Analysis of surgical treatment results in spinal metastasis

Authors

  • Dmytro Petrenko
  • Andrey Popov
  • Oleksandr Chekryzhev

DOI:

https://doi.org/10.15674/0030-59872019274-81

Keywords:

spinal metastasis, decompression, transpedicular fixation, live expectancy

Abstract

Objective: analysis of surgical treatment results in patients with spinal metastasis.

Methods: 26 clinical charts were retrospectively reviewed (16 females, 10 males, aged from 27 to 87 years old) with spinal metastasis who were surgically treated. 11 patients had primary breast tumors, 7 had prostate tumor, 2 patients had thyroid cancer, 2 patients had kidney tumor and 2 had nonspecified primary location. In vast majority of cases metastasis location was ThVI–ThXII (17 patients). Fors urgical indications assessment SINS (spinal instability neoplastic score) and K. Tomita scales were used, neurological deficiency was assessed using H. Frankel scale and tumor spread and degree of epidural compression with ESCC (epidural spine cord compression scale), pain assessed using VAS.

Results: open and punctional biopsy have been performed in 21 patients and 5 patients had emergent surgery because of acute neurological decline. Spinal cord decompression and transpedicular fixation underwent 16 patients, 6 patients had vertebroplasty, 5 patients had minimally invasive palliative decompression. Mean preoperative VAS score was 7.2, mean postoperative VAS score was 5.3. In Frankel B group regression to Frankel C found in 1 patient, pain relief observed in all patients. In group Frankel C neurological symptoms didn’t change in 3 patients, regression to Frankel D observed in 5 patients, decline to B class diagnosed in 1 patient. In group Frankel D shift to Frankel E observed in all patients. In 4 patients neurological symptoms temporary worsened after the surgery with gradual recovery after 2–6 weeks, 1 patient didn’t have neurological recovery.

Conclusions: surgical treatment of spinal metastasis resulted in neurological recovery, postoperative pain relief, improved patient’squality of life.

Author Biographies

Dmytro Petrenko

The Scientific-Practical Medical Centre of Kharkiv National Medical Univercity. Ukraine

MD in Traumatology and Orthopаedics

Andrey Popov

Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

PhD in Traumatology and Orthopаedics

Oleksandr Chekryzhev

The Scientific-Practical Medical Centre of Kharkiv National Medical Univercity. Ukraine

