Journal of Korean Neurosurgical Society

  • 제50권5호
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  • Pages.434-440
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  • 2011
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Efficacy of Decompression and Fixation for Metastatic Spinal Cord Compression : Analysis of Factors Prognostic for Survival and Postoperative Ambulation

  • Park, Jin-Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Rhim, Seung-Chul (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeon, Sang-Ryong (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2011.06.20
  • 심사 : 2011.11.21
  • 발행 : 2011.11.28
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초록

Objective : The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC. Methods : We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively. Results : Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) ($p$=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; $p$=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; $p$=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; $p$=0.038) were prognostic of postoperative ambulation. Conclusion : We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.

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참고문헌

  1. Chaichana KL, Pendleton C, Sciubba DM, Wolinsky JP, Gokaslan ZL : Outcome following decompressive surgery for different histological types of metastatic tumors causing epidural spinal cord compression. Clinical article. J Neurosurg Spine 11 : 56-63, 2009 https://doi.org/10.3171/2009.1.SPINE08657
  2. Chaichana KL, Woodworth GF, Sciubba DM, McGirt MJ, Witham TJ, Bydon A, et al. : Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression. Neurosurgery 62 : 683-692; discussion 683-692, 2008 https://doi.org/10.1227/01.neu.0000317317.33365.15
  3. Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C, et al. : Review of metastatic spine tumour classification and indications for surgery : the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 19 : 215-222, 2010 https://doi.org/10.1007/s00586-009-1252-x
  4. Eleraky M, Papanastassiou I, Vrionis FD : Management of metastatic spine disease. Curr Opin Support Palliat Care 4 : 182-188, 2010 https://doi.org/10.1097/SPC.0b013e32833d2fdd
  5. Gerszten PC, Welch WC : Current surgical management of metastatic spinal disease. Oncology (Williston Park) 14 : 1013-1024; discussion 1024, 1029-1030, 2000
  6. Hirabayashi H, Ebara S, Kinoshita T, Yuzawa Y, Nakamura I, Takahashi J, et al. : Clinical outcome and survival after palliative surgery for spinal metastases : palliative surgery in spinal metastases. Cancer 97 : 476-484, 2003 https://doi.org/10.1002/cncr.11039
  7. Hur JH, Gwak HS, Chang UK, Lee CH : The analysis of primary origin in spinal metastasis occurring as the initial manifestation of malignancy. J Korean Neurosurg Soc 33 : 30-35, 2003
  8. Jang JS, Kim JK, Park WM, Heon Y, Rhee CH, Lee SH : Surgical treatment of metastatic spinal tumor. J Korean Neurosurg Soc 28 : 1491-1497, 1999
  9. Kim HJ : Neurosurgical treatment of spinal metastatic tumor. J KoreanNeurosurg Soc 26 : 1814-1817, 1997
  10. Klimo P Jr, Thompson CJ, Kestle JR, Schmidt MH : A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol 7 : 64-76, 2005 https://doi.org/10.1215/S1152851704000262
  11. Kwon YM, Kim KS, Kuh SU, Chin DK, Jin BH, Cho YE : Survival rate and neurological outcome after operation for advanced spinal metastasis (Tomita's classification > or = type 4). Yonsei Med J 50 : 689-696, 2009 https://doi.org/10.3349/ymj.2009.50.5.689
  12. Leviov M, Dale J, Stein M, Ben-Shahar M, Ben-Arush M, Milstein D, et al. : The management of metastatic spinal cord compression : a radiotherapeutic success ceiling. Int J Radiat Oncol Biol Phys 27 : 231-234, 1993
  13. Li H, Gasbarrini A, Cappuccio M, Terzi S, Paderni S, Mirabile L, et al. : Outcome of excisional surgeries for the patients with spinal metastases. Eur Spine J 18 : 1423-1430, 2009 https://doi.org/10.1007/s00586-009-1111-9
