Artikel
Value of spinal instrumentation for the neurological outcome in metastatic patients with impending spinal instability
Der Nutzen der spinalen Instrumentation auf das neurologischen Outcome von spinal metastasierten Patienten mit unklarer spinaler Stabilität
Suche in Medline nach
Autoren
Veröffentlicht: | 25. Mai 2022 |
---|
Gliederung
Text
Objective: The Spinal Instability Neoplastic Score (SINS) is a commonly used tool to assess spinal stability in metastatic patients to prevent possible sequelae of spinal instability including neurological deterioration. While a SINS value below 7 is regarded as stable and spinal instrumentation is recommended for SINS values exceeding 12, the benefit of spinal instrumentation in cases of “impending instability” (SINS 7-12) is unclear and a new threshold of ≥10 to define instability has been proposed. This study aimed to evaluate the necessity and benefit of spinal instrumentation in patients with SINS 7-12 with regards to neurological outcome.
Methods: In this retrospective study we reviewed 683 patients with spinal epidural metastases treated at our spine center between 2011 and 2021. All cases with a SINS of 7-12 were included and dichotomized into an instrumentation and non-instrumentation group for comparison of neurological outcomes using the Frankel Score. Additionally, a subgroup analysis of instrumented and non-instrumented patients within the subgroups of SINS 7-9 and 10-12 was performed.
Results: 331 (48.5%) patients were enrolled presenting with a SINS score of 7-12. The majority of those (76.1%) were treated with spinal instrumentation, performed more frequently in SINS 10 - 12 (85.9%) than in patients with SINS 7–9 (62.9%; p < 0.001). Post-therapeutic improvements in Frankel score did not differ between the instrumentation (43/252, 17.1%) and non-instrumentation group (16/79, 20.3%; p = 0.612). In the subgroup SINS 7 - 9, Frankel score improved following spinal instrumentation in 12/88 cases (13.6%) and in 10/52 (19.2%) non-instrumented cases (p = 0.577). In the subgroup SINS 10 - 12, Frankel score improved following spinal instrumentation in 30/164 cases (18.3%) and in 6/27 (22.2%) non-instrumented cases (p = 0.278). Complications were more frequent in instrumented (15.5%) than in non-instrumented (5.1%) patients (p = 0.016).
Conclusion: Although spinal instrumentation was the main surgical procedure in our cohort of patients with impending instability, there was no clear benefit in neurologic outcome compared to correspondingly SINS scored patients that underwent non-stabilizing treatment, even in the subgroup of SINS 10-12. While other clinical factors need to be accounted for, our data suggest that treatment without instrumentation should be considered in this patient cohort, opting for further prospective randomized trials.