The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

Abstract

Study Design:Narrative review.Objectives:To review the relevant literature regarding scoring systems for vertebral metastases and quantify their role in contemporary orthopedic practice.Methods:A literature search of PubMed, Google Scholar, and Embase was performed on February 7, 2017. Eight scoring systems were selected for detailed review—7 of which were scores focused solely on patient prognosis (Tokuhashi, Tomita, Bauer, Oswestry Spinal Risk Index, Van der Linden, Rades, and Katagiri). The eighth system reviewed was the Spinal Instability Neoplastic Score, which examines for impending spinal instability in patients with vertebral metastases and represents a novel approach compared with hitherto scoring systems.Results:The Bauer and Oswestry Spinal Risk Index have the most accurate prognostic predictive ability, with the newer Oswestry Spinal Risk Index being favored by the contemporary literature as it demands less investigation and is therefore more readily accessible. There was a growing trend in studies designed to customize scoring systems for individual cancer pathological subtypes. The Spinal Instability Neoplastic Score shows good reliability for predicting instability among surgeons and oncologists.Conclusions:The increased understanding of cancer pathology and subsequent development of customized treatments has led to prolonged survival. For patients with vertebral metastases, this affects surgical candidacy not only on the basis of prognosis but also provides prolonged opportunity for the development of spinal instability. Scoring systems have a useful guidance role in these deciding for/against surgical intervention, but in order to remain contemporary ongoing review, development, and revalidation is mandatory.

Serum albumin level predicts survival after surgical treatment of metastatic femur fractures: a retrospective study

“…Katagiri et al demonstrated that laboratory data can be a significant prognostic factor and included albumin in their prediction model-patients with albumin < 37 g/L had poorer prognosis in their model [13]. This prognostic model was based largely on non-surgically treated patients and may not be applicable to potential surgical candidates [23]. Patients who present with an actual fracture or impending fracture requiring surgery are at a later stage of their malignancy and this may explain why the average serum albumin level in our study group with only surgical-treated patients is 32 g/L.…”

Surgery for spinal metastatic tumors: Prognostication systems in clinical practice (Review)

“…Over several years, the reported scores practically attempted to evaluate the surgical indications and the radicality of the operation, taking survival as a prerequisite (2,3). Their predictive value and clinical relevance have been assessed by several studies, but the results have been inconsistent (3,8,9). Additionally, although they may be of some clinical value, the improvement in overall cancer-related survival and the lack of incorporation of major technological and systemic cancer treatments have limited their reliability and rendered them non-relevant in the current era of metastatic spinal tumor treatment (1).…”

“…Low SINS (0-6) generally suggests a stable lesion, while high-SINS (13)(14)(15)(16)(17)(18) tumors are considered unstable, requiring surgical stabilization. In intermediate-SINS tumors (7)(8)(9)(10)(11)(12), the need for treatment is based on the discretion and the experience of the spinal surgeon (15). The fourth element of consideration in the NOMS algorithm is the extent of the systemic disease.…”

“…Modern clinical practice in oncology warrants accurate, reproducible and easily applied prognostication models that can be used both as guidance for decision-making and as scientific tools for research and clinical audits. The development of a variety of scoring systems over the last 30 years has uncovered the need for such a prognostic instrument and the inherent imperfections of the traditional tools (9). Moreover, given the rapid medical and technological advances in the field of cancer treatment, conventional scoring systems appear insufficient for guiding surgical decisions and have become obsolete, underlying the urgent need for modern prognostication tools (1).…”

“…Moreover, given the rapid medical and technological advances in the field of cancer treatment, conventional scoring systems appear insufficient for guiding surgical decisions and have become obsolete, underlying the urgent need for modern prognostication tools (1). Within these considerations, future challenges include the development of personalized scoring systems that correspond to the histology of the primary tumor and the specific genetic and anatomical prerequisites of particular tumors and individual patients (7,9). The biology of the tumor is of utmost importance, but in cases of urgent surgical intervention due to neurological deficit, the type of the tumor is not among the primary considerations.…”