title: Decompression surgery for spinal metastases: a systematic review.
abstract: OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that the type of treatment was not significantly associated with the rate of local control. The most commonly reported primary tumor types included lung cancer, prostate cancer, breast cancer, renal cancer, and gastrointestinal cancer. CONCLUSIONS This study reports a systematic review of the literature on decompression surgery for spinal metastases. The results of this study can help educate surgeons on the previously published predictors of outcomes following decompression surgery for metastatic spinal disease. However, the authors also identify significant gaps in the literature and the need for future studies investigating the optimal practice with regard to decompression surgery for spinal metastases.
authors.affiliation: The Warren Alpert Medical School of Brown University, Providence, Rhode Island;
authors.forename: Dara
authors.initials: D
authors.lastname: Bakar
authors.affiliation: Center for Spine Health, and |Case Western Reserve University School of Medicine;|Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio;
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Tanenbaum
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia; and.|University of New South Wales, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Center for Spine Health, and |Case Western Reserve University School of Medicine;
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Alentado
authors.affiliation: Center for Spine Health, and |Departments of 2 Neurosurgery and.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.affiliation: Center for Spine Health, and |Departments of 2 Neurosurgery and.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Center for Spine Health, and |Departments of 2 Neurosurgery and.|Orthopaedic Surgery, Cleveland Clinic;
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; ECOG = Eastern Cooperative Oncology Group; EORTC = European Organisation for Research and Treatment of Cancer; EORTC QLQ-30 = Quality of Life questionnaire; EORTC QLQ-BM22 = EORTC Bone Metastases module; KPS = Karnofsky Performance Status; MESCC = metastatic epidural spinal cord compression; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PSA = prostate-specific antigen; RR = risk ratio; ambulation; decompression; spinal cord compression; spinal metastases; survival