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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

  • Original Article - Spine - Other
  • Published:
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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.

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Bart Depreitere

  2. Department of Statistical Science, University College London, London, UK

    Federico Ricciardi

  3. Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, Netherlands

    Mark Arts

  4. Orthopaedics and Traumatology Centre, Clinique Mutualiste de la Porte de L’Orient, L’Orient, France

    Laurent Balabaud

  5. Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark

    Cody Bunger

  6. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Jacob M. Buchowski

  7. Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea

    Chun Kee Chung

  8. Department of Neurosurgery, University Medical Centre Groningen, Groningen, Netherlands

    Maarten Hubert Coppes

  9. Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Canada

    Michael George Fehlings & Eric Maurice Massicotte

  10. Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan

    Norio Kawahara

  11. Spinal Unit, Hospital Universitario Dr Peset, Valencia, Spain

    Juan Antonio Martin-Benlloch

  12. Department of Orthopedic surgery, L’Institut Mutualiste Montsouris, Paris, France

    Christian Mazel

  13. Department of Neurosurgery, Technische Universität München, Munich, Germany

    Bernhard Meyer

  14. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, Netherlands

    Fetullah Cumhur Oner & Jorrit-Jan Verlaan

  15. Department of Neurosurgery, Leiden University Medical Centre, Leiden, Netherlands

    Wilco Peul

  16. Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK

    Nasir Quraishi

  17. Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan

    Yasuaki Tokuhashi

  18. Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan

    Katsuro Tomita

  19. Department of Neurosurgery, Jackson Memorial Hospital, University of Miami, Miami, USA

    Michael Wang

  20. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, UK

    Hugh Alan Crockard & David Choi

Authors
  1. Bart Depreitere
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  2. Federico Ricciardi
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  3. Mark Arts
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  4. Laurent Balabaud
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  6. Jacob M. Buchowski
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  8. Maarten Hubert Coppes
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  9. Michael George Fehlings
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  10. Norio Kawahara
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  11. Juan Antonio Martin-Benlloch
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  12. Eric Maurice Massicotte
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  13. Christian Mazel
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  14. Bernhard Meyer
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  15. Fetullah Cumhur Oner
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  16. Wilco Peul
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  17. Nasir Quraishi
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  18. Yasuaki Tokuhashi
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  19. Katsuro Tomita
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  20. Jorrit-Jan Verlaan
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  21. Michael Wang
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  22. Hugh Alan Crockard
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  23. David Choi
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Corresponding author

Correspondence to Bart Depreitere.

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Funding information

This work was funded by the Global Spine Tumor Study Group, a registered charity of England and Wales, Charity Commission number 1134934, and DePuy Synthes (Johnson and Johnson). This study was performed in part at University College London Biomedical Research Centre, which receives funding from the National Institute for Health Research, UK. The sponsors had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the local institutional research committees according to national regulations and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Depreitere, B., Ricciardi, F., Arts, M. et al. 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. Acta Neurochir 162, 943–950 (2020). https://doi.org/10.1007/s00701-019-04197-5

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  • DOI: https://doi.org/10.1007/s00701-019-04197-5

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