Application of the NSE score (Neurology-Stability-Epidural compression assessment) to establish the need for surgery in spinal metastases of elderly patients: a multicenter investigation.
Epidural compression
NSE score
Separation surgery
Spinal instability
Spinal metastases
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
31 May 2024
31 May 2024
Historique:
received:
02
09
2023
accepted:
23
05
2024
revised:
08
01
2024
medline:
1
6
2024
pubmed:
1
6
2024
entrez:
31
5
2024
Statut:
aheadofprint
Résumé
This retropective multicentric study aims to investigate the clinical applicability of the NSE score in the elderly, to verify the role of this tool as an easy help for decision making also for this class of patients. All elderly patients (> 65 years) suffering from spinal metastases undergoing surgical or non-surgical treatment at the authors' Institutions between 2015 and 2022 were recruited. An agreement group (AG) and non-agreement group (NAG) were identified accordingly to the agreement between the NSE score indication and the performed treatment. Neurological status and axial pain were evaluated for both groups at follow-up (3 and 6 months). The same analysis was conducted specifically grouping patients older than 75 years. A strong association with improvement or preservation of clinical status (p < 0.001) at follow-up was obtained in AG. The association was not statistically significant in NAG at the 3-month follow-up (p 1.00 and 0.07 respectively) and at 6 months (p 0.293 and 0.09 respectively). The group of patients over 75 years old showed similar results in terms of statistical association between the agreement group and better outcomes. Far from the need or the aim to build dogmatic algorithms, the goal of preserving a proper performance status plays a key role in a modern oncological management: functional outcomes of the multicentric study group showed that the NSE score represents a reliable tool to establish the need for surgery also for elderly patients.
Identifiants
pubmed: 38822150
doi: 10.1007/s00586-024-08328-0
pii: 10.1007/s00586-024-08328-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Advancing Cancer Therapy (2021) Nat Cancer 2:245–246. https://doi.org/10.1038/s43018-021-00192-x
doi: 10.1038/s43018-021-00192-x
- Kowdley GC, Merchant N, Richardson JP, Somerville J, Gorospe M, Cunningham SC (2012) Cancer surgery in the elderly. ScientificWorldJournal 2012:303852. https://doi.org/10.1100/2012/303852
doi: 10.1100/2012/303852
pubmed: 22272172
pmcid: 3259553
Aebi M (2003) Spinal metastasis in the elderly. Eur Spine J 12(Suppl 2):S202–S213. https://doi.org/10.1007/s00586-003-0609-9
doi: 10.1007/s00586-003-0609-9
pubmed: 14505120
pmcid: 3591831
Beaufort Q, Terrier LM, Dubory A et al (2021) Spine metastasis in Elderly: encouraging results for Better Survival. Spine (Phila Pa 1976) 46(11):751–759. https://doi.org/10.1097/BRS.0000000000003881
doi: 10.1097/BRS.0000000000003881
pubmed: 33332789
Hussain I, Hartley BR, McLaughlin L et al Surgery for metastatic spinal disease in octogenarians and above: analysis of 78 patients. Global Spine J 2021 Oct 20:21925682211037936. https://doi.org/10.1177/21925682211037936
Newman WC, Bilsky MH (2022) Fifty-year history of the evolution of spinal metastatic disease management. J Surg Oncol 126(5):913–920. https://doi.org/10.1002/jso.27028
doi: 10.1002/jso.27028
pubmed: 36087077
Cofano F, Monticelli M, Ajello M et al (2019 Jan-Dec) The targeted therapies Era beyond the Surgical Point of View: what spine surgeons should know before approaching spinal metastases. Cancer Control 26(1):1073274819870549. https://doi.org/10.1177/1073274819870549
