Abstract
BackgroundPosterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor. However, the indication for addition of posterior decompression have not been examined. The purpose of this study was to investigate a retrospective cohort of outcomes of metastatic spinal tumor treated with minimally invasive spine stabilization (MISt) with or without posterior decompression.MethodsThe subjects were 40 patients who underwent MISt using percutaneous pedicle screws for metastatic spinal tumor, including 20 patients treated with stabilization alone (group A) and 20 patients with added posterior decompression (group B). We analyzed baseline characteristics, postoperative survival time, and perioperative factors such as neurological outcomes, Barthel Index, VAS, and rate of discharge to home.ResultsThe mean ages were 70 and 66 years old (P = 0.06), the mean revised Tokuhashi scores were 7.2 and 5.8 (P = 0.1), the mean spinal instability neoplastic scores (SINS) were 10.5 and 9.0 (P = 0.04), and the mean Barthel Index for ADL were 65.5 and 41.0 (P = 0.06) in groups A and B, respectively. The median postoperative survival time did not differ significantly between groups A and B (12.0 vs. 6.0 months, P = 0.09). Patients in group A had a significantly shorter operation time (166 vs. 232 min, P = 0.004) and lower intraoperative blood loss (120 vs. 478 mL, P < 0.001). Postoperative paralysis (P = 0.1), paralysis improvement rate (P = 0.09), postoperative Barthel Index (P = 0.06), and postoperative VAS (P = 0.6) did not differ significantly between the groups. The modified Frankel classification improved from D1 or D2 before surgery to D3 or E after surgery in 4 of 10 cases (40%) in group A and 8 of 8 patients (100%) in group B (P = 0.01). Significantly more patients were discharged to home in group A (P = 0.02), whereas significantly more patients died in the hospital in group B (P = 0.02).ConclusionsPatients treated without decompression had a shorter operation time, less blood loss, a higher rate of discharge to home, and lower in-hospital mortality, indicating a procedure with lower invasiveness. MISt without decompression is advantageous for patients with D3 or milder paralysis, but decompression is necessary for patients with D2 or severer paralysis.
Highlights
Posterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor
minimally invasive spine stabilization (MISt) without decompression included a significantly shorter operation time and reduced blood loss. These results showed that MISt without decompression is less invasive than MISt with decompression, and this may have led to higher rates of chemotherapy (70%), radiotherapy (70%), and Bone modifying agent (BMA) therapy (90%), the differences were not significant, and the significantly higher rate of discharge to home and lower in-hospital mortality
In the 6 of the 10 patients in group A whose modified Frankel classification did not improve to D3 or E after surgery, the mean Tokuhashi score and spinal instability neoplastic scores (SINS) were 5.1 and 11.6, respectively. Their epidural spinal cord compression scale (ESCCS) were 1a in one, 1c in one, 2 in two, and 3 in two. These results showed that the indication of MISt without decompression should be limited to mild paralysis of higher Tokuhashi score, lower SINS and lower ESCCS, and moderate nerve paralysis of D2 or severer requires decompression
Summary
Posterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor. The purpose of this study was to investigate a retrospective cohort of outcomes of metastatic spinal tumor treated with minimally invasive spine stabilization (MISt) with or without posterior decompression. Most cases of metastatic spinal tumor are systemic diseases with limited treatment [1,2,3,4,5,6]. Palliative posterior stabilization is selected for most cases, but massive bleeding may occur during preparation of the surgical field, application of decompression, and intratumor resection; and surgical stress cannot be neglected for patients with limited prognosis. Minimization of the invasiveness of palliative surgery for metastatic spinal tumor is more important than that of surgery for spinal degenerative disease
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