Figure - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Source publication
Background
Few studies have addressed the impact of palliative surgery for cervical spine metastasis on patients’ performance status (PS) and quality of life (QOL). We investigated the surgical outcomes of patients with cervical spine metastasis and the risk factors for a poor outcome with a focus on the PS and QOL.
Methods
We prospectively analyz...
Context in source publication
Context 1
... univariate analysis showed that variables with a P value of < 0.10 were sex (male), the revised Tokuhashi score, the new Katagiri score, the level of the main lesion, and the Frankel grade at baseline (Table 3). The multivariate analysis identified the level of the main lesion as the only significant risk factor (odds ratio, 5.00; P = 0.025) ( Table 4). The chi-square test showed that the presence of the main lesion at the cervicothoracic junction was a significant risk factor for a poor outcome of surgery for SSM (P = 0.006). ...Citations
... However, neurological sequelae of cervical spinal metastasis can be serious even after treatment. [5][6][7][8][9] The cervicothoracic junction (CTJ), where approximately 10% of all spinal metastases occur, is the most challenging anatomical transitional area for treating spinal pathologies. 8,[10][11][12][13] Although controversial, the consensus of surgical treatment has consistently improved biomechanical stability. ...
... [5][6][7][8][9] The cervicothoracic junction (CTJ), where approximately 10% of all spinal metastases occur, is the most challenging anatomical transitional area for treating spinal pathologies. 8,[10][11][12][13] Although controversial, the consensus of surgical treatment has consistently improved biomechanical stability. 12 Given that instrumentation should cross the CTJ to access lower cervical and upper thoracic spinal metastases, considering the different biomechanical characteristics of this transitional zone is important. ...
... The CTJ is a biomechanically challenging region for spinal surgery and one of the major risk factors for poor surgical outcomes in MCSTs. 8,[10][11][12][13] Interestingly, although the 5.5-mm rod group had significantly more lesions located at the CTJ-a region more unstable than C3-6-with a higher mean SINS than the 3.5-mm rod group, the postoperative collapse rate was significantly lower in the 5.5-mm rod group than in the 3.5-mm rod group. 4 Considering that no significant differences in the number of fixation levels and the presence of anterior reconstruction were observed between the 2 groups, 5.5-mm rods could be regarded as strong contributing stabilizers in avoiding postoperative collapse. ...
Objective:
The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5 mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5 mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5 mm rods.
Methods:
This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses.
Results:
Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5 mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5 mm rod group. Neck pain reduction was significantly better in the 5.5 mm rod group.
Conclusion:
CPS with 5.5 mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5 mm rods to enhance surgical outcomes.
... Treatment of patients with metastatic spine disease requires a nuanced decision-making process utilizing a combination of separation surgery, radiation, and systemic treatments. In our cohort of patients with metastatic epidural disease of the CTJ who underwent separation surgery with constructs spanning the CTJ and an exclusively posterior-only ap- 20 Conversely, Pointillart et al. reported a 19% complication rate in 37 patients who underwent an anterior ap- ...
Objective:
The cervicothoracic junction (CTJ) is a challenging region to stabilize after tumor resection for metastatic spine disease. The objective of this study was to describe the outcomes of patients who underwent posterolateral decompression and instrumented fusion (i.e., separation surgery across the CTJ for instability due to metastatic disease).
Methods:
The authors performed a single-institution retrospective study of a prospectively collected cohort of patients who underwent single-approach posterior decompression and instrumented fusion across the CTJ for metastatic spine disease between 2011 and 2018. Adult patients (≥ 18 years old) who presented with mechanical instability, myelopathy, and radiculopathy secondary to metastatic epidural spinal cord compression (MESCC) of the CTJ (C7-T1) from 2011 to 2018 were included.
Results:
Seventy-nine patients were included, with a mean age of 62.1 years. The most common primary malignancies were non-small cell lung (n = 17), renal cell (11), and prostate (8) carcinoma. The median number of levels decompressed and construct length were 3 and 7, respectively. The average operative time, blood loss, and length of stay were 179.2 minutes, 600.5 ml, and 7.7 days, respectively. Overall, 58 patients received adjuvant radiation, and median dose, fractions, and time from surgery were 27 Gy, 3 fractions, and 20 days, respectively. All patients underwent lateral mass and pedicle screw instrumentation. Forty-nine patients had tapered rods (4.0/5.5 mm or 3.5/5.5 mm), 29 had fixed-diameter rods (3.5 mm or 4.0 mm), and 1 had both. Ten patients required anterior reconstruction with poly-methyl-methacrylate. The overall complication rate was 18.8% (6 patients with wound-related complications, 7 with hardware-related complications, 1 with both, and 1 with other). For the 8 patients (10%) with hardware failure, 7 had tapered rods, all 8 had cervical screw pullout, and 1 patient also experienced rod/screw fracture. The average time to hardware failure was 146.8 days. The 2-year cumulative incidence rate of hardware failure was 11.1% (95% CI 3.7%-18.5%). There were 55 deceased patients, and the median (95% CI) overall survival period was 7.97 (5.79-12.60) months. For survivors, the median (range) follow-up was 12.94 (1.94-71.80) months.
