Andrew J Schoenfeld1, Marco L Ferrone2, Joseph H Schwab3, Justin A Blucher2, Lauren B Barton2, Mitchel B Harris3, James D Kang2. 1. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, United States. Electronic address: ajschoen@neomed.edu. 2. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, United States. 3. Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02214, United States.
Abstract
OBJECTIVES: To assess the impact of surgical intervention on survival, ambulatory capacity, complications and readmissions following treatment for lumbar metastases. PATIENTS AND METHODS: We identified all adult patients treated for lumbar metastases between 2005-2017. To limit the potential for inherent bias to influence determinations, we used principal component analysis to identify confounders to be included in multivariable testing. Multivariable logistic regression was performed, followed by Bayesian analysis to generate conservative estimates of effect size and 95% confidence intervals (CI). In a sensitivity test, analyses were repeated in a population where patients who died before they could initiate treatment were excluded. RESULTS: In the period under study, we identified 571 patients who met inclusion criteria. Twenty-one percent of the cohort received a surgical intervention. Bayes regression indicated surgical intervention was independently associated with decreased mortality at 6-months (odds ratio [OR] 0.49; 95% CI 0.34, 0.68) and 1-year (OR 0.63; 95% CI 0.51, 0.76), along with lower odds of being non-ambulatory at 6-months following presentation (OR 0.29; 95% CI 0.18, 0.45). Surgery was also associated with increased odds of complications (OR 1.60; 95% CI 1.24, 2.06) and readmissions (OR 1.37; 95% CI 1.09, 1.72). Numerous clinical characteristics were found to be associated with the outcomes of interest including serum albumin, lung metastases and vertebral body collapse. CONCLUSIONS: Given the favorable outcomes associated with the incorporation of surgery as a component of treatment, we believe that such interventions may be considered part of the treatment approach in patients with lumbar metastases.
OBJECTIVES: To assess the impact of surgical intervention on survival, ambulatory capacity, complications and readmissions following treatment for lumbar metastases. PATIENTS AND METHODS: We identified all adult patients treated for lumbar metastases between 2005-2017. To limit the potential for inherent bias to influence determinations, we used principal component analysis to identify confounders to be included in multivariable testing. Multivariable logistic regression was performed, followed by Bayesian analysis to generate conservative estimates of effect size and 95% confidence intervals (CI). In a sensitivity test, analyses were repeated in a population where patients who died before they could initiate treatment were excluded. RESULTS: In the period under study, we identified 571 patients who met inclusion criteria. Twenty-one percent of the cohort received a surgical intervention. Bayes regression indicated surgical intervention was independently associated with decreased mortality at 6-months (odds ratio [OR] 0.49; 95% CI 0.34, 0.68) and 1-year (OR 0.63; 95% CI 0.51, 0.76), along with lower odds of being non-ambulatory at 6-months following presentation (OR 0.29; 95% CI 0.18, 0.45). Surgery was also associated with increased odds of complications (OR 1.60; 95% CI 1.24, 2.06) and readmissions (OR 1.37; 95% CI 1.09, 1.72). Numerous clinical characteristics were found to be associated with the outcomes of interest including serum albumin, lung metastases and vertebral body collapse. CONCLUSIONS: Given the favorable outcomes associated with the incorporation of surgery as a component of treatment, we believe that such interventions may be considered part of the treatment approach in patients with lumbar metastases.
Authors: Jennifer Moliterno; Clinton A Veselis; Michael A Hershey; Eric Lis; Ilya Laufer; Mark H Bilsky Journal: Spine J Date: 2014-03-12 Impact factor: 4.166
Authors: Andrew J Schoenfeld; Christopher M Bono; William M Reichmann; Natalie Warholic; Kirkham B Wood; Elena Losina; Jeffrey N Katz; Mitchel B Harris Journal: Spine (Phila Pa 1976) Date: 2011-05-15 Impact factor: 3.468
Authors: Ahmer K Ghori; Dana A Leonard; Andrew J Schoenfeld; Ehsan Saadat; Nathan Scott; Marco L Ferrone; Adam M Pearson; Mitchel B Harris Journal: Spine J Date: 2015-07-06 Impact factor: 4.166
Authors: David Choi; Zoe Fox; Todd Albert; Mark Arts; Laurent Balabaud; Cody Bunger; Jacob M Buchowski; Maarten H Coppes; Bart Depreitere; Michael G Fehlings; James Harrop; Norio Kawahara; Juan A Martin-Benlloch; Eric M Massicotte; Christian Mazel; Fetullah C Oner; Wilco Peul; Nasir Quraishi; Yasuaki Tokuhashi; Katsuro Tomita; Jorit Jan Verlaan; Michael Wang; H Alan Crockard Journal: Neurosurgery Date: 2015-11 Impact factor: 4.654
Authors: Andrew J Schoenfeld; Hai V Le; Youssra Marjoua; Dana A Leonard; Philip J Belmont; Christopher M Bono; Mitchel B Harris Journal: Spine J Date: 2015-09-25 Impact factor: 4.166
Authors: Andrew J Schoenfeld; Paul A Carey; Andrew W Cleveland; Julia O Bader; Christopher M Bono Journal: Spine J Date: 2013-04-09 Impact factor: 4.166