Metastatic Spinal Cord Compression

Schmidt, Meic H.; Klimo, Paul; Vrionis, Frank D.

doi:10.6004/jnccn.2005.0041

Cited by 39 publications

(31 citation statements)

References 99 publications

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“…22,23 Among patients with metastatic spine disease, 10-20% have symptomatic spinal cord compression, resulting in Ͼ 25,000 cases per year, making spinal cord injury from metastasis more common than traumatic spinal cord injury. 22,23,35 The spinal region most commonly affected is the thoracic spine (70%), followed by the lumbar (20%) and cervical (10%) spine. 7,13,14 Within the thoracic segment, 85% of metastases are located ventrally in the vertebral body and epidural space, 15% in the posterior element only, and Ͻ 5% in the epidural or subarachnoid/intramedullary space.…”

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“…7,14 The management of metastatic spine disease is complex, and options for treatment include surgery, radiation, and chemotherapy. 23,35 With surgery, the optimal type of procedure is controversial. Laminectomy was once the treatment of choice for the management of vertebral metastatic disease; 2 however, results with this procedure were disappointing, 14,17,32,41 mainly because of its inadequacies in addressing ventrally located masses.…”

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“…22,35 The spine is the most common osseous site for metastatic deposits, which can result in severe back pain, spinal deformity, pathological fractures, and neurological compromise. 22,23 Among patients with metastatic spine disease, 10-20% have symptomatic spinal cord compression, resulting in Ͼ 25,000 cases per year, making spinal cord injury from metastasis more common than traumatic spinal cord injury.…”

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Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

Kan

Schmidt

2008

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Object The choices available in the management of metastatic spine disease are complex, and the role of surgical therapy is increasing. Recent studies have indicated that patients treated with direct surgical decompression and stabilization before radiation have better functional outcomes than those treated with radiation alone. The most common anterior surgical approach for direct spinal cord decompression and stabilization in the thoracic spine is open thoracotomy; however, thoracotomy for spinal access is associated with morbidity that can be avoided with minimally invasive techniques like thoracoscopy. Methods A minimally invasive thoracoscopic approach was used for the surgical treatment of thoracic and thoracolumbar metastatic spinal cord compression. This technique allows ventral decompression via corpectomy, inter-body reconstruction with expandable cages, and stabilization with an anterolateral plating system designed specifically for minimally invasive implantation. This technique was performed in 5 patients with metastatic disease of the thoracic spine, including the thoracolumbar junction. Results All patients had improvement in preoperative symptoms and neurological deficits. No complications occurred in this small series. Conclusions The minimally invasive thoracoscopic approach can be applied to the treatment of thoracic and thoracolumbar metastatic spine disease in an effort to reduce access morbidity. Preliminary results have indicated that adequate decompression, reconstruction, and stabilization can be achieved with this technique.

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Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

Kan

Schmidt

2008

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“…Metastases to the spinal column occur in 5-10% of cancer patients, and occur in all types of cancer including breast, prostate, lung, and hematologic cancers. 1 They often present with back pain, progressive weakness, decreased sensation, as well as bladder and bowel incontinence, in addition to the systemic effects of cancer. Presently, the treatment options for MSCC are surgery, radiation therapy, chemotherapy, and palliative care.…”

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Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning

