Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review

Brande, Ruben van den; Cornips, Erwin M. J.; Peeters, Marc; Ost, Piet; Billiet, Charlotte; Kelft, Erik Van de

doi:10.1016/j.jbo.2022.100446

Cited by 74 publications

(43 citation statements)

References 75 publications

(195 reference statements)

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“…Spinal metastases are most common in patients with advanced disease among all cancer types (1)(2)(3)(4)(5). They frequently cause vertebral body collapse (VBC) and malignant spinal cord compression (MSCC), resulting in pain and paralysis.…”

Section: Introductionmentioning

confidence: 99%

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Vertebral body collapse after radiotherapy for spinal metastases

et al. 2023

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Spinal metastases are common in patients with advanced stages of cancer and frequently cause vertebral body collapse (VBC). Although conventional radiotherapy (RT) is used for spinal metastases, the rates of occurrence of new VBC and progression of VBC at RT initiation have not been fully investigated. The present retrospective study assessed VBC and its associated risk factors after RT over time and evaluated new VBC and progression of VBC in patients who presented with VBC at RT initiation. The study evaluated 177 patients who received RT for vertebral metastases without paralysis between July 2012 and November 2016. Radiological responses of the irradiated vertebrae were assessed using computed tomography. Follow-up assessments were performed at RT initiation and 1, 2, 3, 4 and 6 months after RT. New VBC occurred in 12% of patients with no prior VBC within 1 month of RT. Multivariate analysis revealed that numeric rating scale (NRS) score (≥4) [relative risk (RR), 27.1; 95% confidence interval (CI), 1.86 to 394.9; P= 0.016] was associated with the occurrence of new VBC at the 1 month follow-up time point. VBC progression occurred in 51% of the patients with collapse at RT initiation. Multivariate analysis revealed that bone quality (lytic metastases) (RR, 3.1; 95% CI, 1.28 to 7.70; P=0.013), NRS score (≥4) (RR, 3.0; 95% CI, 1.18 to 7.45; P=0.021) and tumor involvement of posterolateral elements of the spine (RR, 2.7; 95% CI, 1.03 to 7.29; P=0.04) were associated with the progression of VBC at the 1 month follow-up time point. The current study findings suggested that clinicians should pay attention to the factors that predict the occurrence of new VBC and VBC progression to ensure proper evaluation of conservative treatment effectiveness and facilitate the determination of patients who need close monitoring.

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Section: Introductionmentioning

confidence: 99%

“…VBC is caused by the destruction of the vertebral body. It often accompanies pain and sometimes has paralysis when spinal cord is compressed by collapsed vertebral body (1,2). MSCC is usually caused by the compression of spinal cord by metastatic tumor which extends into the vertebral column.…”

Section: Introductionmentioning

confidence: 99%

Vertebral body collapse after radiotherapy for spinal metastases

et al. 2023

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“…Metastatic epidural spinal cord compression (MESCC) is the secondary compression of the spinal cord due to cancer metastases to the spine or epidural space, and it can reduce the quality of life because of cancer-associated back and leg pain, neurological deficit, and loss of bladder and bowel continence ( 1 , 2 ). The morbidity of this disease is about 5%–10% among patients with malignant tumors ( 1 ), and approximately one out of ten spine metastases patients will develop MESCC ( 3 ). Therapeutic standards for MESCC patients are not yet accessible.…”

Section: Introductionmentioning

confidence: 99%

Preoperative embolization in the treatment of patients with metastatic epidural spinal cord compression: A retrospective analysis

Zhang

Zhao

et al. 2022

Front. Oncol.

