Postoperative Survival and Ambulatory Outcome in Metastatic Spinal Tumors : Prognostic Factor Analysis

Moon, Kyung Yun; Chung, Chun Kee; Jahng, Tae-Ahn; Kim, Hyun Jib; Kim, Chi Heon

doi:10.3340/jkns.2011.50.3.216

Cited by 48 publications

(29 citation statements)

References 25 publications

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“…Four of the patients with a Tokuhashi score <9 showed progression of ambulation, and the overall distribution of ambulation outcome was linear in all 3 groups. Similar to our study, Moon et al [20] defined Tokuhashi score groups with the intention to show differences in ambulatory outcome using the Nurick score [21]. In a 21-year review including 182 patients with different types of tumors and MSCC, the Tokuhashi score was found to be not significantly correlated with postoperative ambulatory function.…”

Section: Discussionsupporting

confidence: 61%

Preoperative Scoring and Limits of Prognostication: Functional Outcome after Surgical Decompression in Metastatic Spinal Cord Compression

et al. 2014

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Objective: To determine whether preoperative parameters correlate with the postoperative functional outcome in para- and tetraplegic patients with lung, kidney, breast and prostate cancer and metastatic spinal cord compression (MSCC). Methods: Information on 43 patients undergoing decompressive surgery and rehabilitation for MSCC was reviewed, including primary tumor, age, pre- and postoperative ambulation status, mobility subcategory of the Spinal Cord Injury Measure (mSCIM) and the Tokuhashi score. Differences between groups were analyzed by the nonparametric χ² test, and correlation coefficients (Spearman's rho) were computed. Results: Preoperative ambulation (p < 0.001), the American Spinal Injury Association Impairment Scale (p < 0.001) and the type of operation (p = 0.02) influenced the postoperative functional outcome. Any positive change in the mSCIM was influenced by preoperative ambulation (p < 0.001). Patients with breast carcinoma showed significantly more positive changes in the mSCIM compared with other tumors (p = 0.002). No correlation was found between the treatment categories of the Tokuhashi score and the preoperative ambulatory status (p = 0.13) or the change in ambulation status (p = 0.29). Conclusion: The postoperative functional outcome of MSCC patients shows a linear association between the categories of the Tokuhashi score and the change in ambulation status. We recommend surgical decompression even in a palliative situation (Tokuhashi score 0-8) with the aim of optimizing the short-term rehabilitation outcome. © 2014 S. Karger AG, Basel

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Section: Discussionsupporting

confidence: 61%

Preoperative Scoring and Limits of Prognostication: Functional Outcome after Surgical Decompression in Metastatic Spinal Cord Compression

et al. 2014

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“…and Quraishi et al . report the same result. It follows that an improved neurological status after treatment is not a certain factor to influence overall survival through their studies, but ambulatory status pre‐treatment is an independent prognostic factor.…”

Section: Discussionsupporting

confidence: 92%

Is Ambulatory Status a Prognostic Factor of Survival in Patients with Spinal Metastases? An Exploratory Meta‐analysis

Yang

Han

Wang

et al. 2018

Orthopaedic Surgery

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This study was conducted to identify the influence of ambulatory status prior to treatment on survival of patients with spinal metastases. Two investigators independently retrieved relevant electronic literature in PubMed, Embase, and Cochrane Library databases, to identify eligible studies. Effect estimates for hazard risk (HR) were extracted and synthesized through fixed-effects or random-effects models as appropriate. A total of 17 eligible studies were identified, with an accumulated number of 3962 participants. HR from 14 studies regarding comparison between ambulatory versus non-ambulatory groups were pooled using a random-effects model, and statistical significance was presented for the pooled HR (HR = 1.96; 95% confidence interval [CI], 1.65-2.34). In subgroups of mixed primary tumor and lung cancer, ambulatory status was considered to be a significant prognostic factor (P < 0.05), while in the subgroup of prostate cancer it was not (HR = 1.72; 95% CI, 0.79-3.74). HR from 4 studies related to comparison between Frankel E versus Frankel C-D were pooled using a fixed-effects model, which revealed statistical significance (HR = 1.73; 95% CI, 1.27-2.36). Ambulatory status is a significant prognostic factor in patients with spinal metastases. However, in patients with primary prostate cancer, the prognostic effect of ambulatory status has not yet been confirmed to be significant.