Cofano F, Di Perna G, Marengo N et al (2020) Transpedicular 3D endoscope-assisted thoracic corpectomy for separation surgery in spinal metastases: feasibility of the technique and preliminary results of a promising experience. Neurosurg Rev 43(1):351–360. https://doi.org/10.1007/s10143-019-01204-2
doi: 10.1007/s10143-019-01204-2
pubmed: 31713701
Cofano F, Di Perna G, Monticelli M et al (2020) Carbon fiber reinforced vs titanium implants for fixation in spinal metastases: a comparative clinical study about safety and effectiveness of the new carbon-strategy. J Clin Neurosci 75:106–111. https://doi.org/10.1016/j.jocn.2020.03.013
doi: 10.1016/j.jocn.2020.03.013
pubmed: 32173153
Di Perna G, Cofano F, Mantovani C et al (2020) Separation surgery for metastatic epidural spinal cord compression: a qualitative review. J Bone Oncol 25:100320. https://doi.org/10.1016/j.jbo.2020.100320
doi: 10.1016/j.jbo.2020.100320
pubmed: 33088700
pmcid: 7559860
Cofano F, Di Perna G, Zenga F et al (2020) The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases. Clin Neurol Neurosurg. ;195:105896. https://doi.org/10.1016/j.clineuro.2020.105896 . Epub 2020 May 19. Erratum in: Clin Neurol Neurosurg. 2021;205:106673
Laufer I, Rubin DG, Lis E et al (2013) The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 18(6):744–751. https://doi.org/10.1634/theoncologist.2012-0293
doi: 10.1634/theoncologist.2012-0293
pubmed: 23709750
pmcid: 4063402
Gasbarrini A, Li H, Cappuccio M, Mirabile L, Paderni S, Terzi S, Boriani S (2010) Efficacy evaluation of a new treatment algorithm for spinal metastases. Spine (Phila Pa 1976) 35(15):1466–1470. https://doi.org/10.1097/BRS.0b013e3181c680b9 . Erratum in: Spine (Phila Pa 1976). 2011;36(2):179
doi: 10.1097/BRS.0b013e3181c680b9
pubmed: 20195197
Sabharwal S, Wilson H, Reilly P, Gupte CM (2015) Heterogeneity of the definition of elderly age in current orthopaedic research. Springerplus 4:516. https://doi.org/10.1186/s40064-015-1307-x
doi: 10.1186/s40064-015-1307-x
pubmed: 26405636
pmcid: 4573966
Fisher CG, DiPaola CP, Ryken TC et al (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35(22):E1221–E1229. https://doi.org/10.1097/BRS.0b013e3181e16ae2
doi: 10.1097/BRS.0b013e3181e16ae2
pubmed: 20562730
Bilsky MH, Laufer I, Fourney DR et al (2010) Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 13(3):324–328. https://doi.org/10.3171/2010.3.SPINE09459
doi: 10.3171/2010.3.SPINE09459
pubmed: 20809724
Anekar AA, Hendrix JM, Cascella M (2023) WHO Analgesic Ladder. [Updated 2023 Apr 23]. StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)
Cofano F, Di Perna G, Alberti A et al (2020) Neurological outcomes after surgery for spinal metastases in symptomatic patients: does the type of decompression play a role? A comparison between different strategies in a 10-year experience. J Bone Oncol 26:100340. https://doi.org/10.1016/j.jbo.2020.100340
doi: 10.1016/j.jbo.2020.100340
pubmed: 33294319
pmcid: 7689400
Amelot A, Balabaud L, Choi D et al (2017) Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery! Spine J 17(6):759–767. https://doi.org/10.1016/j.spinee.2015.07.440
doi: 10.1016/j.spinee.2015.07.440
pubmed: 26239762
De la - R, Goodwin CR, Jain A, Abu-Bonsrah N, Fisher CG, Bettegowda C, Sciubba DM (2016) Development of a metastatic spinal tumor Frailty Index (MSTFI) using a Nationwide Database and its Association with Inpatient Morbidity, Mortality, and length of stay after spine surgery. World Neurosurg 95:548–555e4. https://doi.org/10.1016/j.wneu.2016.08.029
doi: 10.1016/j.wneu.2016.08.029
Massaad E, Williams N, Hadzipasic M et al (2021) Performance assessment of the metastatic spinal tumor frailty index using machine learning algorithms: limitations and future directions. Neurosurg Focus 50(5):E5. https://doi.org/10.3171/2021.2.FOCUS201113
