Decision making for the surgical treatment of vertebral metastases among patients with short predicted survival.

Decision making for the surgical treatment of vertebral metastases among patients with short predicted survival.

World Neurosurg. 2017 Dec 27;:

Authors: Bouras T, Zairi F, Arikat A, Vieillard MH, Allaoui M, Assaker R

Abstract
BACKGROUND: A wide spectrum of treatment choices is proposed for poor-prognosis patients with vertebral metastases. The continuous increase of this population and the propagation of less invasive techniques necessitate further study concerning which patients could benefit from palliative surgery.
METHODS: All patients with a Tokuhashi score ≤ 8 undergone palliative surgical treatment for vertebral metastasis within four years were retrospectively reviewed. Demographics, clinical parameters, and data concerning the disease and the operation were recorded. Patients were assessed on discharge and at two months concerning eventual benefit from surgery, based on pain measurements, motor function (Frankel grade), spinal stability assessment and complications. Statistical analysis was performed to detect possible inter-relations.
RESULTS: Eighty-eight patients were reviewed. Average age was 56.5 years. The mean Tokuhashi score was 5.9 with a mean Karnofsky score of 56.4. Thirty-six patients were immediately improved, 12 were lost on follow-up and 42 were found to have benefitted from surgery two months later. High Karnofsky score, radicular pain, morphine use, absence of complications and immediate improvement predicted benefit from surgery.
CONCLUSIONS: Decision making for a patient with poor prognosis concerning eventual surgery for a vertebral metastasis should be based mainly on the patient's clinical presentation and the primary cancer site is of less importance.

PMID: 29288847 [PubMed - as supplied by publisher]

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