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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Comprehensive surgical treatment strategy for spinal metastases

Chirurgische Behandlungsstrategie für spinale Metastasen

Meeting Abstract

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  • presenting/speaker Arthur Wagner - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
  • Elena Haag - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
  • Ann-Kathrin Jörger - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
  • Philipp Jost - Klinikum rechts der Isar, Technische Universität München, Klinik für Hämatologie und Onkologie, München, Deutschland
  • Stephanie Combs - Klinikum rechts der Isar, Technische Universität München, Abteilung für RadioOnkologie, München, Deutschland
  • Maria Wostrack - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
  • Jens Gempt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV002

doi: 10.3205/21dgnc002, urn:nbn:de:0183-21dgnc0020

Published: June 4, 2021

© 2021 Wagner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Based on a large consecutive single-center series of patients with spinal metastases (SM), we devised a comprehensive treatment algorithm for surgical strategies and adjunct therapies.

Methods: Between January 2007 and December 2018, patients with a SM were screened for study inclusion after an interdisciplinary neurooncological board meeting decided on the treatment plan. We report baseline characteristics, surgical procedures, complication rates, functional status and outcome of a consecutive cohort managed in accordance to a stratified treatment algorithm and adjunct therapy.

Results: 667 consecutive patients underwent 989 operations for SMs at our institution. Mean age was 65 years (range 20 – 94), median preoperative KPS was 80. Most common primary entities were prostate (21.7%), breast (15.9%) and non-small cell lung cancer (10.0%). The thoracic spine was affected in 48.3% of cases, followed by the lumbar spine in 26.7%. We conducted posterior instrumentation with or without vertebral body replacement in a staged approach in 69.5%, sole decompression in 12.4% and vertebral body augmentation in 18.0% of cases. Follow up was available for 58.9% of patients. Median OS amounted to 18.4 months (95% CI 9.8 – 26.9), OS after 12 months was 56.0% and median KPS improved from 70 to 80 by discharge.

Conclusion: Surgical management of SMs should generally represent the first step of a conclusive treatment algorithm. The need to preserve long-term symptom control and biomechanical stability stems from the growing life expectancy of patients with SMs, and requires a staged invasive surgical strategy currently not supported by level I evidence.