Surgical treatment of spinal cord compression from epidural metastasis.

Sundaresan, Narayan; Sachdev, Ved P.; Holland, James F.; Moore, Frank; Sung, Max W.; Paciucci, Paolo Alberto; Wu, Li-Teh; Kelligher, Kevin; Hough, Laura

doi:10.1200/jco.1995.13.9.2330

Cited by 142 publications

(69 citation statements)

References 35 publications

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“…We have reported a median survival of 6 months (95 % CI 4-8 months) and a mean survival of approximately 21 months. This is comparable, if not a little better, than other reports with a mean survival time of 11-16 months [9,17]. Tancioni et al [18] concluded in their study that the prognosis was dependent upon the histology of the primary tumour and visceral metastases.…”

Section: Discussionsupporting

confidence: 58%

“…Then evolved a trend towards posterior decompression combined with stabilisation surgery resulting in improved outcome and survival [9,10]. More recent literature in the last decade including a randomised controlled trial has shown that direct decompression and stabilisation surgery improved the functional outcome and ambulation in patients with MSCC [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

et al. 2012

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Purpose Metastatic spinal cord compression (MSCC) requires expeditious treatment. While there is no ambiguity in the literature about the urgency of care for patients with MSCC, the effect of timing of surgical intervention has not been investigated in detail. The objective of our study was to investigate whether or not the 'timing of surgery' is an important factor in survival and neurological outcome in patients with MSCC. Methods All patients with MSCC presenting to our unit from October 2005 to March 2010 were included in this study. Patients were divided into three groups-those who underwent surgery within 24 h (Group 1, n = 45), between 24 and 48 h (Group 2, n = 23) and after 48 h (Group 3, n = 53) from acute presentation of neurological symptoms. The outcome measures studied were neurological outcome (change in Frankel grade post-operatively), survival (survival rate and median survival in days), incidence of infection, length of stay and complications. Results Patients' age, gender, revised Tokuhashi score, level of spinal metastasis and primary tumour type were not significantly different between the three groups. Greatest improvement in neurology was observed in Group 1, although not significantly when compared against Group 2 (24-48 h; (p = 0.09). When comparisons of neurological outcome were performed for all patients having surgery within 48 h (Groups 1 and 2) versus after 48 h (Group 3), the Frankel grade improvement was significant (p = 0.048) favouring surgery within 48 h of presentation. There was a negative correlation (-0.17) between the delay in surgery and the immediate neurological improvement, suggesting less improvement in those who had delayed surgery. There was no difference in length of hospital stay, incidence of infection, post-operative complications or survival between the groups. Conclusions Our results show that surgery should be performed sooner rather than later. Furthermore, earlier surgical treatment within 48 h in patients with MSCC resulted in significantly better neurological outcome. However, the timing of surgery did not influence length of hospital stay, complication rate or patient survival.

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

et al. 2012

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“…However, the surgical options require significant postprocedural recovery and have associated morbidity and mortality in 19-48% of the cases [17,20], in patients who often have limited life expectancies. Survival time is a factor that must be considered and, although no absolute value has been established, in general, a minimum life expectancy of 3-6 months has been accepted as a prerequisite for surgery [5], which is a problem for the management of terminal patients with intractable pain associated with instability.…”

Section: Discussionmentioning

confidence: 99%

Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life

Álvarez

Pérez-Higueras²,

Quiñones

et al. 2003

European Spine Journal

157

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“…Preoperatively, 44% were nonambulatory. Eighty-two percent of patients were improved, with a median survival of 16 months and 46% 2-year survival [57].…”

Section: More Extensive Proceduresmentioning

confidence: 99%

“…Adjuvant radiotherapy must wait at least 6 weeks if bone is used so that bony union can occur, whereas the delay need not exceed 1 week with methylmethacrylate. Patients are mobilized within a few days of surgery [55][56][57].…”

Section: More Extensive Proceduresmentioning

confidence: 99%

Spinal Cord Compression

Ribas

Schiff

2012

Curr Treat Options Neurol

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Spinal cord disease represents a major cause of morbidity and suffering in cancer patients. Prevention or minimization of neurologic deficits depends on an understanding of early symptoms, clinical course, and treatment options. Early diagnosis is crucial, as current treatments usually arrest the course of the disease but much less commonly restore lost neurologic function. This article will review the epidemiology, pathophysiology, symptomatology, diagnosis, and management of the causes of spinal cord dysfunction directly related to cancer. It will briefly discuss myelopathies related to paraneoplasia and treatment complications. Epidural spinal cord compressionSpinal cord or cauda equina dysfunction resulting from tumor growth in the spinal epidural space is commonly referred to as epidural spinal cord compression (ESCC). In some ways, spinal epidural metastasis (SEM) may be a better term, as it encompasses the phenomena of root, cauda equina, and minor degrees of thecal sac compression SEM/ESCC is the most common cause of spinal cord dysfunction in cancer patients, and will receive the bulk of attention in this article. EpidemiologyAlthough careful, contemporary population-based studies are unavailable, the best evidence suggests that 5% of patients dying of cancer have suffered ESCC [1]. With more than 500,000 Americans succumbing to cancer yearly, there are likely to be more than 25,000 cases of ESCC yearly in the United States.Neurol Clin N Am

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Surgical treatment of spinal cord compression from epidural metastasis.

Cited by 142 publications

References 35 publications

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life

Spinal Cord Compression

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