David Choi1, Menelaos Pavlou2, Rumana Omar2, Mark Arts3, Laurent Balabaud4, Jacob Maciej Buchowski5, Cody Bunger6, Chun Kee Chung7, Maarten Hubert Coppes8, Bart Depreitere9, Michael George Fehlings10, Norio Kawahara11, Chong-Suh Lee12, YeeLing Leung13, Juan Antonio Martin-Benlloch14, Eric Maurice Massicotte10, Christian Mazel15, Bernhard Meyer16, Fetullah Cumhur Oner17, Wilco Peul18, Nasir Quraishi19, Yasuaki Tokuhashi20, Katsuro Tomita21, Christian Ulbricht22, Jorrit-Jan Verlaan17, Michael Wang23, Hugh Alan Crockard24. 1. Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London, London, UK. Electronic address: david.choi@nhs.net. 2. Department of Statistical Science, University College London, London UK. 3. Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, the Netherlands. 4. Orthopaedics and Traumatology Centre, Clinique Mutualiste de la Porte de L'Orient, Lorient, France. 5. Departments of Orthopedic and Neurological Surgery, Washington University, Missouri, USA. 6. Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark. 7. Department of Neurosurgery, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea. 8. Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 9. Division of Neurosurgery, University Hospital Leuven, Leuven, Belgium. 10. Division of Neurosurgery and Spinal Program, University Hospital of Toronto and Toronto Western Hospital, Toronto, Canada. 11. Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan. 12. Department of Orthopedic Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 13. Department of Orthopaedics, Musgrove Park Hospital, Taunton, UK. 14. Spinal Unit, University Hospital Dr. Peset, Valencia, Spain. 15. Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France. 16. TUM School of Medicine, Technische Universitat Munchen, Munich, Germany. 17. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 18. Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands. 19. Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK. 20. Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan. 21. Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan. 22. Department of Neurosurgery, Charing Cross Hospital, London, UK. 23. Department of Neurosurgery, University of Miami Hospital, Miami, USA. 24. Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London, London, UK.
Abstract
AIM: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate. We designed a risk calculator to estimate survival after surgery, to inform clinicians and patients when making management decisions. METHODS: A prospective cohort study was performed, including 1430 patients with spinal metastases who underwent surgery. Of them, 1264 patients from 20 centres were used for model development using a Cox frailty model. Calibration slope, D-statistic and C-index were used for model validation based on 166 patients. Follow-up was to death or minimum of 2 years after surgery. Pre-operative indices (examination findings, pain, Karnofsky physical functioning score, and radiology) were assessed. RESULTS: An algorithm to predict survival was constructed including the tumour type, ambulatory status, analgesic use, American Society of Anesthesiologists score, number of spinal metastases, previous radiotherapy or chemotherapy, presence of visceral metastases, cervical or thoracic spine involvement, as predictors. An Internet-based risk calculator was developed based on this algorithm, with similar or improved accuracy compared to other validated prognostic scoring systems (C-index, 0.68; 95% confidence interval, 0.63--0.73, and calibration slope, 1.00; 95% confidence interval, 0.68--1.32). CONCLUSION: A large, prospective, surgical series of patients with symptomatic spinal metastases was used to create a validated risk calculator that can help clinicians to inform patients about the most appropriate treatment plan. The calculator is available at www.spinemet.com.
AIM: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate. We designed a risk calculator to estimate survival after surgery, to inform clinicians and patients when making management decisions. METHODS: A prospective cohort study was performed, including 1430 patients with spinal metastases who underwent surgery. Of them, 1264 patients from 20 centres were used for model development using a Cox frailty model. Calibration slope, D-statistic and C-index were used for model validation based on 166 patients. Follow-up was to death or minimum of 2 years after surgery. Pre-operative indices (examination findings, pain, Karnofsky physical functioning score, and radiology) were assessed. RESULTS: An algorithm to predict survival was constructed including the tumour type, ambulatory status, analgesic use, American Society of Anesthesiologists score, number of spinal metastases, previous radiotherapy or chemotherapy, presence of visceral metastases, cervical or thoracic spine involvement, as predictors. An Internet-based risk calculator was developed based on this algorithm, with similar or improved accuracy compared to other validated prognostic scoring systems (C-index, 0.68; 95% confidence interval, 0.63--0.73, and calibration slope, 1.00; 95% confidence interval, 0.68--1.32). CONCLUSION: A large, prospective, surgical series of patients with symptomatic spinal metastases was used to create a validated risk calculator that can help clinicians to inform patients about the most appropriate treatment plan. The calculator is available at www.spinemet.com.
Authors: Maria E Tecos; Brittany S Kern; Nathan A Foje; Marilyn L Leif; Mitchell Schmidt; Allie Steinberger; Adam Bajinting; Keely L Buesing Journal: Surg Open Sci Date: 2020-04-26
Authors: Lauren B Barton; Kaetlyn R Arant; Justin A Blucher; Danielle L Sarno; Kristin J Redmond; Tracy A Balboni; Matthew Colman; C Rory Goodwin; Ilya Laufer; Rick Placide; John H Shin; Daniel M Sciubba; Elena Losina; Jeffrey N Katz; Andrew J Schoenfeld Journal: J Bone Joint Surg Am Date: 2021-01-06 Impact factor: 6.558