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 (original) (raw)
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Predictors of neurological recovery after surgery of metastatic epidural spinal cord compression
Neurological Disorders and Therapeutics, 2017
The aim of this study was to identify potential preoperative predictors (inclusive time between onset of motor weakness and surgical decompression) of neurological function and ambulation in a consecutive series of patients with MESCC treated with urgent spinal cord decompression. Material/Methods: 327 patients with MESCC who underwent emergency laminectomy were reviewed retrospectively. Variables evaluated were: age, gender, site of primary tumor, location of spinal cord compression, location and number of affected segments, time between onset of neurological deficits to surgical decompression, the pre-and early postoperative ASIA scores, pre-and postoperative ability to walk and to ambulate and the pre-and postoperative quality of walking. Variables were analyzed with uni-and multivariate methods. A backward stepwise binary logistic regression analysis was performed to determine the effect of the evaluated variables in a multivariate model. Results: The majority of the patients were assigned to ASIA impairment scale grade D. At admission 49.5 % of the patients could walk and 50.5% of the patients were not able to walk. The mean time between onset of neurological deficits and decompression was 114.72 hours +/-173.41 (range 2-1800 hours). Univariate analyses identified preoperative ASIA impairment scale grades, the ability to walk preoperatively, tumor localization, age and duration of symptom (time interval between onset of motor weakness and surgical decompression) as predictors for neurological improvement and outcome. In a multivariate model time between onset of motor weakness and surgical decompression (p<0,05) and the ability to walk preoperatively (p<0.0001) were significant independent predictors for improvement of the ability to walk. Conclusion: Early surgical decompression is important for neurological recovery in patients with MESCC especially with rapid neurological deterioration.
Journal of Neurosurgery: Spine, 2009
Object Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. Recent studies have supported decompressive surgery over radiation therapy for patients who present with MESCC. These studies, however, have grouped all patients with different histological types of metastatic disease into the same study population. The differential outcomes for patients with different histological types of metastatic disease therefore remain unknown. Methods An institutional database of patients undergoing decompressive surgery for MESCC at an academic tertiary-care institution between 1996 and 2006 was retrospectively reviewed. Patients with primary lung, breast, prostate, kidney, or gastrointestinal (GI) cancer or melanoma were identified. Fisher exact and log-rank analyses were used to compare pre-, peri-, and postoperative variables and survival for patients with these different types ...
Neurosurgery, 2008
OBJECTIVE: Metastatic epidural spinal cord compression (MESCC) is a relatively com- mon and debilitating complication of metastatic disease that often results in neurolog- ical deficits. This study was designed to explore associations with maintaining and regaining ambulatory function after decompressive surgery for MESCC. METHODS: Seventy-eight patients undergoing decompressive surgery for MESCC at an academic tertiary care institution between 1995 and
Journal of Clinical Neuroscience, 2018
Objective: Space-occupying spinal metastases (SM), commonly diagnosed because of acute neurological deterioration, consequently lead to immediate decompression with tumor removal or debulking. In this study, we analyzed a series of patients with surgically treated spinal metastases and explicitly sought to determine individual predictors of functional outcome. Patients and methods: 94 patients (26 women, 68 men; mean age 64.0 years) with spinal metastases, who had been surgically treated at our department, were included retrospectively. We reviewed the pre-and postoperative charts, surgical reports, radiographic data for demographics, duration of symptoms, histopathology, stage of systemic disease, co-morbidities, radiographic extension, surgical strategy, neurological performance (Frankel Grade Classification), and the Karnofsky Performance Index (KPI). Results: Emergency surgery within <24 h after discharge had been conducted in 33% of patients. Prostate carcinoma (29.5%) and breast carcinoma (11.6%) were the most common histopathologies. Median KPI was 60% at admission that had significantly improved at discharge (KPI 70%; p = 0.01). The rate of complications without revision was 4.3%, the revision rate 4.2%. From admission to discharge, pain had been significantly reduced (p = 0.019) and motor deficits significantly improved (p = 0.003). KPI had been significantly improved during in-hospital treatment (median 60 vs 70, p = 0.010). In the multivariable analysis, predictors of poor outcome (KPI < 70) were male sex, multiple metastases, and pre-existing bowel and bladder dysfunction. Median follow up was 2 months. Discussion: In our series, surgery for spinal metastases (laminectomy, tumor removal, and mass reduction) significantly reduced pain as well as sensory and motor deficits. We identified male sex, multiple metastases, and pre-existing bowel and bladder dysfunction as predictors of negative outcome.
