Management of neoplastic spinal tumors in a spine surgery care unit
Introduction
The World Health Organisation (WHO) estimates that 10 million people were newly diagnosed with cancer worldwide in 2000 and expects cancer rates to increase by 50% to reach 15 million by 2020. In 2010, an estimated 1.53 million cases of newly diagnosed cancer were expected in the US alone [1]. Bones are the 3rd most common site of metastases following lung and liver [2]. Of the various bones, the spine is the most commonly affected site. As cancer patients live longer, due to an improvement in treatment options, the incidence of spine metastases, which are known to occur in 30 to 50% of cancer patients [3], will also rise. Breast, prostate, lung, kidney, thyroid and multiple myeloma are the most common primary sites, reflecting both the high prevalence of these cancer types and their predilection to the bones. The management of spine metastases is an important concern not only for oncologists but also for patients, as they can severely affect their quality of life. Indeed, axial or radicular pain occurs in up to 80% of patients with spine metastasis [4], [5]. Moreover, spinal cord or cauda equina compression occur in up to 20% of patients with pre-existing spine metastasis and in 5 to 10% of all cancer patients [6]. It is well established that patients with no or slow development of neurological deficits are good candidates for radiotherapy as they have a good functional outcome. In contrary, patients with rapid deterioration within 48 h are not suitable for radiotherapy only, as it demonstrated poor outcomes [7]. Although, surgery allows rapid and wide decompression of neurological elements, emergency interventions are associated with uncertain recovery and increased morbidity in such patients [8]. Neurological impairment may be due to an epidural involvement or to an acute pathologic fracture. Both situations can be avoided if detected and treated early. Management of spine metastasis require a truly multi-disciplinary approach to detect and treat promptly patients at risk, in order to avoid this dreaded complication. A multidisciplinary staff meeting has been established in January 2007 in our institution, and this study aims to assess how it could decrease the proportion of neoplastic spine lesions operated on emergency.
Section snippets
Data collection
Using the coding process, we retrospectively studied patients hospitalized for the treatment of a spine tumor in the spine surgery care unit of the Lille university hospital, between January 2005 and December 2012. The clinical records of 523 patients were carefully analyzed. Age, sex, clinical signs, radiological findings, and histopathological results have been systematically recorded in the medical records. Pain and neurological status were respectively measured using the VAS scale and the
Population
In total, 317 patients were included in the study. There were 166 men and 151 women and the mean age was 57.97 years (range 26–88; SD 12.45). The mean Karnofsky score was 75 (range 40–100; SD 14.59). At the time of admission, 224 patients had a known cancer, while the lesion revealed the disease for the other 93 patients. After final pathological analysis, 60 patients had a multiple myeloma while the 257 others suffered from a solid cancer (Table 2). For patients with known primary cancer, the
Oncological evaluation
The Tokuhashi score [10] aims to assess the life expectancy of the patient based on 6 parameters. This score takes into consideration neurological status, oncologic factors and patient's general condition in making treatment decisions (Table 1). This score aims to guide the choice of therapy by assessing the life expectancy, which is a determining criteria. When the total score is inferior to 8, the life expectancy is likely to be less than 6 months and a palliative approach is preferable. In
Conclusion
There is no consensus regarding the ideal treatment of spine metastasis. Due to the high variability of clinical and radiological presentations, best care requires a multidisciplinary team, involving oncologists, radiation oncologists, interventional radiologists, spine surgeons and rheumatologist. Threatening lesions should benefit from a prompt and individualized treatment to avoid acute dreaded complications.
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Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases
2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :The advent of minimally invasive (MIS) surgery has helped to reduce perioperative complications. The initial studies of percutaneous instrumentation with decompression through a reduced approach showed that this strategy was effective for treating patients suffering from spinal metastasis [14,15]. Thus there appears to be a theoretical benefit of using MIS techniques relative to doing open surgery for treating vertebral metastases [16–20].
Comparison of open versus minimally invasive surgery in the treatment of thoracolumbar metastases
2022, Revue de Chirurgie Orthopedique et TraumatologiqueEffect of combined treatment including surgery and postoperative adjuvant therapy on spinal metastases of Tomita type 7
2019, Clinical Neurology and NeurosurgeryCitation Excerpt :The amount of blood loss is a crucial parameter to evaluate safety of surgery, and it is affected by many factors including primary tumor type, surgical procedure, surgeon’s preference and skills and the use of hemostatic equipment [22]. Outcomes in Fahed’s study demonstrated that the emergency nature of the surgery were associated with increased blood loss because of the wide decompression of neural elements, wide skin incision and muscle desinsertion [23]. However the primary tumor type is of most importance among all these factors as we know [24].
Evaluation of the Relevance of Surgery in Patients with Multiple Myeloma Harboring Symptomatic Spinal Involvement: A Retrospective Case Series
2018, World NeurosurgeryCitation Excerpt :All these factors imply a high risk of neurologic complications,10,17,21-28 and substantially reduce independence and quality of life.29-33 The treatment of myeloma is complex and requires a truly multidisciplinary approach, especially when considering spine lesions.10,24,32,34 Although chemotherapy in combination with bisphosphonates aims to reduce plasma-cell proliferation and bone destruction,9,19,34-38 there is still no consensus regarding the role of local treatments such as radiotherapy, vertebroplasty/kyphoplasty, or surgery.