References

  1. Lewandrowski, K. U., Anderson, M. E., & McLain, R. F. (2011). Rothman-Simeone The spine. Philadelphia: Elsevier Saunders
  2. Choi, D., Crockard, A., Bunger, C., Harms, J., Kawahara, N., Mazel, C., & Tomita, K. (2010). Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. European Spine Journal, 19 (2), 215–222. doi: 10.1007/s00586-009-1252-x
  3. Rougraff, B. T., Kneisl, J. S., & Simon, M. A. (1993). Skeletal metastases of unknown origin. A prospective study of a diagnostic strategy. The Journal of Bone & Joint Surgery. American volume, 75 (9), 1276–1281. doi: 10.2106/00004623-199309000-00003
  4. Siegal, T., & Siegal, T. (1989). Current considerations in the management of neoplastic spinal cord compression. Spine, 14 (2), 223–228. doi: 10.1097/00007632-198902000-00015
  5. Delank, K. S., Wendtner, C., Eich, H. T., & Eysel, P. (2011). The treatment of spinal metastases. Deutsches Aerzteblatt International, 108 (5), 71–80. doi: 10.3238/arztebl.2011.0071
  6. Vyrva, O. E., Golovina, Y. O., & Malyk, R. V. (2017). The differentiated approach to the choice of surgical treatment options in patients with metastatic lesions of long bones. Orthopedics, Traumatology and Prosthetics, 1, 54–62. doi: 10.15674/0030-59872017154-62. (in Ukrainian)
  7. Tomita, K., Kawahara, N., Kobayashi, T., Yoshida, A., Murakami, H., & Akamaru, T. (2001). Surgical strategy for spinal metastases. Spine, 26 (3), 298–306. doi:10.1097/00007632-200102010-00016
  8. Laufer, I., Sciubba, D. M., Madera, M., Bydon, A., Witham, T. J., Gokaslan, Z. L., & Wolinsky, J. P. (2012). Surgical management of metastatic spinal tumors. Cancer Control, 19 (2), 122–128. doi: 10.1177/107327481201900206
  9. Tokuhashi, Y., Matsuzaki, H., Tachikawa, Y., & Oda, H. (2002). A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. The Spine Journal, 2 (5), 74–75. doi: 10.1016/s1529-9430(02)00389-3
  10. Young, R. F., Post, E. M., & King, G. A. (1980). Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. Journal of Neurosurgery, 53 (6), 741–748. doi: 10.3171/jns.1980.53.6.0741
  11. Fourney, D. R., Abi-Said, D., Rhines, L. D., Walsh, G. L., Lang, F. F., McCutcheon, I. E., & Gokaslan, Z. L. (2001). Simultaneous anterior-posterior approach to the thoracic and lumbar spine for the radical resection of tumors followed by reconstruction and stabilization. Journal of Neurosurgery: Spine, 94 (2), 232–244. doi: 10.3171/spi.2001.94.2.0232
  12. Pointillart, V., Vital, J., Salmi, R., Diallo, A., & Quan, G. M. (2011). Survival prognostic factors and clinical outcomes in patients with spinal metastases. Journal of Cancer Research and Clinical Oncology, 137 (5), 849–856. doi: 10.1007/s00432-010-0946-0
  13. Quan, G. M., Vital, J., Aurouer, N., Obeid, I., Palussière, J., Diallo, A., & Pointillart, V. (2011). Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients. European Spine Journal, 20 (11), 1970–1978. doi: 10.1007/s00586-011-1867-6
  14. Wai, E. K., Finkelstein, J. A., Tangente, R. P., Holden, L., Chow, E., Ford, M., & Yee, A. (2003). Quality of life in surgical treatment of metastatic spine disease. Spine, 28 (5), 508–512. doi: 10.1097/01.brs.0000048646.26222.fa
  15. Witham, T. F., Khavkin, Y. A., Gallia, G. L., Wolinsky, J., & Gokaslan, Z. L. (2006). Surgery Insight: current management of epidural spinal cord compression from metastatic spine disease. Nature Clinical Practice Neurology, 2 (2), 87–94. doi: 10.1038/ncpneuro0116
  16. Smith, Z. A., & Fessler, R. G. (2012). Paradigm changes in spine surgery-evolution of minimally invasive techniques. Nature Reviews Neurology, 8 (8), 443–450. doi: 10.1038/nrneurol.2012.110
  17. Berenson, J., Pflugmacher, R., Jarzem, P., Zonder, J., Schechtman, K., Tillman, J. B., & Vrionis, F. (2011). Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. The Lancet Oncology, 12 (3), 225–235. doi: 10.1016/s1470-2045(11)70008-0
  18. . Fisher, C. G., Versteeg, A. L., Schouten, R., Boriani, S., Varga, P. P., Rhines, L. D., & Gokaslan, Z. L. (2014). Reliability of the spinal instability neoplastic scale among radiologists: an assessment of instability secondary to spinal metastases. American Journal of Roentgenology, 203 (4), 869–874. doi: 10.2214/ajr.13.12269
  19. Bilsky, M. H., Laufer, I., Fourney, D. R., Groff, M., Schmidt, M. H., Varga, P. P., Vrionis, F. D., Yamada, Y., Gerszten, P. C., & Kuklo, T. R. (2010). Reliability analysis of the epidural spinal cord compression scale. Journal of Neurosurgery: Spine, 13 (3), 324– 328. doi: 10.3171/2010.3.SPINE09459
  20. Frankel, H. L., Hancock, D. O., Hyslop, G., Melzak, J., Michaelis, L. S., Ungar, G. H., & Walsh, J. J. (1969). The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia, 7 (3), 179–192. doi: 10.1038/sc.1969.30
  21. Fehlings, M. G., Tetreault, L. A., Wilson, J. R., Kwon, B. K., Burns, A. S., Martin, A. R., & Harrop, J. S. (2017). A clinical practice guideline for the management of acute spinal cord injury: introduction, rationale, and scope. Global Spine Journal, 7 (3_suppl), 84S-94S. doi: 10.1177/2192568217703387
  22. Patchell, R. A., Tibbs, P. A., Regine, W. F., Payne, R., Saris, S., Kryscio, R. J., & Young, B. (2005). Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. The Lancet, 366 (9486), 643–648. doi: 10.1016/s0140-6736(05)66954-1
  23. Iacovou, J. W., Marks, J. C., Abrams, P. H., Gingell, J. C., & Ball, A. J. (1985). Cord compression and carcinoma of the prostate: is laminectomy justified? British Journal of Urology, 57 (6), 733–736. doi: 10.1111/j.1464-410x.1985.tb07043.x
  24. Park, S., Lee, C., & Chung, S. (2016). Surgical results of metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC): analysis of functional outcome, survival time, and complication. The Spine Journal, 16 (3), 322–328. doi: 10.1016/j.spinee.2015.11.005
  25. Abdelbaky, A., & Eltahawy, H. (2018). Neurological outcome following surgical treatment of spinal metastases. Asian Journal of Neurosurgery, 13 (2), 247. doi: 10.4103/ajns.ajns_43_16
  26. Falicov, A., Fisher, C. G., Sparkes, J., Boyd, M. C., Wing, P. C., & Dvorak, M. F. (2006). Impact of surgical intervention on quality of life in patients with spinal metastases. Spine, 31 (24), 2849–2856. doi: 10.1097/01.brs.0000245838.37817.40

How to Cite

Petrenko, D., Popov, A., & Chekryzhev, O. (2019). Analysis of surgical treatment results in spinal metastasis. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (2), 74–81. https://doi.org/10.15674/0030-59872019274-81

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Section

ORIGINAL ARTICLES