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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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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

Meeting Abstract

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  • presenting/speaker Moritz Lenschow - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Maximilian Lenz - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Niklas von Spreckelsen - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Johanna Meyer - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Julia Keßling - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Julian Ossmann - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Sergej Telentschak - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Kourosh Zarghooni - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Peter Knöll - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Moritz Perrech - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Roland Goldbrunner - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland
  • Max J. Scheyerer - Universitätsklinikum Köln, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Volker Neuschmelting - Universitätsklinikum Köln, Zentrum für Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV231

doi: 10.3205/22dgnc223, urn:nbn:de:0183-22dgnc2239

Published: May 25, 2022

© 2022 Lenschow 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: 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.