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Treatment Strategy for Impending Instability in Spinal Metastases
Yeon Ho Kim1, Junho Kim1, Sam Yeol Chang1
1Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Clinics in Orthopedic Surgery
|September 9, 2020
Summary
For spinal metastases with impending instability (intermediate SINS score 7-12), surgery may offer better outcomes than conservative treatment. Approximately 33% of conservatively treated patients eventually require surgery, particularly with less than 50% vertebral collapse or tumors in the T3-T10 region.
Area of Science:
- Orthopedics
- Neurosurgery
- Oncology
Background:
- Spinal metastases present complex surgical management challenges.
- The Spinal Instability Neoplastic Score (SINS) aids in evaluating instability.
- Intermediate SINS scores (7-12) indicate impending instability, complicating treatment decisions.
Purpose of the Study:
- To compare outcomes between conservative and operative management for spinal metastases with intermediate SINS scores.
- To assess the rate and factors influencing conversion to surgery in initially conservatively treated patients.
Main Methods:
- Retrospective study of 79 patients with intermediate SINS scores (7-12) from May 2013 to December 2017.
- Exclusion of patients with neurological deficits or cord compression.
- Comparison of initial status and treatment outcomes, including performance status, Tomita, and Tokuhashi scores.
Main Results:
- No significant differences in demographics or primary cancer type between groups.
- Initially operative group showed a tendency for less deterioration in performance status and vertebral height at 1 year.
- 33% conversion rate to surgery in the first year for the conservative group.
- Increased need for surgery with <50% vertebral body collapse (p=0.039) or tumors in the T3-T10 region (p=0.042).
Conclusions:
- Conservative treatment for spinal metastases with intermediate SINS scores has a substantial (33%) first-year conversion rate to surgery.
- Surgical intervention may be preferable for tumors located in the T3-T10 region with less than 50% vertebral body collapse.
