Page 47 - Predicting survival in patients with spinal bone metastasesL

framework for doing so. Secondly, several risk factors should be removed from the models. Other bone metastases, number of spinal metastases and neurologic deficit are all important factors to consider when deciding on surgery, but do not play a role in estimating survival. Lastly, provided neurologic deficit is excluded as a confounder, functional status should be included in any scoring system, as should the presence of visceral metastases. Currently, the only model to contain these risk factors, without the drawback of having to evaluate several others, is the Van der Linden model. If the primary tumor classification would be revised, preferably along the lines of the classification proposed by Tomita, this model would be superior in ease of use as well as accuracy.
Even though estimating survival is an important part of the decision-making process concerning the treatment of symptomatic SEM, it should never be the only point of interest. Neurologic symptoms and their duration, pain, feasibility of other treatment options, stability of the spinal column and expected gain in quality of life should all be discussed, preferably in a multidisciplinary setting.19
Complication rate in this study is high (33%). This is mainly due to the fact that only surgically treated patients were included and that surgical techniques used were aggressive (50% partial or complete corpectomy). A limitation of this study is its retrospective design and the fact that only surgically treated patients are evaluated. Therefore, patients who were referred for surgical consultation but did not receive treatment are not represented in this study. The wide array of surgical interventions used is due to the lack of clinical guidelines during the period described in this study. Also, the heterogeneity of primary tumors can cause discrepancies in recorded survival times of the smaller groups when compared with other studies.
Primary tumor type, presence of visceral metastases and functional status are strong risk factors for determining survival in patients operated for symptomatic spinal epidural metastases and should always be carefully evaluated.
III
SURGICAL COHORT
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