doi: 10.3171/2021.2.FOCUS201113
pubmed: 33932935
MacLean MA, Georgiopoulos M, Charest-Morin R et al AO Spine Knowledge Forum Tumor. Perception of frailty in spinal metastatic disease: international survey of the AO Spine community. J Neurosurg Spine 2023 Mar 3:1–11. https://doi.org/10.3171/2023.1.SPINE221433
Li G, Patil CG, Lad SP, Ho C, Tian W, Boakye M (2008) Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine (Phila Pa 1976) 33(11):1250–1255. https://doi.org/10.1097/BRS.0b013e3181714a44
doi: 10.1097/BRS.0b013e3181714a44
pubmed: 18469700
Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine (Phila Pa 1976) 31(1):99–103. https://doi.org/10.1097/01.brs.0000192678.25586.e5
doi: 10.1097/01.brs.0000192678.25586.e5
pubmed: 16395185
Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA (1992) Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 74:536–543
doi: 10.2106/00004623-199274040-00009
pubmed: 1583048
Reindl R, Steffen T, Cohen L, Aebi M (2003) Elective lumbar spinal decompression in the elderly: is it a high-risk operation? Can J Surg 46:43–46
pubmed: 12585793
pmcid: 3211668
Balabaud L, Pitel S, Caux I et al (2015) Lumbar spine surgery in patients 80 years of age or older: morbidity and mortality. Eur J Orthop Surg Traumatol 25(Suppl 1):S205–S212. https://doi.org/10.1007/s00590-014-1556-3
doi: 10.1007/s00590-014-1556-3
pubmed: 25355305
Reponen E, Tuominen H, Korja M (2014) Evidence for the use of preoperative risk assessment scores in elective cranial neurosurgery: a systematic review of the literature. Anesth Analg 119(2):420–432. https://doi.org/10.1213/ANE.0000000000000234
doi: 10.1213/ANE.0000000000000234
pubmed: 25046789
Ius T, Somma T, Altieri R et al (2020) Is age an additional factor in the treatment of elderly patients with glioblastoma? A new stratification model: an Italian Multicenter Study. Neurosurg Focus 49(4):E13. https://doi.org/10.3171/2020.7.FOCUS20420
doi: 10.3171/2020.7.FOCUS20420
pubmed: 33002864
Evers PD, Logan JE, Sills V, Chin AI (2014) Karnofsky performance status predicts overall survival, cancer-specific survival, and progression-free survival following radical cystectomy for urothelial carcinoma. World J Urol 32(2):385–391. https://doi.org/10.1007/s00345-013-1110-7
doi: 10.1007/s00345-013-1110-7
pubmed: 23756991
Rades D, Conde AJ, Garcia R et al (2015) A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer. Radiat Oncol 10:173. https://doi.org/10.1186/s13014-015-0483-8
doi: 10.1186/s13014-015-0483-8
pubmed: 26282125
pmcid: 4554297
Tabouret E, Gravis G, Cauvin C, Loundou A, Adetchessi T, Fuentes S (2015) Long-term survivors after surgical management of metastatic spinal cord compression. Eur Spine J 24(1):209–215. https://doi.org/10.1007/s00586-014-3676-1
doi: 10.1007/s00586-014-3676-1
pubmed: 25408254
Gao X, Wu Z, Wang T et al (2023) A discussion on the Criteria for Surgical decision-making in Elderly patients with metastatic spinal cord Compression. Global Spine J 13(1):45–52. https://doi.org/10.1177/2192568221991107
doi: 10.1177/2192568221991107
pubmed: 33525916
Barzilai O, Versteeg AL, Goodwin CR et al (2019) Association of neurologic deficits with surgical outcomes and health-related quality of life after treatment for metastatic epidural spinal cord compression. Cancer 125(23):4224–4231. https://doi.org/10.1002/cncr.32420
doi: 10.1002/cncr.32420
pubmed: 31410854
Kortebein P, Symons TB, Ferrando A et al (2008) Functional impact of 10 days of bed rest in healthy older adults. J Gerontol Biol Sci Med Sci 63(10):1076–1081. https://doi.org/10.1093/gerona/63.10.1076
doi: 10.1093/gerona/63.10.1076