Bart Depreitere1, Federico Ricciardi2, Mark Arts3, Laurent Balabaud4, Cody Bunger5, Jacob M Buchowski6, Chun Kee Chung7, Maarten Hubert Coppes8, Michael George Fehlings9, Norio Kawahara10, Juan Antonio Martin-Benlloch11, Eric Maurice Massicotte9, Christian Mazel12, Bernhard Meyer13, Fetullah Cumhur Oner14, Wilco Peul15, Nasir Quraishi16, Yasuaki Tokuhashi17, Katsuro Tomita18, Jorrit-Jan Verlaan14, Michael Wang19, Hugh Alan Crockard20, David Choi20. 1. Division of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. bart.depreitere@uzleuven.be. 2. Department of Statistical Science, University College London, London, UK. 3. Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, Netherlands. 4. Orthopaedics and Traumatology Centre, Clinique Mutualiste de la Porte de L'Orient, L'Orient, France. 5. Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark. 6. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. 7. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. 8. Department of Neurosurgery, University Medical Centre Groningen, Groningen, Netherlands. 9. Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Canada. 10. Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan. 11. Spinal Unit, Hospital Universitario Dr Peset, Valencia, Spain. 12. Department of Orthopedic surgery, L'Institut Mutualiste Montsouris, Paris, France. 13. Department of Neurosurgery, Technische Universität München, Munich, Germany. 14. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, Netherlands. 15. Department of Neurosurgery, Leiden University Medical Centre, Leiden, Netherlands. 16. Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK. 17. Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan. 18. Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan. 19. Department of Neurosurgery, Jackson Memorial Hospital, University of Miami, Miami, USA. 20. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, UK.
Abstract
BACKGROUND: The benefits of surgery for symptomatic spinal metastases have been demonstrated, largely based on series of patients undergoing debulking and instrumentation operations. However, as cancer treatments improve and overall survival lengths increase, the incidence of recurrent spinal cord compression after debulking may increase. The aim of the current paper is to document the postoperative evolution of neurological function, pain, and quality of life following debulking and instrumentation in the Global Spine Tumor Study Group (GSTSG) database. METHODS: The GSTSG database is a prospective multicenter data repository of consecutive patients that underwent surgery for a symptomatic spinal metastasis. For the present analysis, patients were selected from the database that underwent decompressive debulking surgery with instrumentation. Preoperative tumor type, Tomita and Tokuhashi scores, EQ-5D, Frankel, Karnofsky, and postoperative complications, survival, EQ-5D, Frankel, Karnofsky, and pain numeric rating scores (NRS) at 3, 6, 12, and 24 months were analyzed. RESULTS: A total of 914 patients underwent decompressive debulking surgery with instrumentation and had documented follow-up until death or until 2 years post surgery. Median preoperative Karnofsky performance index was 70. A total of 656 patients (71.8%) had visceral metastases and 490 (53.6%) had extraspinal bone metastases. Tomita scores were evenly distributed above (49.1%) and below or equal to 5 (50.9%), and Tokuhashi scores almost evenly distributed below or equal to 8 (46.3%) and above 8 (53.7%). Overall, 12-month survival after surgery was 56.3%. The surgery resulted in EQ-5D health status improvement and NRS pain reduction that was maintained throughout follow-up. Frankel scores improved at first follow-up in 25.0% of patients, but by 12 months neurological deterioration was observed in 18.8%. CONCLUSION: We found that palliative debulking and instrumentation surgeries were performed throughout all Tomita and Tokuhashi categories. These surgeries reduced pain scores and improved quality of life up to 2 years after surgery. After initial improvement, a proportion of patients experienced neurological deterioration by 1 year, but the majority of patients remained stable.
BACKGROUND: The benefits of surgery for symptomatic spinal metastases have been demonstrated, largely based on series of patients undergoing debulking and instrumentation operations. However, as cancer treatments improve and overall survival lengths increase, the incidence of recurrent spinal cord compression after debulking may increase. The aim of the current paper is to document the postoperative evolution of neurological function, pain, and quality of life following debulking and instrumentation in the Global Spine Tumor Study Group (GSTSG) database. METHODS: The GSTSG database is a prospective multicenter data repository of consecutive patients that underwent surgery for a symptomatic spinal metastasis. For the present analysis, patients were selected from the database that underwent decompressive debulking surgery with instrumentation. Preoperative tumor type, Tomita and Tokuhashi scores, EQ-5D, Frankel, Karnofsky, and postoperative complications, survival, EQ-5D, Frankel, Karnofsky, and pain numeric rating scores (NRS) at 3, 6, 12, and 24 months were analyzed. RESULTS: A total of 914 patients underwent decompressive debulking surgery with instrumentation and had documented follow-up until death or until 2 years post surgery. Median preoperative Karnofsky performance index was 70. A total of 656 patients (71.8%) had visceral metastases and 490 (53.6%) had extraspinal bone metastases. Tomita scores were evenly distributed above (49.1%) and below or equal to 5 (50.9%), and Tokuhashi scores almost evenly distributed below or equal to 8 (46.3%) and above 8 (53.7%). Overall, 12-month survival after surgery was 56.3%. The surgery resulted in EQ-5D health status improvement and NRS pain reduction that was maintained throughout follow-up. Frankel scores improved at first follow-up in 25.0% of patients, but by 12 months neurological deterioration was observed in 18.8%. CONCLUSION: We found that palliative debulking and instrumentation surgeries were performed throughout all Tomita and Tokuhashi categories. These surgeries reduced pain scores and improved quality of life up to 2 years after surgery. After initial improvement, a proportion of patients experienced neurological deterioration by 1 year, but the majority of patients remained stable.
Entities:
Keywords:
Debulking surgery; Frankel score; Metastasis; Quality of life; Spine
Authors: Arthur Wagner; Elena Haag; Ann-Kathrin Joerger; Philipp Jost; Stephanie E Combs; Maria Wostrack; Jens Gempt; Bernhard Meyer Journal: Sci Rep Date: 2021-04-12 Impact factor: 4.379