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Published in: European Spine Journal 11/2014

01-11-2014 | Original Article

The outcome and survival of palliative surgery in thoraco-lumbar spinal metastases: contemporary retrospective cohort study

Authors: R. M. Nemelc, A. Stadhouder, B. J. van Royen, T. U. Jiya

Published in: European Spine Journal | Issue 11/2014

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Abstract

Purpose

To evaluate outcome and survival and to identify prognostic variables for patients surgically treated for spinal metastases.

Methods

A retrospective study was performed on 86 patients, surgically treated for spinal metastases. Preoperative analyses of the ASIA and spinal instability neoplastic scores (SINS) were performed. Survival curves of different prognostic variables were made by Kaplan–Meier analysis and the variables entered in a Cox proportional hazards model to determine their significance on survival. The correlation between preoperative radiotherapy and postoperative wound infections was also evaluated.

Results

Survival analysis was performed on 81 patients, 37 women and 44 men. Five patients were excluded due to missing data. Median overall survival was 38 weeks [95 % confidence interval (CI) 27.5–48.5 weeks], with a 3-month survival rate of 81.5 %. Breast tumor had the best median survival of 127 weeks and lung tumor the worst survival of 18 weeks. Univariate analysis showed tumor type, preoperative ASIA score (p = 0.01) and visceral metastases (p = 0.18) were significant prognostic variables for survival. Colon tumors had 5.53 times hazard ratio compared to patients with breast tumor. ASIA-C score had more than 13.03 times the hazard ratio compared to patients with an ASIA-E score. Retrospective analysis of the SINS scores showed 34 patients with a score of 13–18 points, 44 patients with a score of 7–12 points, and 1 patient with a score of 6 points. Preoperative radiotherapy had no influence on the postoperative incidence of deep surgical wound infections (p = 0.37).