Conclusions:
Instrumented fusion across the CTJ demonstrated an 18.8% rate of postoperative complications and an 11% overall 2-year rate of hardware failure in patients who underwent metastatic epidural tumor decompression and stabilization.
... As an advanced stage of cancer, metastatic spinal disease is often characterized by severe back pain, infection, neurological sequelae, and ambulatory disability (8), which are particularly challenging for surgeons. Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12). ...
... Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12). ...
This study aimed to investigate the quality of life and mental health status and further to identify relevant risk factors among advanced cancer patients with spine metastases. This study prospectively included and analyzed 103 advanced cancer patients with spine metastases. Patient's basic information, lifestyles, comorbidities, tumor characteristics, therapeutic strategies, economic conditions, quality of life, anxiety, and depression were collected. Patient's quality of life was assessed using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Subgroup analysis was performed based on different age groups, and a multivariate analysis was performed to test the ability of 20 potential risk factors to predict quality of life, anxiety, and depression. The mean total FACT-G score was only 61.38 ± 21.26. Of all included patients, 52.43% had skeptical or identified anxiety and 53.40% suffered from skeptical or identified depression. Patients had an age of 60 or more and <70 years had the lowest FACT-G score (54.91 ± 19.22), highest HADS anxiety score (10.25 ± 4.22), and highest HADS depression score (10.13 ± 4.94). After adjusting all other potential risk factors, age was still significantly associated with quality of life (OR = 0.57, 95%CI: 0.38–0.86, p < 0.01) and depression (OR = 1.55, 95%CI: 1.00–2.42, p = 0.05) and almost significantly associated with anxiety (OR = 1.52, 95%CI: 0.94–2.43, p = 0.08). Besides, preference to eating vegetables, time since knowing cancer diagnosis, surgical treatment at primary cancer, hormone endocrine therapy, and economic burden due to cancer treatments were found to be significantly associated with the quality of life. A number of comorbidities and economic burden due to cancer treatments were significantly associated with anxiety. Advanced cancer patients with spine metastases suffer from poor quality of life and severe anxiety and depression, especially among patients with an age of 60 or more and <70 years. Early mental health care and effective measures should be conducted to advanced cancer patients with spine metastases, and more attention should be paid to take care of patients with an age of 60 or more and <70 years in terms of their quality of life and mental health status.
... Spinal cord decompression via tumor laminectomy renders the affected segments of the spine less stable, promoting sagittal malalignment such as post-laminectomy kyphosis that is associated not only with pain, but also with neurological deterioration. This particularly holds true for junctional segments, where often not only posterior, but also anterior column stabilization may be warranted [24,25]. ...
Simple Summary
Spinal metastases affect an exceptionally high number of cancer patients and thereby represent a common challenge for healthcare providers. Patients may suffer from debilitating symptoms, including excruciating back pain, immobility and even neurological dysfunction. An exceptionally acute clinical presentation is caused by the compression of the spinal cord through growth of a spinal metastasis within the spinal canal, which may leave the patient with acute spinal cord injury in need of rapid surgical treatment. In clinical practice and science, no true timeframe has yet been defined within which these patients need to undergo surgery, although it is generally understood that their recovery and functional rehabilitation correlate with the time to surgery after symptom onset. In our study, we analyzed a surgically treated cohort of patients with acute spinal cord injury by metastatic compression to investigate the correlation of the timing of surgery with neurological recovery. We were able to identify a subgroup of patients with significantly improved recovery, in whom surgery was initiated within 16 h after admission. Complication rates were not significantly more frequent in this subgroup compared to patients operated on after 16 h. Based on these findings, we conclude that striving for surgery as early as feasible is a warranted strategy in patients with acute neurological deterioration due to metastatic spinal cord compression.
