Minimal Access Surgery for Spinal Metastases: Prospective Evaluation of a Treatment Algorithm Using Patient-Reported Outcomes

Barzilai, Ori; McLaughlin, Lily; Amato, Mary-Kate; Reiner, Anne S.; Ogilvie, Shahiba Q.; Lis, Eric; Yamada, Yoshiya; Bilsky, Mark H.; Laufer, Ilya

doi:10.1016/j.wneu.2018.08.182

Cited by 39 publications

(19 citation statements)

References 39 publications

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“…Fehlings et al 11 analyzed prospectively collected data from the AOSpine North American Clinical Research Network and demonstrated that surgery combined with radiation and systemic therapies provides immediate and sustained improvement in pain, neurologic, and HRQoL outcomes showing improvement in ODI, EQ-5D, pain interference, and SF-36 scores. 11 Additional prospective cohort studies demonstrated improvement in HrQOL following open surgery, 2,12 as well as following minimally invasive surgery 13 for treatment of spinal metastases. In a recent analysis of the Epidemiology, Process and Outcomes of Spine Oncology (EPOSO) data, significant improvement in HRQoL was demonstrated using both SF-36 and the SOSGOQ in patients with oligometastatic and widespread metastatic disease 14 demonstrating improvement in HRQoL for all surgically treated patients, regardless of the extent of systemic disease.…”

Section: Patient Evaluation and Treatment Indicationsmentioning

confidence: 98%

“…Methods for spinal stabilization vary and may entail open surgery, percutaneous stabilization or, in select cases of isolated anterior column compromise, kyphoplasty/vertebroplasty. 13 Separation surgery and minimal access surgery represent some of the most recent advances in decompression and stabilization techniques for spinal tumor surgery and may well be changing the conventional surgical indications for this patient population. In places with limited access to SBRT, surgeons and oncologists must continue to rely on the more aggressive excisional surgical techniques to improve HRQoL and local control for patients with spinal tumors.…”

Section: Treatment Techniquesmentioning

confidence: 99%

“…82 Minimal access spine techniques for the treatment of spinal tumors are gaining acceptance as they have limited perioperative morbidity, allow for quick recovery and rapid return to radiation or systemic treatment. 13 For spinal tumor surgery, MAS techniques include percutaneous instrumentation, mini-open approaches for decompression, and tumor removal with or without tubular/expandable retractors and thoracoscopy/endoscopy. 83 Studies have shown decreased blood loss, transfusion rates, and hospitalization length with minimal access surgery (MAS) stabilization techniques.…”

Section: Treatment Techniquesmentioning

confidence: 99%

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Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice

Barzilai

Boriani

Fisher

et al. 2019

Global Spine Journal

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Study Design: Literature review. Objective: To provide an overview of the recent advances in spinal oncology, emphasizing the key role of the surgeon in the treatment of patients with spinal metastatic tumors. Methods: Literature review. Results: Therapeutic advances led to longer survival times among cancer patients, placing significant emphasis on durable local control, optimization of quality of life, and daily function for patients with spinal metastatic tumors. Recent integration of modern diagnostic tools, precision oncologic treatment, and widespread use of new technologies has transformed the treatment of spinal metastases. Currently, multidisciplinary spinal oncology teams include spinal surgeons, radiation and medical oncologists, pain and rehabilitation specialists, and interventional radiologists. Consistent use of common language facilitates communication, definition of treatment indications and outcomes, alongside comparative clinical research. The main parameters used to characterize patients with spinal metastases include functional status and health-related quality of life, the spinal instability neoplastic score, the epidural spinal cord compression scale, tumor histology, and genomic profile. Conclusions: Stereotactic body radiotherapy revolutionized spinal oncology through delivery of durable local tumor control regardless of tumor histology. Currently, the major surgical indications include mechanical instability and high-grade spinal cord compression, when applicable, with surgery providing notable improvement in the quality of life and functional status for appropriately selected patients. Surgical trends include less invasive surgery with emphasis on durable local control and spinal stabilization.

