A Novel Classification System for Spinal Instability in Neoplastic Disease

Fisher, Charles G.; DiPaola, Christian P.; Ryken, Timothy C.; Bilsky, Mark H.; Shaffrey, Christopher I.; Berven, Sigurd; Harrop, James S.; Fehlings, Michael G.; Boriani, Stefano; Chou, Dean; Schmidt, Meic H.; Polly, David W.; Biagini, R.; Burch, Shane; Dekutoski, Mark B.; Ganju, Aruna; Gerszten, Peter C.; Gokaslan, Ziya L.; Groff, Michael W.; Liebsch, Norbert J.; Mendel, Ehud; Okuno, Scott H.; Patel, Shreyaskumar; Rhines, Laurence D.; Rose, Peter S.; Sciubba, Daniel M.; Sundaresan, Narayan; Tomita, Katsuro; Varga, Péter; Vialle, Luiz Roberto; Vrionis, Frank D.; Yamada, Yoshiya; Fourney, Daryl R.

doi:10.1097/brs.0b013e3181e16ae2

Cited by 987 publications

(301 citation statements)

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“…Since then, various criteria have been developed for the selection of patients that would benefi t most from surgical treatment 9,13 . Th e degree of spinal cord compression has been better defi ned 15 , a framework has been established for considering spinal instability brought about by malignant disease 16 , and most recently, the required extent of treatment has been better defi ned 17 . Th us, spinal surgery has established its place within the complex, multidisciplinary and palliative approach to patients with spinal metastatic disease.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Surgical Treatment of Metastatic Disease of the Vertebral Column

Franić¹,

Bilić

Dokuzović

et al. 2016

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SUMMARY -Spinal metastatic disease is a rather common occurrence and defi nitely warrants attention and treatment due to the high likelihood of leaving cancer patients severely disabled in their fi nal months of life. Recent developments in the understanding of the behavior of diff erent tumor types, as well as advances in surgical treatment, are allowing for the evolution of treatment algorithms, especially when surgical treatment is to be considered. Th is paper gives an overview of the decisionmaking process and the array of surgical options currently available.

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Section: Surgical Techniquesmentioning

confidence: 99%

Surgical Treatment of Metastatic Disease of the Vertebral Column

Franić¹,

Bilić

Dokuzović

et al. 2016

acc

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“…In terms of malignant tumors, surgery plays a very limited role in tumor control. Mechanical instability has recently been defined for neoplastic disease and a scoring system, spinal instability neoplastic score (SINS), has been developed to aid in this assessment 20 . The recognition of spinal instability resulting from tumor is imperative because an unstable spine will not respond to radiation and/or chemotherapy, but requires an intervention, such as brace application, percutaneous cement augmentation and/or pedicle screws, or open surgery.…”

Section: Patient's Evaluation -Treatment Decision Processmentioning

confidence: 99%

“…However, patients' with severe pain due to instability or in specific selected cases may have benefits of small surgical procedures for stabilization/ decompression if they can tolerate it, after thorough multidisciplinary analysis 9,10 . Instability, evaluated by the SINS, is an indication for surgery that is independent of other variables, such as tumor histology or radiosensitivity 8,20 . Modern spinal instrumentation with anterior and/ or posterior fixation can decrease the pain and improve neurological function secondary to spinal instability 10,35 .…”

Section: Open Surgerymentioning

confidence: 99%

“…Surgical consultation is recommended when patients had a score of 7 to 18. Mechanical instability is an indication for surgical stabilization, regardless of tumor radioresistance to cEBRT or histology 20 .…”

Section: -Mechanical Instabilitymentioning

confidence: 99%

“…Mechanical instability in the setting of neoplastic spinal disease can be evaluated used the SINS (Table 3), a new comprehensive classification system recently proposed that is based on patient symptoms and radiographic criteria in an attempt to predict eventual spinal instability 20 .…”

Section: -Mechanical Instabilitymentioning

confidence: 99%

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An update in the management of spinal metastases

Joaquim

Powers

Laufer

et al. 2015

Arq. Neuro-Psiquiatr.

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Advances in cancer treatment over the past decade, such biologics and immunotherapy are improving patient outcomes and consequently life expectancy. The most common sites for metastases in the general population with cancer are the liver and lungs, followed by bone. Considering bone metastases, the majority will affect the spine 1 . Some studies estimate that up to 40% of all patients with cancer will have spinal metastases (SM) during the course of their disease 2,3 . The most frequent histologic types of cancer that give rise to bone metastases are breast, prostate and lung cancer 4 . Most of the spinal metastases are diagnosed following the diagnosis of the primary cancer. However, in about 10% of the patients, SM is the first manifestation of an unknown primary tumor 1 . Spinal cord compression is expected in up to 20% of the patients with SM. Approximately 95% of the patients with SM will demonstrate epidural metastases, mainly affecting the vertebral body and the pedicle regions, whereas 5% will present with intradural and less than 1% with intramedullary metastases 5,6 . Symptomatic spinal cord compression occurs more frequently in the thoracic spine, followed by cervical and then lumbar. The greater incidence of SM in the thoracic spine is attributed to the higher number of vertebrae and small canal diameter AbstrActThe best clinical treatment for spinal metastases requires an integrated approach with input from an interdisciplinary cancer team. The principle goals of treatment are maintenance or improvement in neurologic function and ambulation, spinal stability, durable tumor control, and pain relief. The past decade has witnessed an explosion of new technologies that have impacted our ability to reach these goals, such as separation surgery and minimally invasive spinal procedures. The biggest advance, however, has been the evolution of stereotactic radiosurgery that has demonstrated durable tumor control both when delivered as definitive therapy and as a postoperative adjuvant even for tumors considered markedly resistant to conventional external beam radiation. In this paper, we perform an update on the management of spinal metastases demonstrating the integration of these new technologies into a decision framework NOMS that assesses four basic aspects of a patient's spine disease: Neurologic, Oncologic, Mechanical Instability and Systemic disease.Keywords: spinal metastases, bone metastases, diagnosis, management, treatment, NOMS.resumo O tratamento dos pacientes com metástases na coluna requer uma abordagem multidisciplinar por equipe especializada em oncologia. Os objetivos básicos do tratamento são a manutenção/ melhora da função neurológica com preservação da deambulação, manutenção da estabilidade da coluna, controle tumoral e alívio da dor. A última década testemunhou uma explosão de novas tecnologias que auxiliaram a atingir os objetivos terapêuticos, como a cirurgia de separação e procedimentos minimamente cirúrgicos minimamente invasivos. Contudo, o maior avanço terapêutico constitui-se d...

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Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases

Bindels,

Mercier,

Gal

et al. 2024

JAMA Netw Open

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ImportanceConventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported.ObjectiveTo compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain.Data SourcesA structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT.Study SelectionComparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases.Data Extraction and SynthesisTwo independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.Main Outcomes and MeasuresOverall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study’s definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis.ResultsThere were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results.Conclusions and RelevanceIn this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.

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A Novel Classification System for Spinal Instability in Neoplastic Disease

Cited by 987 publications

References 34 publications

Surgical Treatment of Metastatic Disease of the Vertebral Column

Surgical Treatment of Metastatic Disease of the Vertebral Column

An update in the management of spinal metastases

Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases

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