Department of Orthopedic Surgery, Peking University First Hospital, Beijing.
Department of Orthopedic Surgery, Hainan hospital of the PLA General Hospital, Sanya, China.
Clin Spine Surg. 2020 Oct;33(8):296-306. doi: 10.1097/BSD.0000000000001031.
Various survival scoring systems have been developed to help surgeons select the best candidates for appropriate therapies in patients with metastatic spinal disease. This study aims to discuss the current status and future directions of scoring systems for the prediction of survival prognosis in these patients. The search terms "spine metastases," "metastatic spinal disease," and "metastatic spinal cord compression" were combined with "survival prognosis," "scoring system," and "score" to elicit relevant literatures in PubMed and Embase databases. As a result, 159 articles were selected from PubMed, and 246 articles were extracted from Embase. After reviewing each article, we carefully included and analyzed 74 articles about the development and evaluation of scoring systems for predicting survival prognosis in spine metastases. In this review, those scoring systems were stratified into the historic scoring systems and the modern scoring systems on the basis of the proposed time. The historic scoring systems, including the original/revised Tokuhashi scoring system, the Bauer scoring system, the Tomita scoring system, and the Linden scoring system, and the modern scoring systems, such as the Lei scoring system, the Bartels scoring system, the Mizumoto scoring system, the Bollen scoring system, the Rades scoring system, Oswestry Spinal Risk Index, and the Choi risk calculator, were introduced and discussed in this review. Besides, the clinical effectiveness and pitfalls of the existing systems and the future directions of the next generation of scoring systems were also addressed and discussed. We recommended these scoring systems as preferable reference tools to help doctors to select surgical candidates. In patients with long-term life expectancy, radical surgery, such as wide or marginal excision, can be considered in patients with neurological deficits, spine instability, or severe back pain. Besides, with the advancement and improvement of medical technologies, surgical procedures are changing, which can affect surgical indications such as vertebroplasty, minimal invasive surgery, and percutaneous stabilization, which can also be used in patients with spine instability or severe back pain, and do not require much recovery; hence, they can even be used in patients with relative short-term life expectancy. However, the decision about the treatment of patients with metastatic spinal disease is so complicated and should never rely on prognostic scores alone. The final therapeutic decision should be made by interdisciplinary corporations of oncologists, radiologists, and spinal surgeons. Besides, individual intentions should be respected.
各种生存评分系统已经被开发出来，以帮助外科医生在患有转移性脊柱疾病的患者中选择最合适的治疗方法。本研究旨在讨论目前用于预测这些患者生存预后的评分系统的现状和未来方向。在 PubMed 和 Embase 数据库中，我们将搜索词“脊柱转移”、“转移性脊柱疾病”和“转移性脊髓压迫”与“生存预后”、“评分系统”和“评分”相结合，以引出相关文献。结果，从 PubMed 中选择了 159 篇文章，从 Embase 中提取了 246 篇文章。在仔细审查每篇文章后，我们精心纳入并分析了 74 篇关于开发和评估预测脊柱转移生存预后评分系统的文章。在本综述中，这些评分系统根据提出的时间分为历史评分系统和现代评分系统。历史评分系统包括原始/修订的 Tokuhashi 评分系统、Bauer 评分系统、Tomita 评分系统和 Linden 评分系统，现代评分系统包括 Lei 评分系统、Bartels 评分系统、Mizumoto 评分系统、Bollen 评分系统、Rades 评分系统、Oswestry 脊柱风险指数和 Choi 风险计算器。此外，还介绍和讨论了现有系统的临床效果和缺陷以及下一代评分系统的未来方向。我们建议将这些评分系统作为帮助医生选择手术候选人的首选参考工具。对于预期寿命较长的患者，如果存在神经功能缺损、脊柱不稳定或严重背痛，可考虑行根治性手术，如广泛或边缘切除术。此外，随着医疗技术的进步和提高，手术方法也在发生变化，这也会影响到椎体成形术、微创外科和经皮稳定等手术适应证，对于脊柱不稳定或严重背痛的患者也可以使用，而且不需要太多的恢复时间，甚至对于预期寿命相对较短的患者也可以使用。然而，对于患有转移性脊柱疾病的患者的治疗决策是如此复杂，不能仅仅依靠预后评分来决定。最终的治疗决策应由肿瘤学家、放射科医生和脊柱外科医生的跨学科团队做出。此外，还应该尊重个人意愿。
