How good are the outcomes of instrumented debulking operations for symptomatic spinal metastases and how long do they stand? A subgroup analysis in the global spine tumor study group database

Bart Depreitere, Federico Ricciardi, Mark Arts, Laurent Balabaud, Cody Bunger, Jacob M. Buchowski, Chun Kee Chung, Maarten Hubert Coppes, Michael George Fehlings, Norio Kawahara, Juan Antonio Martin-Benlloch, Eric Maurice Massicotte, Christian Mazel, Bernhard Meyer, Fetullah Cumhur Oner, Wilco Peul, Nasir Quraishi, Yasuaki Tokuhashi, Katsuro Tomita, Jorrit Jan VerlaanMichael Wang, Hugh Alan Crockard, David Choi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The benefits of surgery for symptomatic spinal metastases have been demonstrated, largely based on series of patients undergoing debulking and instrumentation operations. However, as cancer treatments improve and overall survival lengths increase, the incidence of recurrent spinal cord compression after debulking may increase. The aim of the current paper is to document the postoperative evolution of neurological function, pain, and quality of life following debulking and instrumentation in the Global Spine Tumor Study Group (GSTSG) database. Methods: The GSTSG database is a prospective multicenter data repository of consecutive patients that underwent surgery for a symptomatic spinal metastasis. For the present analysis, patients were selected from the database that underwent decompressive debulking surgery with instrumentation. Preoperative tumor type, Tomita and Tokuhashi scores, EQ-5D, Frankel, Karnofsky, and postoperative complications, survival, EQ-5D, Frankel, Karnofsky, and pain numeric rating scores (NRS) at 3, 6, 12, and 24 months were analyzed. Results: A total of 914 patients underwent decompressive debulking surgery with instrumentation and had documented follow-up until death or until 2 years post surgery. Median preoperative Karnofsky performance index was 70. A total of 656 patients (71.8%) had visceral metastases and 490 (53.6%) had extraspinal bone metastases. Tomita scores were evenly distributed above (49.1%) and below or equal to 5 (50.9%), and Tokuhashi scores almost evenly distributed below or equal to 8 (46.3%) and above 8 (53.7%). Overall, 12-month survival after surgery was 56.3%. The surgery resulted in EQ-5D health status improvement and NRS pain reduction that was maintained throughout follow-up. Frankel scores improved at first follow-up in 25.0% of patients, but by 12 months neurological deterioration was observed in 18.8%. Conclusion: We found that palliative debulking and instrumentation surgeries were performed throughout all Tomita and Tokuhashi categories. These surgeries reduced pain scores and improved quality of life up to 2 years after surgery. After initial improvement, a proportion of patients experienced neurological deterioration by 1 year, but the majority of patients remained stable.

Original languageEnglish
Pages (from-to)943-950
Number of pages8
JournalActa Neurochirurgica
Volume162
Issue number4
DOIs
StatePublished - Apr 1 2020

Keywords

  • Debulking surgery
  • Frankel score
  • Metastasis
  • Quality of life
  • Spine

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