PURPOSE: In patients with metastatic disease to the spine, patient selection for surgery and the extent of surgery to perform thereafter remains controversial, with the patient's survival prognosis the most important consideration. For this reason, we conducted a prospective study investigating prognostic factors and clinical outcomes in a consecutive series of patients with vertebral metastases. METHODS: A total of 142 consecutive patients with vertebral metastases referred to us for consideration of surgery were prospectively enrolled into this study. Of these, 118 patients subsequently underwent palliative surgery for intractable pain or radiculopathy, bony instability or spinal cord compression. Patients were followed up for 12 months or until death. A multivariate analysis of the patients was conducted using the Cox proportional hazards model. The survival predictive accuracy of the Tokuhashi score was also investigated. For the patients who underwent surgery, pre- and post-operative outcomes were assessed on pain, neurological deficit, function and overall quality of life. RESULTS: The overall 12-month mortality rate was 50.7% and the median survival was 5 months. Multivariate analysis showed that independent prognostic factors for survival after spinal metastases include primary tumour type, Karnofsky functional status, ASA score and pain. Neither the original nor revised Tokuhashi scores were reliable in predicting survival in our European population. In the patients who underwent operative intervention, there was an immediate and prolonged improvement in pain, neurological deficit, function and quality of life in the majority of cases. CONCLUSIONS: The potential for rapid and maintained improvement in clinical outcome and quality of life should be considered when selecting patients with metastatic disease to the spine for surgery rather than basing decisions solely on survival prognostic factors comprising current scoring systems.
PURPOSE: In patients with metastatic disease to the spine, patient selection for surgery and the extent of surgery to perform thereafter remains controversial, with the patient's survival prognosis the most important consideration. For this reason, we conducted a prospective study investigating prognostic factors and clinical outcomes in a consecutive series of patients with vertebral metastases. METHODS: A total of 142 consecutive patients with vertebral metastases referred to us for consideration of surgery were prospectively enrolled into this study. Of these, 118 patients subsequently underwent palliative surgery for intractable pain or radiculopathy, bony instability or spinal cord compression. Patients were followed up for 12 months or until death. A multivariate analysis of the patients was conducted using the Cox proportional hazards model. The survival predictive accuracy of the Tokuhashi score was also investigated. For the patients who underwent surgery, pre- and post-operative outcomes were assessed on pain, neurological deficit, function and overall quality of life. RESULTS: The overall 12-month mortality rate was 50.7% and the median survival was 5 months. Multivariate analysis showed that independent prognostic factors for survival after spinal metastases include primary tumour type, Karnofsky functional status, ASA score and pain. Neither the original nor revised Tokuhashi scores were reliable in predicting survival in our European population. In the patients who underwent operative intervention, there was an immediate and prolonged improvement in pain, neurological deficit, function and quality of life in the majority of cases. CONCLUSIONS: The potential for rapid and maintained improvement in clinical outcome and quality of life should be considered when selecting patients with metastatic disease to the spine for surgery rather than basing decisions solely on survival prognostic factors comprising current scoring systems.
Authors: E A Enkaoua; L Doursounian; G Chatellier; F Mabesoone; T Aimard; G Saillant Journal: Spine (Phila Pa 1976) Date: 1997-10-01 Impact factor: 3.468
Authors: Alexis Falicov; Charles G Fisher; Joe Sparkes; Michael C Boyd; Peter C Wing; Marcel F Dvorak Journal: Spine (Phila Pa 1976) Date: 2006-11-15 Impact factor: 3.468
Authors: Ahmed Ibrahim; Alan Crockard; Pierre Antonietti; Stefano Boriani; Cody Bünger; Alessandro Gasbarrini; Anders Grejs; Jürgen Harms; Norio Kawahara; Christian Mazel; Robert Melcher; Katsuro Tomita Journal: J Neurosurg Spine Date: 2008-03
Authors: Rachit Kumar; Anick Nater; Ahmed Hashmi; Sten Myrehaug; Young Lee; Lijun Ma; Kristin Redmond; Simon S Lo; Eric L Chang; Albert Yee; Charles G Fisher; Michael G Fehlings; Arjun Sahgal Journal: Neurooncol Pract Date: 2015-07-27
Authors: N A Quraishi; S R Manoharan; G Arealis; A Khurana; S Elsayed; K L Edwards; B M Boszczyk Journal: Eur Spine J Date: 2013-01-18 Impact factor: 3.134
Authors: L Bollen; G C W de Ruiter; W Pondaag; M P Arts; M Fiocco; T J T Hazen; W C Peul; P D S Dijkstra Journal: Eur Spine J Date: 2013-03-02 Impact factor: 3.134