et al. 2007

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Study design: Retrospective, descriptive study. Objective: To determine if patients with metastatic spinal cord compression (MSCC) make significant functional gains through rehabilitation. To study survival and predictors of survival in MSCC. To explore predictive factors for high or low functional gains in MSCC. Setting: Inpatient neuro-oncology rehabilitation ward, Henderson General Hospital, Hamilton, Canada. Methods: Clinical records were examined for 63 inpatients with MSCC. Demographics, treatment of MSCC, length of rehabilitation, admission, and discharge Functional Independence Measure (FIM) scores, Tokuhashi score and survival data were collected. Statistical analyses included nonparametric comparisons, Kaplan-Meier analyses, Cox regression, and exploratory logistic regression. Results: FIM score improved from 83 to 102 (Po0.0001). Estimated median survival from time of rehabilitation was 10.0 months. Kaplan-Meier analysis showed longer survival in patients with high Tokuhashi scores (9-15) compared to low scores (0-8) (Po0.005); and high FIM change (413) compared to low FIM change (p13) (Po0.02). Cox regression revealed that high FIM gain and high Tokuhashi score were prognostic factors. Logistic regression showed Tokuhashi score (odds ratio (OR) ¼ 1.30, 95% confidence interval (CI) ¼ 1.04-1.62) and length of rehabilitation (OR ¼ 1.04, 95% confidence interval (CI) ¼ 1.01-1.07) were associated with high FIM gain. Conclusions: Rehabilitation improves functional outcomes in MSCC. Patients who had a high Tokuhashi score and achieved high functional gains after rehabilitation had longer survival. Tokuhashi score and length of rehabilitation were associated with high FIM gain. The Tokuhashi score can help identify patients with good prognosis and potential for improvement during rehabilitation.

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“…16 Treatment advances have led to improved survival rates for many cancer types, but this has led to a greater incidence of metastatic disease, specifically to the vertebral column, which occurs in up to 40% of patients with evidence of metastatic disease. 20,29 Additionally, the spine is the most common site for osseous metastatic spread that commonly results in severe, debilitating back pain, spinal deformity, pathological fractures, and spinal cord compression with resultant neurological compromise. 20,21 Not all patients with spinal metastatic disease develop neurological compromise, but approximately 10%-20% of patients present with symptomatic spinal cord compression.…”

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The role of the mini-open thoracoscopic-assisted approach in the management of metastatic spine disease at the thoracolumbar junction

Ravindra

Brock

Awad

et al. 2016

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OBJECTIVE Treatment advances have resulted in improved survival for many cancer types, and this, in turn, has led to an increased incidence of metastatic disease, specifically to the vertebral column. Surgical decompression and stabilization prior to radiation therapy have been shown to improve functional outcomes, but anterior access to the thoracolumbar junction may involve open thoracotomy, which can cause significant morbidity. The authors describe the treatment of 12 patients in whom a mini-open thoracoscopic-assisted approach (mini-open TAA) to the thoracolumbar junction was used to treat metastatic disease, with an analysis of outcomes. METHODS The authors reviewed a retrospective cohort of patients treated for thoracolumbar junction metastatic disease with mini-open TAA between 2004 and 2016. Data collection included operative time, estimated blood loss, length of stay, follow-up duration, and pre- and postoperative visual analog scale scores and Frankel grades. RESULTS Twelve patients underwent a mini-open TAA procedure for metastatic disease at the thoracolumbar junction. The mean age of patients was 59 years (range 53–77 years), mean estimated blood loss was 613 ml, and the mean duration of the mini-open TAA procedure was 234 minutes (3.8 hours). The median length of stay in the hospital was 7.5 days (range 5–21 days). All 12 patients had significant improvement in their postoperative pain scores in comparison with their preoperative pain scores (p < 0.001). No patients suffered from worsening neurological function after surgery, and of 7 patients who presented with neurological dysfunction, 6 (86%) had an improvement in their Frankel grade after surgery. No patients experienced delayed hardware failure requiring reoperation over a mean follow-up of 10 months (range 1–45 months). CONCLUSIONS The mini-open TAA to the thoracolumbar junction for metastatic disease is a durable procedure that has a reduced morbidity rate compared with traditional open thoracotomy for ventral decompression and fusion. It compares well with traditional and novel posterior approaches to the thoracolumbar junction. The authors found a significant improvement in preoperative pain and neurological symptoms that supports greater use of the mini-open TAA for the treatment of complex metastatic disease at the thoracolumbar junction.

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Metastatic Spinal Cord Compression

Cited by 39 publications

References 99 publications

Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning

The role of the mini-open thoracoscopic-assisted approach in the management of metastatic spine disease at the thoracolumbar junction

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