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“…9,11,18,31 In contrast, the most frequent tumor mass in the epidural compartment results from metastatic disease. 3,11,21,24 Currently, the primary treatment of choice for the majority of spinal tumors is gross-total resection (GTR) with preservation of neurological function. 6,11,25,30,39,42 Object.…”

mentioning

confidence: 99%

“…11 Based on their site of origin, such neoplasms occur either as epidural or intradural (extramedullary or intramedullary) tumors. 3,6,11,21,24,25,30,39,42 The histopathological diagnosis of spinal neoplasms is routinely established according to the WHO criteria, and specific tumor entities show preferred spinal compartments: The most common tumor entities found intradurally are meningiomas (29%), nerve sheath tumors (24%), ependymomas (23%), and astrocytomas (6%). 9,11,18,31 In contrast, the most frequent tumor mass in the epidural compartment results from metastatic disease.…”

mentioning

confidence: 99%

Analysis of 5-aminolevulinic acid–induced fluorescence in 55 different spinal tumors

Millesi

Kiesel

Wöehrer

et al. 2014

FOC

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Object Subtotal resection (STR) of spinal tumors can result in tumor recurrence. Currently, no clinically reliable marker is available for intraoperative visualization of spinal tumor tissue. Protoporphyrin IX (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) is capable of visualizing malignant gliomas. Fluorescence-guided resections of malignant cerebral gliomas using 5-ALA have resulted in an increased rate of complete tumor removal. Recently, the application of 5-ALA has also been described in the first cases of spinal tumors. Therefore, the aim of this observational study was to systematically investigate 5-ALA–induced fluorescence characteristics in different spinal tumor entities. Methods Three hours before the induction of anesthesia, 5-ALA was administered to patients with different intra- and extradural spinal tumors. In all patients a neurosurgical resection or biopsy of the spinal tumor was performed under conventional white-light microscopy. During each surgery, the presence of PpIX fluorescence was additionally assessed using a modified neurosurgical microscope. At the end of an assumed gross-total resection (GTR) under white-light microscopy, a final inspection of the surgical cavity of fluorescing intramedullary tumors was performed to look for any remaining fluorescing foci. Histopathological tumor diagnosis was established according to the current WHO classification. Results Fifty-two patients with 55 spinal tumors were included in this study. Resection was performed in 50 of 55 cases, whereas 5 of 55 cases underwent biopsy. Gross-total resection was achieved in 37 cases, STR in 5, and partial resection in 8 cases. Protoporphyrin IX fluorescence was visible in 30 (55%) of 55 cases, but not in 25 (45%) of 55 cases. Positive PpIX fluorescence was mainly detected in ependymomas (12 of 12), meningiomas (12 of 12), hemangiopericytomas (3 of 3), and in drop metastases of primary CNS tumors (2 of 2). In contrast, none of the neurinomas (8 of 8), carcinoma metastases (5 of 5), and primary spinal gliomas (3 of 3; 1 pilocytic astrocytoma, 1 WHO Grade II astrocytoma, 1 WHO Grade III anaplastic oligoastrocytoma) revealed PpIX fluorescence. It is notable that residual fluorescing tumor foci were detected and subsequently resected in 4 of 8 intramedullary ependymomas despite assumed GTR under white-light microscopy. Conclusions In this study, 5-ALA–PpIX fluorescence was observed in spinal tumors, especially ependymomas, meningiomas, hemangiopericytomas, and drop metastases of primary CNS tumors. In cases of intramedullary tumors, 5-ALA–induced PpIX fluorescence is a useful tool for the detection of potential residual tumor foci.

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Postoperative Survival and Ambulatory Outcome in Metastatic Spinal Tumors : Prognostic Factor Analysis

Cited by 48 publications

References 25 publications

Preoperative Scoring and Limits of Prognostication: Functional Outcome after Surgical Decompression in Metastatic Spinal Cord Compression

Preoperative Scoring and Limits of Prognostication: Functional Outcome after Surgical Decompression in Metastatic Spinal Cord Compression

Is Ambulatory Status a Prognostic Factor of Survival in Patients with Spinal Metastases? An Exploratory Meta‐analysis

Analysis of 5-aminolevulinic acid–induced fluorescence in 55 different spinal tumors

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