was the most common site of cord compression (76 patients). Surgical treatment involved urgent and extensive laminectomy decompression. Concomitant spinal stabilization was required in 10 cases, involving posterior rib graft fusion in seven and Harrington rod instrumentation in three. At last follow-up review, 29 of these patients were living with an average postoperative survival of 2.3 years; 71 patients had died with an average survival of 8.8 months. Surgical decompression produced effective pain relief in 70% of the patients. Postoperatively, 58 patients could walk; of these, 40 were walking and continent of urine 6 months following surgery (including five patients who were totally paraplegic on admission). Positive approach and aggressive management in this problem can achieve results superior to those generally reflected in the literature.

scholarly journals International Variability in Spinal Metastasis Treatment: A Survey of the AO Spine Community

2021 ◽  
pp. 219256822110469
Author(s):  
Zach Pennington ◽  
Jose L. Porras ◽  
Sheng-Fu Larry Lo ◽  
Daniel M. Sciubba
Keyword(s):  
Multidisciplinary Team ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Fellowship Training ◽  
Cancer Center ◽  
Spinal Instability ◽  
Multidisciplinary Teams ◽  
Practice Setting ◽  
Surgical Specialty

Study Design International survey. Objectives To assess variability in the treatment practices for spinal metastases as a function of practice setting, surgical specialty, and fellowship training among an international group of spine surgeons. Methods An anonymous internet-based survey was disseminated to the AO Spine membership. The questionnaire contained items on practice settings, fellowship training, indications used for spinal metastasis surgery, surgical strategies, multidisciplinary team use, and postoperative follow-up priorities and practice. Results 341 gave complete responses to the survey with 76.3% identifying spinal oncology as a practice focus and 95.6% treating spinal metastases. 80% use the Spinal Instability Neoplastic Score (SINS) to guide instrumentation decision-making and 60.7% recruit multidisciplinary teams for some or all cases. Priorities for postoperative follow-up are adjuvant radiotherapy (80.9%) and systemic therapy (74.8%). Most schedule first follow-up within 6 weeks of surgery (62.2%). Significant response heterogeneity was seen when stratifying by practice in an academic or university-affiliated center, practice in a cancer center, completion of a spine oncology fellowship, and self-identification as a tumor specialist. Respondents belonging to any of these categories were more likely to utilize SINS ( P < .01-.02), recruit assistance from plastic surgeons (all P < .01), and incorporate radiation oncologists in postoperative care ( P < .01-.03). Conclusions The largest variability in practice strategies is based upon practice setting, spine tumor specialization, and completion of a spine oncology fellowship. These respondents were more likely to use evidenced-based practices. However, the response variability indicates the need for consensus building, particularly for postoperative spine metastasis care pathways and multidisciplinary team use.

scholarly journals P.129 Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumor histology

2016 ◽  
Vol 43 (S2) ◽  
pp. S50-S50
Author(s):  
A Dakson ◽  
E Leck ◽  
M Butler ◽  
G Thibault-Halman ◽  
S Christie
Keyword(s):  
Metastatic Disease ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Scoring Systems ◽  
Epidemiological Data ◽  
Spinal Instability ◽  
Mechanical Instability ◽  
Imaging Studies ◽  
Tumor Histology ◽  
Multiple Metastases

Background: This study aims to provide epidemiological data concerning spinal instability and patterns of metastatic invasion of the spine based on tumor histology. Methods: We allocated 285 patients with spinal metastatic disease through a retrospective review. SINS was calculated using good-quality computed tomography (CT) imaging studies. Spinal metastases were also grouped into intracompartmental, extracompartmental or multiple metastases. Results: Esophageal cancer was the least likely to be associated with instability with about 64% of cases being stable. The highest rate of instability scores was observed in breast carcinoma with 18% of cases graded as unstable. Renal cell carcinoma was associated with lytic spinal metastases whereas blastic metastases mostly occurred in prostate carcinoma (P<0.001). Whereas 68.1% of cases represented multiple metastases, the remainder was associated with either intracompartmental (13.3%) or extracompartmental (18.6%) disease. The highest degrees of spinal instability (intermediate and unstable categories) were associated with extra-compartmental metastatic disease (P<0.001). Conclusions: This study sheds light on the patterns of spinal metastatic disease and mechanical instability on the basis of tumor histology, utilizing standardized scoring systems. The utilization of such scoring systems allows for a standardized approach towards description and analysis of spinal metastasis facilitating clinical research in this avenue.

