title: Efficacy evaluation of a new treatment algorithm for spinal metastases.
abstract: METHODS
  A semiprospective clinical study was conducted.
  
  
  OBJECTIVE
  To evaluate the efficacy of a new treatment algorithm for spinal metastases.
  
  
  BACKGROUND
  The surgical treatments in spinal metastatic have been progressing in recent years, while the surgical indications have been controversial. A new treatment algorithm for spinal metastases was developed and prospectively applied clinically in our department since 2002.
  
  
  METHODS
  This study included 202 patients with 206 lesions treated in January 1997 to December 2006 and continuously followed-up for more than 6 months or dead within this period. A total of 124 patients with 124 lesions were operated before 2002 were allocated to the control group and 78 patients with 82 lesions prospectively treated after 2002 were allocated to the prospective study group. The primary managements were nonsurgical treatment, palliative surgery, debulking, and en bloc resection. Neurologic evolvement, postoperative survival time, and local recurrence/development rates were statistically compared as the indexes of treatment outcome.
  
  
  RESULTS
  Although there was no significant difference of neurologic evolvement immediately after operation (P = 0.24), the prospective study group achieved significantly better neurologic function than the control group long time after operation (P = 0.03). No significant difference (P = 0.26) was shown in local recurrence/development rate comparison. The mean postoperative survival time comparison showed significant difference (P < 0.01).
  
  
  CONCLUSIONS
  The efficacy of the algorithm has been validated preliminarily by the significantly longer survival time and better long-time neurologic function evolvement in the prospectively study group. But the algorithm should continuously be in development and be updated with the latest improvement in metastatic treatment.
authors.affiliation: Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy. alessandro.gasbarrini@yahoo.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Haomiao
authors.initials: H
authors.lastname: Li
authors.forename: Michele
authors.initials: M
authors.lastname: Cappuccio
authors.forename: Loris
authors.initials: L
authors.lastname: Mirabile
authors.forename: Stefania
authors.initials: S
authors.lastname: Paderni
authors.forename: Silvia
authors.initials: S
authors.lastname: Terzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D013131:Spine / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome