A population-based study of surgery for spinal metastases. Survival rates and complications.

The management of spinal metastases is palliative and aimed at improving quality of life at an acceptable risk. This population study uses administrative databases and measures survivorship and complication rates after surgery for spinal metastases. The effects of various potential predictor variables were evaluated. We identified 987 patients with a median survival for all types of cancer of 227 days. The one and three-month mortality was 9% and 29%, respectively. Increasing age, male gender and primary lung cancer were significant risk factors for death within 30 days of surgery. A preoperative neurological deficit contributed a 19% increase in mortality and a 71% increase in the risk of postoperative wound infection. We found an overall major complication rate of 27%. This information will provide patients, families and clinicians with objective data which will help in the choice of treatment and the understanding of the surgical risk and outcome.

[1]  C. Bombardier,et al.  Accuracy of administrative data for assessing outcomes after knee replacement surgery. , 1997, Journal of clinical epidemiology.

[2]  H. Bauer Posterior Decompression and Stabilization for Spinal Metastases. Analysis of Sixty-seven Consecutive Patients* , 1997, The Journal of bone and joint surgery. American volume.

[3]  K. Kelliher,et al.  Surgery for Solitary Metastases of the Spine: Rationale and Results of Treatment , 2002, Spine.

[4]  Alvan R. Feinstein,et al.  Multivariable Analysis: An Introduction , 1996 .

[5]  T Onomura,et al.  Survival Rates of Patients With Metastatic Spinal Cancer After Scintigraphic Detection of Abnormal Radioactive Accumulation , 1996, Spine.

[6]  J. Kostuik,et al.  Spinal Stabilization of Vertebral Column Tumors , 1988, Spine.

[7]  P. McCormack,et al.  Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. , 1985, Journal of neurosurgery.

[8]  J. O'neil,et al.  Treatment of tumors of the thoracic and lumbar spinal column. , 1988, Clinical orthopaedics and related research.

[9]  K. Hammerberg Surgical Treatment of Metastatic Spine Disease , 1992, Spine.

[10]  G. Chatellier,et al.  Vertebral Metastases: A Critical Appreciation of the Preoperative Prognostic Tokuhashi Score in a Series of 71 Cases , 1997, Spine.

[11]  S. Helweg-Larsen Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients , 1996, Acta neurologica Scandinavica.

[12]  T. Yamamuro,et al.  Posterior Decompression and Stabilization for Multiple Metastatic Tumors of the Spine , 1992, Spine.

[13]  Lori Holden,et al.  Quality of Life in Surgical Treatment of Metastatic Spine Disease , 2003, Spine.

[14]  R. Baggs,et al.  Pathogenesis of vertebral metastasis and epidural spinal cord compression , 1990, Cancer.

[15]  S. Seagren,et al.  Prognostic factors in the management of metastatic epidural spinal cord compression , 1980, Journal of Neuro-Oncology.

[16]  Y. Tokuhashi,et al.  Scoring System for the Preoperative Evaluation of Metastatic Spine Tumor Prognosis , 1990, Spine.

[17]  R. Wedin,et al.  Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. , 1995, Acta orthopaedica Scandinavica.

[18]  Casey K. Lee,et al.  Surgical Treatment of Tumors of the Spine , 1986, Spine.

[19]  S. Swisher,et al.  Transthoracic vertebrectomy for metastatic spinal tumors. , 1998, Journal of neurosurgery.

[20]  J. Meder,et al.  Spinal metastases with neurological manifestations. Review of 600 cases. , 1983, Journal of neurosurgery.

[21]  K. Bridwell,et al.  Posterior Segmental Spinal Instrumentation (PSSI) with Posterolateral Decompression and Debulking for Metastatic Thoracic and Lumbar Spine Disease: Limitations of the Technique , 1988, Spine.

[22]  J J Wise,et al.  Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. , 1999, Spine.

[23]  J. Klekamp,et al.  Surgical Results for Spinal Metastases , 1998, Acta Neurochirurgica.

[24]  K. Harrington Anterior decompression and stabilization of the spine as a treatment for vertebral collapse and spinal cord compression from metastatic malignancy. , 1988, Clinical orthopaedics and related research.

[25]  Z. Ghogawala,et al.  Spinal Radiation Before Surgical Decompression Adversely Affects Outcomes of Surgery for Symptomatic Metastatic Spinal Cord Compression , 2001, Spine.

[26]  DAVID A. WONG,et al.  Spinal Metastases: The Obvious, the Occult, and the Impostors , 1990, Spine.

[27]  G. A. Young,et al.  MALNUTRITION IN SURGICAL PATIENTS An Unrecognised Problem , 1977, The Lancet.