  14. Maranzano E, Latini P : Effectiveness of radiation therapy without surgery in metastatic spinal cord compression : final results from a prospective trial. Int J Radiat Oncol Biol Phys 32 : 959-967, 1995 https://doi.org/10.1016/0360-3016(95)00572-G
  15. Melcher I, Disch AC, Khodadadyan-Klostermann C, Tohtz S, Smolny M, Stöckle U, et al. : Primary malignant bone tumors and solitary metastases of the thoracolumbar spine : results by management with total en bloc spondylectomy. Eur Spine J 16 : 1193-1202, 2007 https://doi.org/10.1007/s00586-006-0295-5
  16. North RB, LaRocca VR, Schwartz J, North CA, Zahurak M, Davis RF, et al. : Surgical management of spinal metastases : analysis of prognostic factors during a 10-year experience. J Neurosurg Spine 2 : 564-573, 2005 https://doi.org/10.3171/spi.2005.2.5.0564
  17. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. : Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer : a randomised trial. Lancet 366 : 643-648, 2005 https://doi.org/10.1016/S0140-6736(05)66954-1
  18. Putz C, Wiedenhöfer B, Gerner HJ, Fürstenberg CH : Tokuhashi prognosis score : An important tool in prediction of the neurological outcome in metastatic spinal cord compression : a retrospective clinical study. Spine (Phila Pa 1976) 33 : 2669-2674, 2008 https://doi.org/10.1097/BRS.0b013e318188b98f
  19. Rades D, Huttenlocher S, Dunst J, Bajrovic A, Karstens JH, Rudat V, et al. : Matched pair analysis comparing surgery followed by radiotherapy and radiotherapy alone for metastatic spinal cord compression. J Clin Oncol 28 : 3597-3604, 2010 https://doi.org/10.1200/JCO.2010.28.5635
  20. Rades D, Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, et al. : Final results of a prospective study comparing the local control of short-course and long-course radiotherapy for metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 79 : 524-530, 2011 https://doi.org/10.1016/j.ijrobp.2009.10.073
  21. Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P : Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 63 : 676-684, 1985 https://doi.org/10.3171/jns.1985.63.5.0676
  22. Tanaka M, Nakahara S, Ito Y, Kunisada T, Misawa H, Koshimune K, et al. : Surgical treatment of metastatic vertebral tumors. Acta Med Okayama 63 : 145-150, 2009
  23. Tokuhashi Y, Ajiro Y, Umezawa N : Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine (Phila Pa 1976) 34 : 69-73, 2009 https://doi.org/10.1097/BRS.0b013e3181913f19
  24. Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J : A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 30 : 2186-2191, 2005 https://doi.org/10.1097/01.brs.0000180401.06919.a5
  25. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T : Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26 : 298-306, 2001 https://doi.org/10.1097/00007632-200102010-00016
  26. Weigel B, Maghsudi M, Neumann C, Kretschmer R, Müller FJ, Nerlich M : Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976) 24 : 2240-2246, 1999 https://doi.org/10.1097/00007632-199911010-00012
  27. Yamashita T, Aota Y, Kushida K, Murayama H, Hiruma T, Takeyama M, et al. : Changes in physical function after palliative surgery for metastatic spinal tumor : association of the revised Tokuhashi score with neurologic recovery. Spine (Phila Pa 1976) 33 : 2341-2346, 2008 https://doi.org/10.1097/BRS.0b013e3181878733
  28. Zelefsky MJ, Scher HI, Krol G, Portenoy RK, Leibel SA, Fuks ZY : Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy. Cancer 70 : 2319-2325, 1992 https://doi.org/10.1002/1097-0142(19921101)70:9<2319::AID-CNCR2820700918>3.0.CO;2-8

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  13. Association of neurologic deficits with surgical outcomes and health‐related quality of life after treatment for metastatic epidural spinal cord compression vol.125, pp.23, 2011, https://doi.org/10.1002/cncr.32420
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