Abstract
ObjectiveThis study aims to evaluate different prognostic factors after surgical management of metastatic spinal tumors regarding clinical condition, preoperative investigations, histopathological results, and surgical data.MethodsSeventy patients diagnosed as metastatic spinal tumors with neurological deficits and/or unstable spine operated for spinal decompression with or without instrumental fixation according to Spinal Instability Neoplastic Score (SINS) at our institute during the period from May 2014 to October 2018 with follow-up at least 9 months.ResultsLymphoma metastases were the commonest spinal metastases of 23% with significant p value = 0.001, males and ages above 50 years old were significantly affected. High vascularity and bone invasion were significant operative findings. Significant good prognostic factors for both survival and Klekampe score improvement were paretic patients, > 15 preoperative Klekampe score, early surgery, ≤ 3 vertebral affection, extradural tumor location, gross total resection, and metastatic tumors from multiple myeloma, thyroid gland, lymphoma, and prostatic gland.ConclusionEarly surgeries aiming neural decompression and keeping spinal stability according to Spinal Instability Neoplastic Score for patients with spinal metastases are the main hope for better survival and neurological improvement.
Highlights
Skeletal metastasis is second to lung and liver metastases
Patients who were fit for surgery operated for spinal decompression, tumor resection, and instrumental fixation when indicated according to Spinal Instability Neoplastic Score (SINS) [10]
We found the survival after 9 months from surgery 58/ 70(83%) patients with statistically significant (p* < 0.05) good prognostic factors for survival; paretic patients, > 15 preoperative Klekampe score, early surgery till 1 month duration of spinal symptoms, one vertebral affection, lumber affection, extradural or intraduralextramedullary tumor location, gross total resection, and metastatic tumors from multiple myeloma, thyroid gland, lung, or prostatic gland
Summary
Skeletal metastasis is second to lung and liver metastases. Spinal metastases estimate more than 10% of patients with tumors [1]. More than 80% of primary tumors were presented by metastases. The commonest primary tumors with bone metastases are prostate (84%), breast (72%), thyroid (50%), kidney (37%), pancreas (33%), and lung (31%) [2]. Extradural lesions either pure epidural or originating from the vertebra and extending to epidural space account for up to 95% of spinal metastatic lesions [3]. The thoracic spine is the commonest part involved. Intradural-extramedullary and intramedullary seeding account for 5–6% and 0.5–1% of spinal metastases, Pain is the commonest symptom in 90% of patients [4]. Rapid progression is common in patients presented with neurological deficits [5]
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