Evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic spine metastasis from lung cancer.

BACKGROUND: The management of spine metastases is an increasing concern for spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of spine metastases, there is a lack of studies focusing on lung cancer alone. PURPOSE: To assess the effectiveness and safety of surgery in the management of symptomatic spine metastases from lung cancer. METHODS: We retrospectively reviewed all patients (n = 53) who underwent surgery for spine metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered "surgical success". RESULTS: No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of spine metastases (p = 0.0216). CONCLUSION: A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.

Long-segment percutaneous screw fixation for thoraco-lumbar spine metastases: a single center's experience.

BACKGROUND: The management of spine metastases is an increasing concern for spine surgeons. Their treatment is mainly palliative with the goal to preserve or restore the patients' quality of life. Many minimally invasive techniques have been introduced with the aim to reduce the morbidity associated with more traditional open approaches. We aimed to evaluate the efficiency of long segment percutaneous pedicle screw stabilization for the treatment of instability associated with symptomatic thoracolumbar spine metastases. METHODS: In this prospective study, we included all patients who underwent the percutaneous placement of pedicle screws in our institution between January 2008 and June 2014, for the palliative treatment of a symptomatic thoracolumbar spine metastasis. All patients had a normal examination. Postoperative radiation therapy was planned within 2 weeks following the stabilization. A clinical and radiological follow-up were planned at 3 months, 6 months and 1 year. Pain was measured using VAS and functional status was assessed using the Frankel Grading system. CT scan was performed before discharge and at each office evaluation. RESULTS: Forty-four patients have been included. There were 26 men and 18 women, with a mean age of 57.3 years (range 36-79 years). The mean operative time was 85 minutes (range 47-124 min), and the estimated blood loss was inferior to 100 mL in all cases. The mean length of hospital stay was 5.2 days (range 3-18 days). All patients underwent postoperative radiation therapy within 2 weeks. Pain was significantly improved from the early postoperative period (P<0.001). Visual Analogic Scale scores decreased from 6.3 (2-10) to 3.0 (0-6) at discharge. No patient worsened his neurological condition postoperatively. One patient required a revision surgery at 3 months due to an important tumor progression at the treated level. Radiological follow-up demonstrated no case of misplacement, hardware breakage or loosening. CONCLUSIONS: As the treatment of spine metastases is largely palliative, minimally invasive techniques should be discussed first to limit the impact of surgery in critical patients. Long-segment percutaneous screw fixation followed by early radiation therapy, appears to be a safe and effective treatment option to ensure solid and durable stability, as well as a good local tumor control.