Conclusions

Patients with spinal metastases had a median survival of 38 weeks postoperative. The primary tumor type and ASIA score were significant prognostic factors for survival. Preoperative radiotherapy neither had influence on survival nor did it constitute a risk for postoperative surgical wound infections.
Literature
1.
go back to reference Arrigo RT, Kalanithi P, Cheng I, Alamin T, Carragee EJ, Mindea SA et al (2011) Predictors of survival after surgical treatment of spinal metastasis. Neurosurgery 68:674–681PubMedCrossRef Arrigo RT, Kalanithi P, Cheng I, Alamin T, Carragee EJ, Mindea SA et al (2011) Predictors of survival after surgical treatment of spinal metastasis. Neurosurgery 68:674–681PubMedCrossRef
2.
go back to reference Bauer HC (2005) Controversies in the surgical management of skeletal metastases. J Bone Joint Surg Br 87:608–617PubMedCrossRef Bauer HC (2005) Controversies in the surgical management of skeletal metastases. J Bone Joint Surg Br 87:608–617PubMedCrossRef
3.
go back to reference Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C et al (2010) Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 19:215–222PubMedCrossRefPubMedCentral Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C et al (2010) Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 19:215–222PubMedCrossRefPubMedCentral
4.
go back to reference Chong S, Shin SH, Yoo H, Lee SH, Kim KJ, Jahng TA et al (2012) Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients’ survival. Spine J 12:1083–1092PubMedCrossRef Chong S, Shin SH, Yoo H, Lee SH, Kim KJ, Jahng TA et al (2012) Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients’ survival. Spine J 12:1083–1092PubMedCrossRef
5.
go back to reference Dalbayrak S, Onen MR, Yilmaz M, Naderi S (2010) Clinical and radiographic results of balloon kyphoplasty for treatment of vertebral body metastases and multiple myelomas. J Clin Neurosci 17:219–224PubMedCrossRef Dalbayrak S, Onen MR, Yilmaz M, Naderi S (2010) Clinical and radiographic results of balloon kyphoplasty for treatment of vertebral body metastases and multiple myelomas. J Clin Neurosci 17:219–224PubMedCrossRef
6.
go back to reference Demura S, Kawahara N, Murakami H, Nambu K, Kato S, Yoshioka K et al (2009) Surgical site infection in spinal metastasis: risk factors and countermeasures. Spine (Phila Pa 1976) 34:635–639CrossRef Demura S, Kawahara N, Murakami H, Nambu K, Kato S, Yoshioka K et al (2009) Surgical site infection in spinal metastasis: risk factors and countermeasures. Spine (Phila Pa 1976) 34:635–639CrossRef
7.
go back to reference Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF (2006) Impact of surgical intervention on quality of life in patients with spinal metastases. Spine (Phila Pa 1976) 31:2849–2856CrossRef Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF (2006) Impact of surgical intervention on quality of life in patients with spinal metastases. Spine (Phila Pa 1976) 31:2849–2856CrossRef
8.
go back to reference Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465CrossRef Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465CrossRef
9.
go back to reference Fisher CG, Dipaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH et al (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35:E1221–E1229CrossRef Fisher CG, Dipaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH et al (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35:E1221–E1229CrossRef
10.
go back to reference Garg AK, Shiu AS, Yang J, Wang XS, Allen P, Brown BW et al (2012) Phase 1/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer 118:5069–5077PubMedCrossRefPubMedCentral Garg AK, Shiu AS, Yang J, Wang XS, Allen P, Brown BW et al (2012) Phase 1/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer 118:5069–5077PubMedCrossRefPubMedCentral
11.
go back to reference Ghogawala Z, Mansfield FL, Borges LF (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976) 26:818–824CrossRef Ghogawala Z, Mansfield FL, Borges LF (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976) 26:818–824CrossRef
12.
go back to reference Harrington KD (1986) Metastatic disease of the spine. J Bone Joint Surg Am 68:1110–1115PubMed Harrington KD (1986) Metastatic disease of the spine. J Bone Joint Surg Am 68:1110–1115PubMed
13.
go back to reference Hirabayashi H, Ebara S, Kinoshita T, Yuzawa Y, Nakamura I, Takahashi J et al (2003) Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer 97:476–484PubMedCrossRef Hirabayashi H, Ebara S, Kinoshita T, Yuzawa Y, Nakamura I, Takahashi J et al (2003) Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer 97:476–484PubMedCrossRef
14.
go back to reference Jacobs WB, Perrin RG (2001) Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11:e10PubMed Jacobs WB, Perrin RG (2001) Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 11:e10PubMed
15.
go back to reference Jansson KA, Bauer HC (2006) Survival, complications and outcome in 282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases. Eur Spine J 15:196–202PubMedCrossRefPubMedCentral Jansson KA, Bauer HC (2006) Survival, complications and outcome in 282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases. Eur Spine J 15:196–202PubMedCrossRefPubMedCentral
16.
go back to reference Kaloostian PE, Zadnik PL, Awad AJ, McCarthy E, Wolinsky JP, Sciubba DM (2013) En bloc resection of a pheochromocytoma metastatic to the spine for local tumor control and for treatment of chronic catecholamine release and related hypertension. J Neurosurg Spine 18:611–616PubMedCrossRef Kaloostian PE, Zadnik PL, Awad AJ, McCarthy E, Wolinsky JP, Sciubba DM (2013) En bloc resection of a pheochromocytoma metastatic to the spine for local tumor control and for treatment of chronic catecholamine release and related hypertension. J Neurosurg Spine 18:611–616PubMedCrossRef
17.
go back to reference Kassamali RH, Ganeshan A, Hoey ET, Crowe PM, Douis H, Henderson J (2011) Pain management in spinal metastases: the role of percutaneous vertebral augmentation. Ann Oncol 22:782–786PubMedCrossRef Kassamali RH, Ganeshan A, Hoey ET, Crowe PM, Douis H, Henderson J (2011) Pain management in spinal metastases: the role of percutaneous vertebral augmentation. Ann Oncol 22:782–786PubMedCrossRef
18.
go back to reference Lee S, Chun M (2012) Pain relief by Cyberknife radiosurgery for spinal metastasis. Tumori 98:238–242PubMed Lee S, Chun M (2012) Pain relief by Cyberknife radiosurgery for spinal metastasis. Tumori 98:238–242PubMed
19.