Interventions for the treatment of metastatic extradural spinal cord compression in adults
PubMed, 2008
Background: Metastatic epidural spinal cord compression (MESCC) is often treated with radiotherapy and corticosteroids. Recent reports suggest benefit from decompressive surgery. Objectives: To determine effectiveness and adverse effects of radiotherapy, surgery and corticosteroids in MESCC. Search strategy: CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS and CANCERLIT were searched; last search ran July 2008 Selection criteria: We selected randomized controlled trials (RCTs) of radiotherapy, surgery and corticosteroids in adults with MESCC. Data collection and analysis: Three review authors independently assessed quality of included studies and extracted data. We calculated risk ratios (RR) and numbers needed to treat to benefit (NNT) with 95% confidence intervals (CI) and assessed heterogeneity. Main results: We identified six trials (n = 544). One trial (n = 276) compared radiotherapy 30 Gray in eight fractions with 16 Gray in two fractions and showed no difference. Overall ambulatory rates were 71% versus 68%, (RR 1.02, CI 0.90 to 1.15); 91% versus 89% of ambulant patients maintained ambulation (RR 1.02, CI 0.93 to 1.12); 28% versus 29% of non-ambulant patients regained ambulation (RR 0.98, CI 0.51 to 1.88). In one trial (n = 101) decompressive surgery had significantly better outcomes than radiotherapy in selected patients. Overall ambulatory rates were 84% versus 57% (RR 0.67, CI 0.53 to 0.86, NNT 3.70 CI 2.38 to 7.69); 94% versus 74% maintained ambulation (RR 0.79, CI 0.64 to 0.98, NNT 5.00 CI 2.78 to 33.33); 63% versus 19% regained ambulation (RR 0.30, CI 0.10 to 0.89; NNT 2.27 CI 1.35 to 7.69). Median survival was 126 days versus 100 days. Laminectomy offered no advantage (n = 29, 1 trial). Three trials provided insufficient evidence about the role of corticosteroids (n = 105, Overall ambulation RR 0.91, CI 0.68 to 1.23). Serious adverse effects were significantly higher in high dose corticosteroid arms (n = 77, two RCTs, RR 0.12, CI 0.02 to 0.97). Authors' conclusions: Patients with stable spines retaining the ability to walk may be treated with radiotherapy. One trial indicates that short course radiotherapy suffices in patients with unfavourable histologies or predicted survival of less than six months. There is some evidence of benefit from decompressive surgery in ambulant patients with poor prognostic factors for radiotherapy; and in non-ambulant patients with a single area of compression, paraplegia < 48 hours, non-radiosensitive tumours and a predicted survival of more than three months. High dose corticosteroids carry a significant risk of serious adverse effects.
Neurosurgical Focus, 2021
OBJECTIVE The aim of this study was to compare outcomes of separation surgery for metastatic epidural spinal cord compression (MESCC) in patients undergoing minimally invasive surgery (MIS) versus open surgery. METHODS A retrospective study of patients undergoing MIS or standard open separation surgery for MESCC between 2009 and 2019 was performed. Both groups received circumferential decompression via laminectomy and a transpedicular approach for partial corpectomy to debulk ventral epidural disease, as well as instrumented stabilization. Outcomes were compared between the two groups. RESULTS There were 17 patients in the MIS group and 24 in the open surgery group. The average age of the MIS group was significantly older than the open surgery group (65.5 vs 56.6 years, p < 0.05). The preoperative Karnofsky Performance Scale score of the open group was significantly lower than that of the MIS group, with averages of 63.0% versus 75.9%, respectively (p = 0.02). This was also evide...
