Page 38 - Predicting survival in patients with spinal bone metastasesL

CHAPTER III
Seven patients underwent percutaneous vertebroplasty, 46 had limited posterior decompressieve surgery and 52 patients had extended decompressieve surgery in the form of an intralesional corpectomy. One patient was treated with an en bloc resection. (table 4).
Table 4. Surgical details. *Patients treated with percutaneous vertebroplasty excluded
Surgical details
Number (%)
Type of surgery
Percutaneous vertebroplasty Decompression w/o fixation Decompression with fixation Partial corpectomy Complete corpectomy
En bloc resection
Approach Posterior Anterior Combined
Means of stabilization*
No additional stabilization Pedicle screws / rods
Cage with additional fixation
Risk factors
7 (7) 24 (22) 22 (21) 12 (11) 40 (38) 1 (1)
86 (81) 11 (10) 9 (9)
24 (24) 30 (30) 45 (46)
All available patient records were retrospectively studied for gender, age, site of the primary tumor, location of the symptomatic spinal metastasis, preoperative functioning according to the Karnofsky performance status (KPS)9,10, the presence of visceral metastases, the presence of other spinal and extraspinal bone metastases and neurologic functioning according to the Frankel classification11. Based on the survival data from this study, the primary tumor scores of the Tomita and Van der Linden models were adapted to better reflect the study population: in the Van der Linden model, kidney cancer was added to the ‘prostate group’ and thyroid cancer was added to the ‘breast group’. In the Tomita model, prostate cancer was moved to the ‘moderate growth’ category. KPS was scored in the period leading to surgery and not shortly before, to avoid the influence of acute neurologic decline. Date of surgery, date of complications and date of death were obtained from medical records or from general practitioners.
Statistical analysis
Survival time was calculated as the difference in months between date of surgery and date of death or last follow-up, with a minimum follow-up of eleven months.
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