go back to reference Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H et al (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17:1488–1495PubMedCrossRefPubMedCentral Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H et al (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17:1488–1495PubMedCrossRefPubMedCentral
20.
go back to reference Matsumoto M, Tsuji T, Iwanami A, Watanabe K, Hosogane N, Ishii K et al (2013) Total en bloc spondylectomy for spinal metastasis of differentiated thyroid cancers: a long-term follow-up. J Spinal Disord Tech 26:E137–E142PubMedCrossRef Matsumoto M, Tsuji T, Iwanami A, Watanabe K, Hosogane N, Ishii K et al (2013) Total en bloc spondylectomy for spinal metastasis of differentiated thyroid cancers: a long-term follow-up. J Spinal Disord Tech 26:E137–E142PubMedCrossRef
21.
go back to reference Metcalfe S, Gbejuade H, Patel NR (2012) The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors: consecutive case series of 50 patients. Spine (Phila Pa 1976) 37:1375–1383CrossRef Metcalfe S, Gbejuade H, Patel NR (2012) The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors: consecutive case series of 50 patients. Spine (Phila Pa 1976) 37:1375–1383CrossRef
22.
go back to reference Mobbs RJ, Sivabalan P, Li J (2011) Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 18:741–749PubMedCrossRef Mobbs RJ, Sivabalan P, Li J (2011) Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 18:741–749PubMedCrossRef
24.
go back to reference Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648PubMedCrossRef Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648PubMedCrossRef
25.
go back to reference Pointillart V, Vital JM, Salmi R, Diallo A, Quan GM (2011) Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137:849–856PubMedCrossRef Pointillart V, Vital JM, Salmi R, Diallo A, Quan GM (2011) Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137:849–856PubMedCrossRef
26.
go back to reference Ringel F, Stoffel M, Stuer C, Meyer B (2006) Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery 59:ONS361–ONS366PubMedCrossRef Ringel F, Stoffel M, Stuer C, Meyer B (2006) Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery 59:ONS361–ONS366PubMedCrossRef
27.
go back to reference Sioutos PJ, Arbit E, Meshulam CF, Galicich JH (1995) Spinal metastases from solid tumors. Analysis of factors affecting survival. Cancer 76:1453–1459PubMedCrossRef Sioutos PJ, Arbit E, Meshulam CF, Galicich JH (1995) Spinal metastases from solid tumors. Analysis of factors affecting survival. Cancer 76:1453–1459PubMedCrossRef
28.
go back to reference Sundaresan N, Rothman A, Manhart K, Kelliher K (2002) Surgery for solitary metastases of the spine: rationale and results of treatment. Spine (Phila Pa 1976) 27:1802–1806CrossRef Sundaresan N, Rothman A, Manhart K, Kelliher K (2002) Surgery for solitary metastases of the spine: rationale and results of treatment. Spine (Phila Pa 1976) 27:1802–1806CrossRef
29.
go back to reference Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 30:2186–2191CrossRef Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 30:2186–2191CrossRef
30.
go back to reference Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 15:1110–1113CrossRef Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 15:1110–1113CrossRef
31.
go back to reference Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26:298–306CrossRef Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26:298–306CrossRef
32.
go back to reference van der Linden YM, Dijkstra SP, Vonk EJ, Marijnen CA, Leer JW (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103:320–328PubMedCrossRef van der Linden YM, Dijkstra SP, Vonk EJ, Marijnen CA, Leer JW (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103:320–328PubMedCrossRef
33.
go back to reference Wang J, Boerma M, Fu Q, Hauer-Jensen M (2006) Radiation responses in skin and connective tissues: effect on wound healing and surgical outcome. Hernia 10:502–506PubMedCrossRef Wang J, Boerma M, Fu Q, Hauer-Jensen M (2006) Radiation responses in skin and connective tissues: effect on wound healing and surgical outcome. Hernia 10:502–506PubMedCrossRef
34.
go back to reference Wang XS, Rhines LD, Shiu AS, Yang JN, Selek U, Gning I et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13:395–402PubMedCrossRefPubMedCentral Wang XS, Rhines LD, Shiu AS, Yang JN, Selek U, Gning I et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13:395–402PubMedCrossRefPubMedCentral
35.
go back to reference White BD, Stirling AJ, Paterson E, Squith-Coe K, Melder A (2008) Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance. BMJ 337:a2538PubMedCrossRef White BD, Stirling AJ, Paterson E, Squith-Coe K, Melder A (2008) Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance. BMJ 337:a2538PubMedCrossRef
36.
go back to reference Yao KC, Boriani S, Gokaslan ZL, Sundaresan N (2003) En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 15:E6PubMed Yao KC, Boriani S, Gokaslan ZL, Sundaresan N (2003) En bloc spondylectomy for spinal metastases: a review of techniques. Neurosurg Focus 15:E6PubMed
37.
38.
go back to reference Zairi F, Arikat A, Allaoui M, Marinho P, Assaker R (2012) Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis. J Neurosurg Spine 17:19–23PubMedCrossRef Zairi F, Arikat A, Allaoui M, Marinho P, Assaker R (2012) Minimally invasive decompression and stabilization for the management of thoracolumbar spine metastasis. J Neurosurg Spine 17:19–23PubMedCrossRef
39.
go back to reference Zairi F, Marinho P, Allaoui M, Assaker R (2013) New advances in the management of thoracolumbar spine metastasis. Bull Cancer 100:435–441PubMed Zairi F, Marinho P, Allaoui M, Assaker R (2013) New advances in the management of thoracolumbar spine metastasis. Bull Cancer 100:435–441PubMed
40.
go back to reference Zairi F, Marinho P, Bouras A, Allaoui M, Assaker R (2013) Recent concepts in the management of thoracolumbar spine metastasis. J Neurosurg Sci 57:45–54PubMed Zairi F, Marinho P, Bouras A, Allaoui M, Assaker R (2013) Recent concepts in the management of thoracolumbar spine metastasis. J Neurosurg Sci 57:45–54PubMed
Metadata
Title
The outcome and survival of palliative surgery in thoraco-lumbar spinal metastases: contemporary retrospective cohort study
Authors
R. M. Nemelc
A. Stadhouder
B. J. van Royen
T. U. Jiya
Publication date
01-11-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 11/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3268-0

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