Sustained improvement in quality of life after surgery for spinal metastases: cohort study of 922 patients

Proceedings of the BASS 2015 Bath Meeting / The Spine Journal 15 (2015) 50S–85S

did not demonstrate progression of osseus autofusion and remodelling, operative intervention was chosen. Stability was achieved in both groups. All patients demonstrated preservation of spinal cord function except for one patient had residual neurological deficit (Frankel C). One patient had moderate residual pain (VAS 4). CONCLUSIONS: Serial evaluation of spinal stability with pain assessment, neurological evaluation and multimodal imaging, including CT and MRI serves to optimize decision making in cervical spine myeloma management. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None.

Frankel Grade

64S

n=8

E

n = 14

n=5

D

n=3

n=2

C

n=2

B

n=1

n=2

A

n=1

http://dx.doi.org/10.1016/j.spinee.2014.12.072 Pre-operave

Sustained improvement in quality of life after surgery for spinal metastases: cohort study of 922 patients David Choi, Nasir Quraishi, Alan Crockard; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG BACKGROUND CONTEXT: Metastatic spinal cancer is a common condition that may lead to spinal instability, pain and paralysis. In the 1980s, surgery was discouraged because results showed worse neurological outcomes compared to radiotherapy alone. However, with the advent of spinal stabilisation, the role of surgery has regained centre stage. PURPOSE: By analysing the largest surgical series of patients with epidural spinal metastases, we sought to verify that surgery provides sustained improvement in patients’ quality of life. STUDY DESIGN/SETTING: Prospective cohort study: the multicentre database of the ‘‘Global Spine Tumour Study Group’’. PATIENT SAMPLE: 922 consecutive patients with spinal metastases who underwent surgery. OUTCOME MEASURES: Self-reported: Pre- and post-operative assessment of Euroqol EQ-5D quality of life, visual analogue score (VAS) for pain Functional: Karnofsky score; Surgeon-assessed: complications and survival. METHODS: A prospective longitudinal study of consecutive patients who were admitted for surgery to treat symptomatic spinal metastases at 17 orthopaedic spinal units or neurosurgical centres. Outcome measures were recorded to determine whether spinal surgery influences quality of life. RESULTS: EQ-5D, VAS pain score and Karnofsky physical functioning score improved rapidly after surgery and these improvements were sustained in patients who survived up to 2 years after surgery. In specialised spine centres, the technical intra-operative complication rate of surgery was low, however almost a quarter of patients experienced post-operative systemic adverse events. CONCLUSIONS: Surgical treatment for spinal metastases keeps patients walking, independent, and with little pain, resulting in good quality of life. However, as a group, patients with cancer are vulnerable to post-operative systemic complications, hence the importance of appropriate patient selection. CONFLICTS OF INTEREST: None. FUNDING SOURCES: DePuy Synthes research grant.

Post-operave

Figure 1. Pre-operative and post-operative Frankel grade. Note stable or improved Frankel grades in all patients.

PURPOSE: To evaluate patient characteristics, clinical and radiological outcomes of minimally invasive, lateral-approach corpectomy (MIDLaC) for decompression and stabilization of metastatic spinal cord compression (MSCC). STUDY DESIGN/SETTING: Retrospective study of prospective cohort. PATIENT SAMPLE: Nineteen patients consecutively treated with MIDLaC and pedicle screw fixation between May’12 and July’14. OUTCOME MEASURES: Self-report measures: Pain VAS. Radiological measures: Sagittal deformity correction, vertebral body height. Operative measures: Operation duration, blood loss. Clinical variables: Demographics, Tokuhashi score, mortality, complications, opioid usage, Frankel grade. RESULTS: All nineteen patients(mean age: 67.6612.7years) successfully underwent MIDLaC with excellent neural decompression. Operative duration was 188.4630.3min for single-level MIDLaC, and 327.2671.9min for multi-level surgery (p!0.0001). Mean blood loss per spinal level was 390.8mL with a decrease to 102.3mL without renal cell MSCC. 47.4% of patients had a Tokuhashi score of 0-8. There was one approach-related complication and nil perioperative mortality. The overall complication rate was 15.8% (n53). The overall mortality rate was 36.8% (n57). 31.6% of patients improved by one or more Frankel grades, and no patients demonstrated worsening neurology post-operatively. VAS was significantly improved post-operatively (p!0.05). Vertebral body height was significantly increased (þ7.668.1mm, p50.002), with improvements in lumbar lordosis (8.367.3degrees) and thoracic kyphosis (2.467.1degrees).

http://dx.doi.org/10.1016/j.spinee.2014.12.073

Minimally Invasive Direct Lateral Corpectomy (MIDLaC) of the thoraco-lumbar spine for metastatic spinal cord compression Terence Tan, Jocelyn Chu, Christopher Thien, Yi Yuen Wang; St Vincent’s Hospital Melbourne, 55 Victoria Parade, Fitzroy, Victoria, 3065, Australia BACKGROUND CONTEXT: Conventional surgical approaches for MSCC are associated with high mortality and morbidity. Multiple scoring systems are utilized in patient selection for surgery. Minimal-access minimally invasive surgery, with benefits of reduced morbidity and equivalent efficacy, can be adapted towards management of MSCC.

Figure 2. Case 1.Pre-operative (left) sagittal computed tomography (CT) demonstrating T11 vertebral fracture with bony retropulsion and spinal cord indentation (arrow). Post-operative (right) sagittal CT showing a T11 corpectomy and insertion of an expandable titanium cage