Neurological Outcome and Complications in Patients With Surgically Treated Spinal Metastases

Erion Junior de Andrade, MD, MSc, DMD, DDS; Samilly Conceição Maia Martins, MD; Cleiton Formentin, MD; Otávio Turolo, MD, PhD; Victor Leal de Vasconcelos, MD, MSc; Enrico Ghizoni, MD, PhD; Helder Tedeschi, MD, PhD; Andrei Fernandes Joaquim, MD, PhD

Disclosures

Spine. 2020;45(10):679-685. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective cohort.

Objective: Evaluate the epidemiology of surgical patients with spinal metastases, identify the complications, and evaluate their neurological prognoses.

Summary of Background Data: The development of new oncological treatments and screening tests have increased the survival of oncologic patients, and consequently, the incidence of metastatic lesions of the spine.

Methods: Retrospective cohort of 40 patients surgically treated at the Hospital de Clínicas of UNICAMP for spinal metastases from January 2010 to September 2018, after diagnosis of symptomatic spinal cord compression and/or mechanical instability of the spine. Retrospectively analyzed patient charts applied the SINS score to evaluate the presence of mechanical instability. Neurological function was classified based on the Frankel index preoperative and postoperatively. To evaluate the association between variables, the Chi-square test, Fisher exact test, or Fisher–Freeman–Halton test was applied. For evaluating the improvement of neurological status between the Frankel scores before and after surgery, the McNemar test was applied for categorical and qualitative variables. In both the tests, variables with values of P > 0.05 were considered.

Results: Pain as the reason for the first visit presented an odds ratio (OR) = 2.44 (95% [CI]: 1.14–5.2) for instrumentation need (P = 0.024). A higher SINS score corresponded to the indication for instrumentation surgery due to the instability of the spine (P = 0.004). Within 30 days postoperative, five patients (11.1%) had complications. There was a statistically significant neurological improvement in patients who underwent surgery (P = 0.002).

Conclusion: Pain as the first symptom was related to mechanical instability of the spine and surgical instrumentation. Patients treated with surgery presented improvement of the neurological function in the postoperative period.

Level of Evidence: 3

Introduction

The development of new therapies and screening tests have increased the survival of oncological patients, and consequently, the incidence of metastatic lesions of the spine.[1–3] The objective of the treatment of these lesions is the maintenance of quality of life based on the four following pillars: pain relief, maintenance of neurological function, spine stability, and local control of the disease.[4,5]

Surgery in vertebral metastases is considered a palliative treatment reserved for patients with a life expectancy of >3 months who can tolerate the procedure. Patients with severe pain due to instability may benefit from surgical procedures for stabilization/decompression after multidisciplinary analysis.[5–7] Thus, the knowledge of factors related to the functional prognosis of these patients is imperative.

The present study aims to evaluate the epidemiology of surgical patients with spinal metastases, identify the complications of the procedure and their relationships with the other epidemiological variables, and evaluate their neurological prognoses.

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