Scientific outcomes of multidisciplinary remedy together with palliative posterior spinal stabilization surgical procedure and postoperative adjuvant remedy for metastatic spinal tumor.
J Orthop Surg Res. 2018 Feb 05;13(1):30
Authors: Uei H, Tokuhashi Y, Maseda M, Nakahashi M, Sawada H, Nakayama E, Soma H
BACKGROUND: Surgical procedures carried out for metastatic spinal tumor are largely palliative and are controversial for sufferers with quick life expectancy. We investigated whether or not palliative posterior spinal stabilization surgical procedure with postoperative multidisciplinary remedy leads to enchancment of life prognosis and actions of day by day residing (ADL) in sufferers with metastatic spinal tumor.
METHODS: The themes had been 55 sufferers who underwent palliative posterior-only instrumentation surgical procedure for metastatic spinal tumor at our hospital between 2012 and 2015. Postoperative survival, early paralysis enchancment, ADL enchancment, and price of discharge to house had been examined.
RESULTS: The sufferers included 37 males and 18 females, and the imply age on the time of surgical procedure was 66.eight years previous. The imply Tokuhashi rating was 7.1, the imply spinal instability neoplastic rating (SINS) was 9.Four, and the epidural spinal twine compression scale (ESCCS) was grade three in 20 sufferers (36.three%). The imply Barthel index for ADL was 48.7. The median postoperative survival time decided utilizing the Kaplan-Meier technique was 12.zero months (95% confidence interval 2.Four-21.5). Concerning enchancment of paralysis, the modified Frankel scale was improved by one grade or extra or grade E was maintained in 35 sufferers (63.6%), whereas paralysis aggravated in 2 (three.6%). In surgical procedure, standard posterior decompression and fixation had been utilized in 31 sufferers (56.three%), and minimally invasive backbone stabilization was utilized in 24 (43.6%). Postoperative chemotherapy was carried out in 31 sufferers (56.three%), radiotherapy was utilized in 38 (69.zero%), and a bone-modifying agent was administered in 39 (70.2%). Concerning ADL, the imply Barthel index improved from 48.5 earlier than surgical procedure to 74.5 after surgical procedure. Thirty-seven sufferers (67.2%) had been discharged to house.
CONCLUSIONS: ADL improved and allowed discharge to house, and postoperative adjuvant remedy might be administered at a excessive price in sufferers who obtained palliative posterior spinal stabilization surgical procedure. Survival time prolonged past the preoperative life expectancy in lots of sufferers. Sufferers with a metastatic spinal tumor have quick life expectancy and paralysis brought on by spinal instability and spinal twine compression. Nonetheless, multidisciplinary remedy together with palliative posterior spinal stabilization surgical procedure with decreased invasiveness and postoperative adjuvant remedy are efficient in these sufferers.
PMID: 29402333 [PubMed – in process]