Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Abstract

ObjectivesTo summarize the epidemiological characteristics of patients following surgery for spinal metastases retrospectively and make a univariate analysis to identify independent variables that could affect the operation decision making.MethodsThis was a multicenter retrospective review of patients with spinal metastasis who were treated with surgery from 1 January 2007 to 31 July 2019. Basic clinical data were analyzed retrospectively by univariate analysis to identify independent variables that could affect the decision of operation modalities, including gender, age, spinal metastatic site, Frankel score, Karnofsky performance score (KPS), spinal instability neoplastic score (SINS), visual analogue scale (VAS), Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, primary tumor, extraspinal metastasis, visceral metastasis, and bone lesion (osteolytic, osteoblastic or mixed).ResultsA total of 580 patients including 332 males and 248 females were enrolled in the study with an average age of 58.26 years old (range, 13–86 years old). The most common spinal metastatic level was the thoracic vertebra (190 [32.76%]), followed by the lumbar vertebra (146 [25.17%]), cervical vertebra (47 [8.10%]), and sacral vertebra (35 [6.03%]). Metastases involving more than two sites of the cervical, thoracic, lumbar, and sacral vertebrae arose in 162 (27.93%) patients. For primary tumor, there were 198 (34.14%) cases of lung cancer, 41 (7.07%) cases of kidney cancer, 39 (6.72%) cases of breast cancer, 38 (6.55%) cases of gastrointestinal cancer, 35 (6.03%) cases of lymphoma and myeloma, 25 (4.31%) cases of prostate cancer, 24 (4.14%) cases of liver cancer, 23 (3.97%) cases of mesenchymal tissue sarcoma, 20 (3.45%) cases of thyroid cancer, and 84 (14.48%) cases were tumor with unknown origin. Sixty‐three (10.86%) patients received minimally invasive surgery, 460 (79.31%) patients received palliative surgery, and the remaining 57 (9.83%) received tumor resection. According to the univariate analysis, the KPS score, SINS score, VAS score, Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, and bone lesion (osteolytic, osteoblastic or mixed) were independent and favorable factors affecting the surgery modalities.ConclusionsSurgical treatment for spinal metastases was mainly to relieve pain, rebuild spinal stability, improve nerve function, control local tumors, and improve the quality of life of patients. For middle‐aged and elderly patients with good general conditions, severe pain, spinal pathological fracture, spine instability and without urinary and fecal incontinence, early surgical treatment should be actively carried out.

Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma

“…Most patients with spinal metastasis presented severe pain, neurologic compression, and spinal instability, and the goal of surgery was not curing but relieving symptoms ( 27 ). Patients undergoing our minimally invasive treatment had better pain relief and ODI improvement than patients who underwent open surgery.…”

Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

“…Predilection of spinal metastases is not completely understood. Metastases are located at a single spinal level in 70% of the cases, with a predilection to the thoracic spine, followed by the lumbar, the cervical, and the sacral levels (1,14). Metastases involving more than two spinal sites were found in 30% of patients.…”

“…The spine is the most common site of bone metastases in general and skeletal metastases in particular, with a prevalence of 30-70% and 20-40% in cancer patients respectively (1,2).Thus, spinal metastases are a concerning health issue as well as an economic burden (3,4), despite the fact that the management of these patients has considerably evolved both in terms of surgery and radiotherapy (RT) (5)(6)(7)(8).…”

Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review

“…Within the skeletal system, the spine is the most common site of metastases[ 1 , 2 ]. The metastatic spinal level is reportedly 32.76%-71.6% at the thoracic vertebra, 25.17%-60% at the lumbar spine, 8.10%-22.9% at the cervical spine[ 3 , 4 ]. Surgical intervention is indicated for metastatic lesions causing neurologic compression, instability, and rapid deterioration of function.…”