Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis.
METHODS
Prospective study.


OBJECTIVE
To evaluate our treatment outcome for spinal metastases using our treatment strategy based on prognostic scoring system.


BACKGROUND
In the treatment of spinal metastases, life expectancy is most important, and our scoring system for metastatic spine tumor prognosis has been useful for such prognostic evaluation.


METHODS
Conservative treatment or palliative surgery was indicated in patients with a predicted prognosis of less than 6 months or in those with multiple vertebral metastases, whereas excisional surgery was performed in patients with a predicated prognosis of 1 year or more, or with a predicted prognosis of 6 months or more, and with metastasis in a single vertebra. One hundred eighty-three patients were prospectively treated according to this principle using our prognostic scoring system, and the outcome was evaluated.


RESULTS
The consistency rate between the predicted prognosis from the criteria of the scoring system and the actual survival period was high in patients within each score range (0-8, 9-11, or 12-15), 87.9% in the 183 patients. Only the palliative surgery group (n = 55) showed a significant improvement of the Barthel index between before and after treatment (P < 0.01). The mean maximum Barthel index after treatment in any modality ran parallel to the total scores of our scoring system.


CONCLUSIONS
The prognostic criteria using our scoring system were useful for the pretreatment evaluation of prognosis irrespective of the treatment modality. In any treatment, the survival period of the patients affected the functional prognosis; therefore, it may be appropriate and realistic to select treatment methods by giving first priority to the life expectancy of patients.
Tokuhashi
Yasuaki
Y
Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, Japan. ytoku@med.nihon-u.ac.jp
Ajiro
Yasumitsu
Y
Umezawa
Natsuki
N
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010166:Palliative Care; D010243:Paralysis / Q000628:therapy; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011878:Radiotherapy; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D016896:Treatment Outcome