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Section: Patient Evaluation and Treatment Indicationsmentioning

confidence: 98%

Section: Treatment Techniquesmentioning

confidence: 99%

Section: Treatment Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice

Barzilai

Boriani

Fisher

et al. 2019

Global Spine Journal

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“…Combining kyphoplasty with radiofrequency ablation instead in regard of radioprotection is therefore not necessary and yielded inferior results in local control [5]. Previous findings showed that kyphoplasty with irradiation can be accomplished in an average time of 65 min and, due to its percutaneous approach, is a surgical intervention, but is considered minimally invasive [9,23]. Systemic therapy can thus be concomitantly administered without aggravating side-effects (e. g. prolonged wound healing time or increased radiation toxicity).…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

et al. 2020

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Introduction The spine represents the site which is most frequently affected by bone metastases in patients with systemic cancer. Of all local treatment options, combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provides both, instantaneous stabilization and immediate pain relief. We here report on the long-term outcomes of the largest cohort treated with Kypho-IORT to date. Methods Between 2009 and 2019 a total of 104 patients underwent Kypho-IORT to vertebral tumors in the thoracic, lumbar, or sacral spine with transpedicular kyphoplasty and intraoperative irradiation with a needle-shaped electronic brachytherapy source at our center. Patients were treated either on trial, within the prospective Kypho-IORT studies (NCT01280032 and NCT02773966), or, after completion of the study, off trial but compliant with the study protocol. Follow-up and imaging with computed tomography (CT) or magnetic resonance imaging was scheduled after 3 and 6 months and then bi-annually. Results A total of 143 vertebrae (89 thoracic spine, 53 lumbar spine, and 1 sacral spine) were treated in 104 patients. The median follow-up was 14.5 months (range 0.4–109). Local progression occurred in 10 patients (10 vertebrae) after a median time of 22.3 months (range 1.5–73) resulting in local control rates of 97.1, 95.9, and 94.2% at 6, 12, and 24 months, respectively. Overall survival was 74.6, 61.7, and 50.3% at 6, 12, and 24 months, respectively. A single serious adverse event was reported. Conclusion In addition to immediate pain reduction and stabilization, Kypho-IORT shows excellent long-term local control with minimal side effects.

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“…Minimal access treatment algorithm for metastatic thoracolumbar compression fractures. Adapted from Barzilai et al 14 …”

Section: Treatment Algorithmsmentioning

confidence: 99%

The Role of Minimal Access Surgery in the Treatment of Spinal Metastatic Tumors

Barzilai

Bilsky

Laufer

2020

Global Spine Journal

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Study Design: Literature review. Objective: To provide an overview of the recent advances in minimal access surgery (MAS) for spinal metastases. Methods: Literature review. Results: Experience gained from MAS in the trauma, degenerative and deformity settings has paved the road for MAS techniques for spinal cancer. Current MAS techniques for the treatment of spinal metastases include percutaneous instrumentation, mini-open approaches for decompression and tumor resection with or without tubular/expandable retractors and thoracoscopy/endoscopy. Cancer care requires a multidisciplinary effort and adherence to treatment algorithms facilitates decision making, ultimately improving patient outcomes. Specific algorithms exist to help guide decisions for MAS for extradural spinal metastases. One major paradigm shift has been the implementation of percutaneous stabilization for treatment of neoplastic spinal instability. Percutaneous stabilization can be enhanced with cement augmentation for increased durability and pain palliation. Unlike osteoporotic fractures, kyphoplasty and vertebroplasty are known to be effective therapies for symptomatic pathologic compression fractures as supported by high level evidence. The integration of systemic body radiation therapy for spinal metastases has eliminated the need for aggressive tumor resection allowing implementation of MAS epidural tumor decompression via tubular or expandable retractors and preliminary data exist regarding laser interstitial thermal therapy and radiofrequency ablation for tumor control. Neuronavigation and robotic systems offer increased precision, facilitating the role of MAS for spinal metastases. Conclusions: MAS has a significant role in the treatment of spinal metastases. This review highlights the current utilization of minimally invasive surgical strategies for treatment of spinal metastases.

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Minimal Access Surgery for Spinal Metastases: Prospective Evaluation of a Treatment Algorithm Using Patient-Reported Outcomes

Cited by 39 publications

References 39 publications

Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice

Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

The Role of Minimal Access Surgery in the Treatment of Spinal Metastatic Tumors

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