Abstract
Purpose Minimally invasive spine stabilization (MISt) using percutaneous pedicle screws plays a significant role in palliative surgery for metastatic spinal tumors. However, few studies have investigated surgical outcomes based on the epidural spinal cord compression scale (ESCCS). The purpose of this study was to examine outcomes of metastatic spinal tumors as evaluated by ESCCS in patients treated by MISt. Methods The subjects were 56 patients who underwent MISt for metastatic spinal tumors, including 34 patients with ESCCS 2 or milder (group A) and 22 patients with ESCCS 3 (group B). We analyzed baseline characteristics, perioperative factors and clinical results such as postoperative survival time, neurological outcomes, Barthel Index for activities of daily living (ADL), visual analogue scale (VAS), and the rate of discharge to home. Results The baseline age (P=0.07), tumor diagnosis (P=0.23), spinal level of compression (P=0.35), American Spinal Injury Association classification (P=0.49), revised Tokuhashi score (P=0.92), spinal instability neoplastic score (P=0.28), VAS (P=0.35), Barthel Index (P=0.07), American Society of Anesthesiologists physical status classification (P=0.76), and type of surgery (P=0.40) did not differ significantly between the two groups. The median postoperative survival time did not differ significantly between the groups (12.0 versus 15.0 months, P=0.60). Neurological improvement by at least 1 grade or maintenance of grade E was favorable in group A. Patients in group A had less posterior decompression (P=0.006), a higher rate of chemotherapy (P=0.009), a higher postoperative Barthel Index (P=0.04), and a higher rate of discharge to home (P=0.01) and no patients died in the hospital (P=0.004). Conclusions No significant difference was noted in the postoperative survival time between the 2 groups. Patients in the ESCCS 2 or milder group had favorable neurological improvement, higher rates of chemotherapy, better postoperative ADL, and the higher rate of discharge to home.
Highlights
The majority of metastatic spinal tumors are cancer metastasis, a systemic disease for which treatment is limited [1,2,3,4]
Evaluation methods of the grade of nerve compression associated with metastatic spinal tumors include the epidural spinal cord compression scale (ESCCS) based on T2-weighted axial magnetic resonance imaging (MRI) [8]
Minimally invasive spine stabilization (MISt) with percutaneous pedicle screws (PPS) for metastatic spinal tumors [15, 16, 23] was indicated for intractable pain due to spinal instability or threat of instability defined by the spinal instability neoplastic score (SINS) [24], spinal paralysis, such as any change in the motor examination, or radiation-resistant cancer such as kidney cancer or thyroid cancer
Summary
The majority of metastatic spinal tumors are cancer metastasis, a systemic disease for which treatment is limited [1,2,3,4]. Evaluation methods of the grade of nerve compression associated with metastatic spinal tumors include the epidural spinal cord compression scale (ESCCS) based on T2-weighted axial magnetic resonance imaging (MRI) [8]. This scale employs a 6-grade evaluation method where 0 represents a tumor staying in the vertebra, 1a represents an epidural impingement without deformation of the thecal sac, 1b represents a tumor compressing the thecal sac, and 1c represents a deformation of the thecal sac with spinal cord abutment in the absence of spinal cord compression.
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