Surgical Extent of Metastatic Spine Tumor Excision and Its Effects on Postoperative Ambulatory Function: Comparison of Extensive Wide versus Palliative Excision Surgery / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs). SUMMARY OF LITERATURE REVIEW: Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported. MATERIALS AND METHODS: Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed. RESULTS: The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively). CONCLUSIONS: The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival.

The Comparision of the Radiofrequency Ablasion Therapy with Vertebroplasty and Radiotherapy in Metastatic Spine Tumor / 대한정형외과학회잡지

PURPOSE: To evaluation the availability of combined treatment with radiofrequency (RF) ablation with vertebroplasty in patients with metastatic spine tumor. MATERIALS AND METHODS: Between March 2007 and March 2009, 34 patients with the metastatic spine tumor, RF ablation with vertebroplasty was performed in 17 patients, and radiotherapy in the other 17 patients. Cumulative 1-year patient survival rate were compared with the both groups. Pain relief and quality of life were evaluated with use of the visual analogue scale (VAS) and Roland Moris Questionnaire (RMQ). RESULTS: Nine of 17 patients with the RF ablasion therapy with vertebroplasty and 8 of 17 patients with radiotherapy were died. Tumor necrosis was observed in 61.2+/-22.4% (range 28-100%) of the tumor volume. In terms of pain relief, VAS score of preoperative, 1 week and 4 weeks following were 7.12, 3.82 and 3.65 in RF ablation with vertebroplasty group, and 7.00, 5.39 and 4.94 in radiotherapy group(p-value <0.001, <0.001). The score of RMQ score was improved from 12.94 to 7.18 in operation group (p-value <0.001), and 14.11 to 10.89 in radiotherapy group(p-value 0.001). But in terms of pain relief (score of VAS) and quality of life (score of RMQ), RF with vertebroplasty group showed significantly better than the radiotheray group (VAS, p for intercation 0.004, RMQ, p for interaction 0.024). CONCLUSION: RF with vertebroplasty is thought to be a useful method to improve the pain relief and quality of life in patients with metastatic spine tumor.

Combined en Bloc Spondylectomy and Chest Wall Resection for Malignant Tumors Invading Spinal Column and Chest Wall

We performed combined spondylectomy for 2 patients of malignant tumors invading spinal column and chest wall. For one patient with Pancoast tumor, anterolateral thoracotomy, apical lobectomy, chest wall resection, and hemispondylectomy were performed. For another patient with solitary metastatic tumor from nasopharyngeal cancer, posterolateral thoracotomy, chest wall resection, and total en bloc spondylectomy were performed with anterior and posterior instrumentation. The tumor including invaded chest wall and spinal column werewas removed completely in both patients. No local recurrence was found at 18 months follow-up evaluation in both patients.

Atypical Presentation of Spinal Tuberculosis Misadiagnosed as Metastatic Spine Tumor

We present a case of a 68-year-old female with an atypical form of spinal tuberculosis, which involved posterior elements with multiple foci in two noncontiguous vertebral levels. The lesions caused spastic paraparesis and urinary hesitation. There was no evidence of pulmonary or other extrapulmonary tuberculous disease. Based on clinical and radiographic findings, this atypical spinal tuberculosis was preoperatively misdiagnosed as metastatic spine tumor. The histopathologic finding confirmed tuberculosis and the patient was treated successfully with surgery and antituberculous therapy. In case of a spinal lesion of unknown origin, it is important to be aware that atypical spinal tuberculosis can mimic metastatic spine tumor and tuberculosis should always be considered.

A Survival Analysis of Surgically Treated Metastatic Spine Tumors

OBJECTIVE: The purpose of this study is to assess the survival and prognostic factors of surgically treated metastatic spine tumors. METHODS: A retrospective review of 68 patients who underwent the surgical treatment of metastatic spine tumors from 1988 to 2001 was conducted. The survival of each patient was confirmed on Feb 2002. The survival rates were calculated and several variables were examined for prognostic factors. RESULTS: Postoperative mean survival time was 21.1 months. Three month and 2 year cumulative survival was 70.3% and 21.4%, respectively. The patients who survived less than 3 months after operation were 23(33.8%). The significant prognostic factors were the category of primary tumors, postoperative ambulation, preoperative functional status, and the interval between initial diagnosis and spine metastasis. CONCLUSION: The postoperative survival was related with the biologic behavior of primary tumor and general physical condition. High mortality rate in postoperative three months suggests that more sophisticated selection criterion is needed.

A Clinical Analysis of Metastatic Spine Tumors: Analysis of Prognostic Factors and Scoring System for Prognostic Evaluation

The purpose of treatment for metastatic spine tumor is to improve the quality of life. So, it is very important to carefully select the surgical candidates to prevent unnecessary surgery-related morbidity and mortality. For this purpose, the authors have surveyed 200 cases of spinal metastasis treated by radiotherapy alone or radiotherapy plus surgery to determine prognostic factors. In this study, we attempted to examine retrospectively the four factors, e.g.,primary tumor, pretreatment neurologic status, general condition and degree of cancer extension, affecting the prognosis of metastatic spine tumors. Each factor was ranked from 1 to 3 points according to the severity and the total score for each patient was obtained by adding the these points. As a result, it was found that the total score was highly correlated to the survival period. While the patients with a total score of 6 or lower survived 100 days or less, those of 10 or higher survived 300 days or more on average. Therefore, authors believe this scoring system would be helpful to the determine treatment modalities and the selection of the most suitable operative procedures.

A Clinical Analysis of Metastatic Spine Tumors

The authors analyed 27 cases of metastatic spine tumor in regard to diagnostic procedures, effects of radiation and their average survival time. Technetium-99m radiolabeled polyphosphate bone scans were superior to any other diagnostic procedures as a screening test for the early detection of spine metastases. Spinal CT scans with myelogram were useful to define the anatomic extent of destruction and cord comprssion. To prevent myelopathy, early radiation therapy was certainly helpful. The decompressive laminectomy alone have contributed little to the patients in regard to the prolongation of life and the correction of neurological deteriorations. The authors concluded that the one-stage laminectomy and adequate posterior stabilization with the use of internal fixation devices were the choice of treatment for control of pain and prevention of the complications from spinal instability in the following patients: 1) with early progressive myelopathy: 2) who were unable to move due to the pain evoked by motion; and 3) who showed the evidence of spinal instability radiologically and/or clinically.