Clinical outcomes and risk factors in patients with cervical metastatic spinal cord compression after posterior decompressive and spinal stabilization surgery
Authors Lei M, Yu J, Yan S, An X, Liu Y
Received 19 August 2018
Accepted for publication 15 November 2018
Published 11 January 2019 Volume 2019:15 Pages 119—127
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Mingxing Lei,1,* Jun Yu,2,* Shiju Yan,1 Xiao An,1 Yaosheng Liu3
1Department of Orthopedic Surgery, Hainan Hospital of the PLA General Hospital, Sanya, People’s Republic of China; 2Department of Anesthesiology, The Fourth Medical Center of PLA General Hospital, Beijing, People’s Republic of China; 3Department of Orthopedic Surgery, The 307th Hospital, Beijing, People’s Republic of China
*These authors contributed equally to this work
Purpose: The aim of this study was to investigate the clinical results of surgery for cervical spine metastasis and identify clinical risk factors affecting postoperative survival and neurological outcome.
Patients and methods: A retrospective analysis of medical records was performed on 19 patients who had undergone decompressive surgery and spine stabilization due to metastatic spinal cord compression in the cervical spine. All patients had severe pain before surgery. Worst pain, average pain, and pain interference were evaluated using the visual analog scale (range, 0–10) for each patient at baseline and following surgery. Neurological recovery was assessed using the Japanese Orthopaedic Association Score (JOAS). In addition, associations between ten characteristics and postoperative survival and neurological outcomes were analyzed in the study.
Results: The mean worst pain score in a 24-hour period was 8.6 before the operation. At 1 day, 1, 3, 6, and 12 months after the operation, the mean worst pain scores decreased to 5.6, 4.5, 3.8, 2.6, and 2.4 (all P<0.001 vs baseline), respectively. Similar decreases in average pain and pain interference were also observed. The median JOAS in a 24-hour period was 11.0 before the operation. At 1 day, 1, 3, 6, and 12 months after the operation, the median JOAS increased to 12.0 (P=0.469), 13.0 (P=0.010), 14.0 (P<0.001), 15.0 (P<0.001), and 14.0 (P<0.001), respectively. According to the multivariate analysis, postoperative survival was significantly associated with the type of primary tumor (P=0.033), preoperative ambulatory status (P=0.004), extra-spinal bone metastasis (P=0.021), 125I seed brachytherapy (P=0.014), and complication status (P=0.009). Better neurological outcome was found to be correlated with higher JOAS (P=0.013). Surgery-related complications occurred in 26.3% of patients.
Conclusion: Posterior decompression and spine stabilization for painful cervical spine metastasis resulting from spinal cord compression were found to be effective for neurological recovery and pain control with a tolerable rate of complications.
Keywords: cervical spine metastasis, surgery, survival prognosis, neurological outcome, visual analog scale, Japanese Orthopaedic Association Score
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