Abstract
Background: Patients with metastatic spinal cord compression (MSCC) may experience long-term functional impairment. It has been established that surgical decompression improves neurological outcomes, but the effect of early surgery remains uncertain. Our objective was to evaluate the impact of early versus late surgery for acute MSCC due to spinal metastases (SM). Methods: We retrospectively reviewed a consecutive cohort of all patients undergoing surgery for SMs at our institution. We determined the prevalence of acute MSCC; the time between acute neurological deterioration as well as between admission and surgery (standard procedure: decompression and instrumentation); and neurological impairment graded by the ASIA scale upon presentation and discharge. Results: We screened 693 patients with surgery for spinal metastasis; 140 patients (21.7%) had acute MSCC, defined as neurological impairment corresponding to ASIA grade D or lower, acquired within 72 h before admission. Non-MSCC patients had surgery for SM-related cauda equina syndrome, radiculopathy and/or spinal instability. Most common locations of the SM in acute MSCC were the thoracic (77.9%) and cervical (10.7%) spine. Per standard of care, acute MSCC patients underwent surgery including decompression and instrumentation, and the median time from admission to surgery was 16 h (interquartile range 10–22 h). Within the group of patients with acute MSCC, those who underwent early surgery (i.e., before the median 16 h) had a significantly higher rate of ASIA improvement by at least one grade at discharge (26.5%) compared to those who had late surgery after 16 h (10.1%; p = 0.024). Except for a significantly higher sepsis rate in the late surgery group, complication rates did not differ between the late and early surgery subgroups. Conclusions: We report data on the largest cohort of patients with MSCC to date. Early surgery is pivotal in acute MSCC, substantially increasing the chance for neurological improvement without increasing complication rates. We found no significant impact when surgery was performed later than 24 h after admission. These findings will provide the framework for a much-needed prospective study. Until then, the treatment strategy should entail the earliest possible surgical intervention.
The number of advanced-age patients with spinal metastases is rising. This study was performed to clarify the characteristics and surgical outcomes of spinal metastases in advanced-age patients. We prospectively analyzed 216 patients with spinal metastases from 2015 to 2020 and divided them into three age groups: <70 years (n = 119), 70–79 years (n = 73), and ≥80 years (n = 24). Although there were no significant intergroup differences in preoperative characteristics and surgery-related factors except for age, patients aged ≥80 years tended to have a worse performance status (PS), Barthel index, and EuroQol-5 dimension (EQ-5D) before and after surgery than the other two groups. Although the median PS, mean Barthel index and mean EQ-5D greatly improved postoperatively in each group, the median PS and mean Barthel index at 6 months and the mean EQ-5D at 1 month postoperatively were significantly poorer in the ≥80-year group than the 70–79-year group. The rates of postoperative complications and re-deterioration of the EQ-5D were significantly higher in the oldest group than in the other two groups. Although surgery for spinal metastases improved the PS, Barthel index, and EQ-5D regardless of age, clinicians should be aware of the poorer outcomes and higher complication rates in advanced-age patients.
Objectives:
Patients undergoing surgery for cervical spine metastases are at risk for unplanned readmission due to comorbidities and chemotherapy/radiation. Our objectives were to: 1) report the incidence of unplanned readmission, 2) identify risk factors associated with unplanned readmission, and 3) determine the impact of an unplanned readmission on long-term outcomes.
Methods:
A single-center, retrospective, case-control study was undertaken of patients undergoing cervical spine surgery for metastatic disease between 02/2010-01/2021. The primary outcome of interest was unplanned readmission within 6-months. Survival analysis was performed for overall survival (OS) and local recurrence (LR).
Results:
A total of 61 patients underwent cervical spine surgery for metastatic disease with the following approaches: 11(18.0%) anterior, 28(45.9%) posterior, and 22(36.1%) combined. Mean age was 60.9±11.2years and 38(62.3%) were males. A total of 9/61(14.8%) patients had an unplanned readmission, 3 for surgical reasons and 6 for medical reasons. No difference was found in demographics, preoperative Karnofsky Performance Scale(KPS)(p=0.992), motor strength(p=0.477), or comorbidities(p=0.213) between readmitted patients versus not. Readmitted patients had a higher rate of preoperative radiation(p=0.009). No statistical differences were found in operative time(p=0.893), estimated blood loss(p=0.676), length of stay(p=0.720), discharge disposition(p=0.279), and operative approach(p=0.450). Furthermore, no difference was found regarding complications(p=0.463), postoperative KPS(p=0.535), and postoperative Modified McCormick Scale(MMS)(p=0.586). Lastly, unplanned readmissions were not associated with OS(log-rank;p=0.094) or LR(log-rank;p=0.110).
Conclusions:
In patients undergoing cervical spine metastasis surgery, readmission occurred in 15%, 33% for surgical reasons and 67% for medical reasons. Preoperative radiotherapy was associated with increased unplanned readmissions, yet readmission had no association with OS or LR.