Neurological Outcome and Complications in Patients with Surgically Treated Spinal Metastases
SPINE, 2019
Study Design: Retrospective cohort. Objective: Evaluate the epidemiology of surgical patients with spinal metastases, identify the complications and evaluate their neurological prognoses. Summary of Background Data: The development of new oncological treatments and screening tests have increased the survival of oncologic patients, and consequently, the incidence of metastatic lesions of the spine. Methods: Retrospective cohort of 40 patients surgically treated at the Hospital de Clínicas of UNICAMP for spinal metastases from January 2010 to September 2018, after diagnosis of symptomatic spinal cord compression and/or mechanical instability of the spine. Retrospectively analysed patient charts and applied the SINS score to evaluate the presence of mechanical instability. Neurological function was classified based on the Frankel index preoperative and postoperatively. To evaluate the association between variables, the Chisquare test, Fisher exact test, or Fisher-Freeman-Halton test was applied. For evaluating the improvement of neurological status between the Frankel scores before and after surgery, the McNemar test was applied for categorical and qualitative variables. In both tests, variables with values of p > 0.05 were considered. Results: Pain as the reason for the first visit presented an odds ratio (OR) = 2.44 (95% [CI]: 1.14-5.2) for instrumentation need (p = 0.024). A higher SINS score corresponded to the indication for instrumentation surgery due to the instability of the spine (p = 0.004). Within 30 days postoperative, five patients (11.1%) had complications. There was a statistically significant neurological improvement in patients who underwent surgery (p = 0.002). Conclusion: Pain as the first symptom was related to mechanical instability of the spine and surgical instrumentation. Patients treated with surgery presented improvement of the neurological function in the postoperative period.
The spine journal : official journal of the North American Spine Society, 2015
There have been no previous studies looking at the outcome of surgical decompression (+/-stabilisation) for various grades of epidural spinal cord compression (ESCC) due to spinal metastases. To determine the outcome of surgical treatment in patients with ESCC using the Bilsky 6-point scale. Retrospective cohort review of prospectively collected data PATIENT SAMPLE: A consecutive series of 101 patients managed over the period of 3 years for ESCC due to spinal metastases in a tertiary spine surgery referral unit were included. Data on age, gender, revised Tokuhashi score, pre-operative Frankel grade, tumour histology, MRI scan based Bilsky cord compression grade, post-operative Frankel grade at last follow up, complications and survivorship data were collected. Frankel grading system for function was used to evaluate the patient's pre- and post-operative neurological status. Patient survival and post-operative complications were also collected. Average patient age was 64.7 years ...
Spinal Cord, 2008
Study Design: Retrospective study utilizing the standard patient data documentation of a spinal cord injury (SCI) unit. Objective: To examine the efficacy and outcome of posterior decompression and stabilization for metastatic cord compression. Setting: Orthopedic university hospital with large SCI unit. Methods: The 34 consecutive patients who had presented with symptoms of spinal cord compression due to metastatic disease and progressive neurologic deficit were treated using a uniform surgical approach (posterior decompression and stabilization). After surgery, all treatment options available in a full-featured SCI unit were applied as necessary and suitable. Outcome was rated concerning neurologic function (American Spinal Injury Association, ASIA), functional status (Functional Independence Measure) and pain. The results were compared to the published results, focusing on publications describing results of anterior surgical approaches to the spine. Results: Evaluation of the results of the ASIA exams showed that progression of the neurologic deficit could be stopped in the majority of casesFhowever recovery of neurologic function was rare. The functional status could be improved markedly and good pain reduction was achieved. Conclusion: Immediate surgery can be recommended if the general condition of the patient warrants surgical intervention. Using accepted standards of documentation for SCI, a clear perspective of the results that can be expected is provided. Comparing the results of this study with the current literature there is no evidence that anterior approaches are superior.