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PurposeThe purpose of the study was to assess the effectiveness and safety of preoperative embolization in the treatment of patients with metastatic epidural spinal cord compression (MESCC).MethodsA retrospective analysis of 138 MESCC patients who underwent decompressive surgery and spine stabilization was performed in a large teaching hospital. Among all enrolled patients, 46 patients were treated with preoperative embolization (the embolization group), whereas 92 patients did not (the control group). Patient’s baseline clinical characteristics, surgery-related characteristics, and postoperative neurological status, complications, and survival prognoses were collected and analyzed. Subgroup analysis was performed according to the degree of tumor vascularity between patients with and without preoperative embolization.ResultsPatients with severe hypervascularity experienced more mean blood loss in the control group than in the embolization group, and this difference was statistically significant (P=0.02). The number of transfused packed red cells (PRC) showed a similar trend (P=0.01). However, for patients with mild and moderate hypervascularity, both blood loss and the number of PRC transfusion were comparable across the two groups. Regarding decompressive techniques, the embolization group (64.29%, 9/14) had a higher proportion of circumferential decompression in comparison to the control group (30.00%, 9/30) among patients with severe hypervascularity (P=0.03), whereas the rates were similar among patients with mild (P=0.45) and moderate (P=0.54) hypervascularity. In addition, no subgroup analysis revealed any statistically significant differences in operation time, postoperative functional recovery, postoperative complications, or survival outcome. Multivariate analysis showed that higher tumor vascularity (OR[odds ratio]=3.69, 95% CI [confident interval]: 1.30-10.43, P=0.01) and smaller extent of embolization (OR=4.16, 95% CI: 1.10-15.74, P=0.04) were significantly associated with more blood loss.ConclusionsPreoperative embolization is an effective and safe method in treating MESCC patients with severe hypervascular tumors in terms of intra-operative blood loss and surgical removal of metastatic tumors. Preoperative tumor vascularity and extent of embolization are independent risk factors for blood loss during surgery. This study implies that MESCC patients with severe hypervascular tumors should be advised to undergo preoperative embolization.

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“…Due to improvements of the treatment protocols of many cancer types, above all, cancer of the hematopoietic and lymphoid system has become a “chronic disease” with a nearly normal life expectancy [ 7 ]. As a consequence, the number of patients with SM is increasing [ 8 ]. This leads to a change of mindset, calling for new therapeutic strategies when treating spinal tumors and metastases to guarantee a maximum of independent life for these patients.…”

Section: Introductionmentioning

confidence: 99%

“…This leads to a change of mindset, calling for new therapeutic strategies when treating spinal tumors and metastases to guarantee a maximum of independent life for these patients. While SMs are the most frequent neoplasms of the spine, being found in about 15–35% of cancer patients [ 8 , 9 ] primary bone tumors of the spine are rare (less than 5% of spinal neoplasms) [ 10 ]. Treatment decisions are made interdisciplinary and individually, taking into account the patient’s symptoms, the degree of osteolytic instability, the degree of epidural compression, the radio- and chemosensitivity of the tumor and the overall prognosis [ 4 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy

Joerger

Seitz

Lange

et al. 2022

Cancers

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(1) Background: Surgery for spinal metastases has gained a decisive role in modern oncological treatment. Recently, carbon-fiber-reinforced (CFR) polyethyl-ether-ether-ketone (PEEK) pedicle screw systems were introduced, reducing artifacts on imaging and showing less perturbation effects on photon radiation. Preliminary clinical experience with CFR-PEEK implants for spinal metastases exists. The aim of this monocentric study is to report on the safety and efficacy of CFR-PEEK pedicle screw systems for spinal neoplasms in a large cohort of consecutive patients. (2) Methods: We retrospectively analyzed prospectively the collected data of consecutive patients being operated on from 1 August 2015 to 31 October 2021 using a CFR-PEEK pedicle screw system for posterior stabilization because of spinal metastases or primary bone tumors of the spine. (3) Results: We included 321 patients of a mean age of 65 ± 13 years. On average, 5 ± 2 levels were instrumented. Anterior reconstruction was performed in 121 (37.7%) patients. Intraoperative complications were documented in 30 (9.3%) patients. Revision surgery for postoperative complications was necessary in 55 (17.1%) patients. Implant-related complications, such as intraoperative screw breakage (3.4%) and screw loosening (2.2%), were rare. (4) Conclusions: CFR-PEEK is a safe and efficient alternative to titanium for oncological spinal instrumentation, with low complication and revision rates in routine use and with the advantage of its radiolucency.

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Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review

Cited by 74 publications

References 75 publications

Vertebral body collapse after radiotherapy for spinal metastases

Vertebral body collapse after radiotherapy for spinal metastases

Preoperative embolization in the treatment of patients with metastatic epidural spinal cord compression: A retrospective analysis

CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy

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