Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Yahanda, Alexander T.; Buchowski, Jacob M.; Wegner, Adam M.

doi:10.21037/atm.2019.04.83

Cited by 45 publications

(37 citation statements)

References 72 publications

(115 reference statements)

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“…Invaded cancerous cells to spinal column are mostly originates from followings: lungs (31%), breasts (9%), prostate (8%), lymphoma (6%), melanoma (4%), unknown sources (2%), kidneys (1%) and other malignancies including multiple myeloma (3%). In cases of no intervention, poor prognosis expects patients with spinal metastasis [12].…”

Section: Discussionmentioning

confidence: 99%

First Experience of Intra-Operative Radiation Therapy (IORT) during Kyphoplasty in Patients Diagnosed with Spinal Metastasis in Iran

Seddighi¹,

Seddighi²,

Nikouei³

et al. 2021

austinjclincaserep

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Object: Based on previous studies, 30 to 40% of cancer patients are diagnosed with bone metastasis. Median Overall Survival (OS) of patients who are diagnosed with spinal metastasis (vertebral structures) is about 7 to 9 months which with recent progresses in oncologic and radiotherapy treatment modalities, their prognosis is slightly developed. In this study, authors plan to evaluate the effects of Intra-operative Radiation Therapy (IORT) in patients who are candidate for Kyphoplasty procedure. Methods: In this study, we have included patients who are diagnosed with spinal metastasis with radiological and histopathological confirmation. From July 2017 to December 2018, we have included 9 patients who fulfilled our predefined inclusion and exclusion criteria into our case-series study performed on Shohada Tajrish Hospital. Patients underwent radiotherapy during Kyphoplasty by our IORT device INTRABEAM (Carl Zeiss AG, Germany) as “Kypho-IORT’ procedure. We have evaluated these patients in post-operative period, as well as on 2 weeks, 1 month, 2 months and 6 months on post-operative period as our follow-up plan. Results: In this study, 9 patients (5 males and 4 females) with mean age of 68 years with spinal metastasis from breast (4 cases), prostate (2 cases), lung (2 cases) and gastrointestinal tract (1 case), underwent Kypho-IORT for 15 vertebrae levels with individualized radiation dose and interval. In postoperative follow-up period, patients exhibit pain relief (in 78%) assessed by Visual Assessment Score (VAS) and improvement in their Quality of Life (QoL). No major complications including new neurological deficit, major cement leak and embolic disorders were encountered during the study; however, minor cement leak encountered in 4 cases, and 2 patients have expired during follow up period; however, other patients are still alive and under follow-up with mean OS of 10 months. Conclusion: This study is the first experience of evaluation of IORT effects during Kyphoplasty in Iran, in patients diagnosed with spinal metastasis with poor prognosis, to improve their quality of life, local control rate and their OS. This study could be considered as one of the pioneers in continuing the evaluation of Kypho-IORT as a novel technique in these group of patients.

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Section: Discussionmentioning

confidence: 99%

First Experience of Intra-Operative Radiation Therapy (IORT) during Kyphoplasty in Patients Diagnosed with Spinal Metastasis in Iran

Seddighi¹,

Seddighi²,

Nikouei³

et al. 2021

austinjclincaserep

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“…13,19,20 More recent reports have presented lower rates of infection, which may be associated with less invasive techniques. 15,21,22 Due to complications three months after hospital discharge, readmission and reoperation rates ranged from 9.7% to 16.8%, evidencing the impact of the disease and its treatment on the health system. [23][24][25][26] Surgical treatment of spinal metastases carries the same risks as non-oncological surgeries, plus the risk of complicating factors associated with oncological disease and its metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Complications can reduce patients' quality of life, and one of the goals of surgical treatment is to improve this, reinforcing the need for careful evaluation of the indication for surgical treatment. 22 Low albumin levels, additional comorbidities, pathological fractures, involvement of more than three vertebral levels, combined approach, age, type of tumor, blood transfusion and Charlson comorbidity index have all been reported as factors associated with complications of surgical treatment. 21,22 The most frequently reported complication is infection or dehiscence of the surgical wound, which varies from 1.5% to 30% of patients.…”

Section: Discussionmentioning

confidence: 99%

Complications of Surgical Treatment of Spinal Metastases

et al. 2021

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Objectives: To evaluate the complications of surgical treatment in a group of patients with spinal metastasis with epidural compression, undergoing surgical treatment. Methods: This is a comparative retrospective study (level of evidence III), which evaluated 96 patients with spinal metastases undergoing surgical treatment. Intra- and postoperative complications were obtained from the patients’ medical records and correlated with the following clinical characteristics: tumor type, tumor location, neurological deficit, age, number of affected vertebrae, Tokuhashi scale, Tomita scale, Karnofsky performance scale, and type of approach. Results: Complications of surgical treatment were observed in 29 (30.20%) patients. Surgical wound infection was the most frequent complication, observed in 15% of patients. Conclusions: Surgical treatment of spinal metastases presents complications in about 30% of patients and their occurrence should be considered in the treatment planning, weighing the risks and benefits for achieving the treatment goals. Level III evidence; Retrospective Study.

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“…Even though studies show that surgery is an important part of the treatment of metastatic spinal tumors, preoperative and/or postoperative radiotherapy is still essential 32 . The timing of radiotherapy should be 1-2 weeks before and after surgery to avoid postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O‐Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction

Zhou

Wang

Xiao

et al. 2020

Orthopaedic Surgery

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Objective To evaluate the safety and efficacy of O‐arm‐guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction. Methods Patients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF‐36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded. Results Twenty‐three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery (P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF‐36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved (P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm (P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm (P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery. Conclusion In the short term, O‐arm‐guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.

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Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Cited by 45 publications

References 72 publications

First Experience of Intra-Operative Radiation Therapy (IORT) during Kyphoplasty in Patients Diagnosed with Spinal Metastasis in Iran

First Experience of Intra-Operative Radiation Therapy (IORT) during Kyphoplasty in Patients Diagnosed with Spinal Metastasis in Iran

Complications of Surgical Treatment of Spinal Metastases

Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O‐Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction

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