Spinal Fixation after Anterior Decompression for Symptomatic Spinal Metastasis

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 324-327 ◽  
Author(s):  
Richard G. Perrin ◽  
Robert J. McBroom
Keyword(s):  
Steel Plate ◽  
Screw Fixation ◽  
Spinal Metastasis ◽  
Spinal Column ◽  
Spinal Metastases ◽  
Rotational Stability ◽  
Spinal Fixation ◽  
Anterior Decompression ◽  
Surgical Strategies ◽  
Spinal Stabilization

Abstract Surgical strategies for the treatment of symptomatic spinal metastases must take into account both decompression of the spinal cord and stabilization of the spinal column. A method is described for securing spinal stabilization in patients who have undergone surgical decompression for symptomatic spinal metastases by an anterior approach. The fixation device used is a tailor-made prosthesis consisting of a U-shaped stainless steel plate permitting screw fixation to secure axial and rotational stability with an interposed methyl methacrylate strut to provide axial strength and support. The device has been used successfully in 51 patients who have undergone anterior decompression procedures for symptomatic spinal metastases. (Neurosurgery 22:324-327, 1988)

scholarly journals Outcomes of Surgical Decompression for Spinal Metastases From Gynecological Cancers: A Retrospective Cohort Study

2021 ◽  
Vol 7 (1) ◽  
pp. 37-48
Author(s):  
Luiz Alves Vieira Netto ◽  
◽  
Luís Felipe Araújo Peres ◽  
Nayara Matos Pereira ◽  
Alice Jardim Zaccariotti1 ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Spinal Injury ◽  
Spinal Metastasis ◽  
Gynecological Cancer ◽  
Spinal Metastases ◽  
Decompressive Surgery ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Spinal Stability

Background and Aim: Gynecological cancer is one of the most common types of cancer worldwide. Nonetheless, spinal metastasis from gynecological cancer is scarcely reported in the literature. In cases of spinal cord compression, the standard treatment is a decompressive surgery followed by radiotherapy treatment for selected patients. This study aimed to report the overall survival and surgical results in patients presenting with gynecological spinal metastases who underwent spinal cord/nerve root decompression and stabilization. Methods and Materials/Patients: A total of 18 patients were included in this study. The surgical procedures were performed from 2012 to 2019. The evaluation of neurological status, spinal stability, and pain were performed using the American Spinal Injury Association Impairment Scale (ASIA), Spinal Instability Neoplastic Score (SINS), and Visual Analogue Scale (VAS), respectively. Results: The lumbar spine was the most affected location (n=30; 50.0%). Regarding the preoperative neurological deficits, 16 cases (n=16; 88.9%) presented ASIA graded A–D before the surgery, being reduced to five (n=5; 27.8%) after the procedures. The pain level means (pre-and postoperative) were 9.39±0.79 and 2.28±1.44. The overall median survival was 6.1 months (95% Confidence Interval [CI] of 1.10–11.13 months). The mean survival of ambulatory and non-ambulatory patients before the surgery was 7.36 months and 3.2 months, respectively (P=0.007 – Log-rank Mantel–Cox). Conclusion: Decompressive surgery and stabilization promote mechanical pain relief, spinal stability, an improvement of neurological function, and indirectly improving quality of life, despite a dismal overall survival of patients who present with metastatic spinal compression disease.

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