Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2020 Sep;12(3):337-342. doi: 10.4055/cios20014. Epub 2020 Jun 26.
Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7-12) indicates impending instability, which makes it difficult to determine the proper treatment strategy. In this study, we aimed to compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7-12. Further, we evaluated the time for conversion to surgery in patients who had initially undergone conservative treatment and identified the factors associated with the conversion.
Among the patients with a spinal metastasis with an intermediate SINS of 7-12 from May 2013 to December 2017, those who were followed up for more than 12 months were enrolled in this study. Patients with signs of a neurologic deficit or cord compression at the initial diagnosis were excluded. Finally, 79 patients (47 in the initially conservative group and 32 in the initially operative group) were enrolled in this study. The performance status, Tomita score, and Tokuhashi score were assessed for group comparison. Components of SINS, the Bilsky grade, and radiosensitivity of tumor were evaluated to determine factors associated with conversion to surgery.
Average follow-up was 20.9 months (range, 12-46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group ( = 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3-T10), the need for conversion to surgery increased statistically significantly ( = 0.039 and = 0.042, respectively).
The rate of conversion to surgery in initially conservatively treated patients was about 33% in the first year. When a tumor is located in T3-T10 and less than 50% vertebral body collapse is present, surgery may be the better choice than conservative treatment.
由于涉及多种因素，确定脊柱转移瘤的手术治疗方法具有一定难度。脊柱不稳定肿瘤评分（SINS）系统是评估脊柱转移瘤不稳定的可靠工具。中间 SINS（评分 7-12）表示即将发生不稳定，这使得确定适当的治疗策略变得困难。在这项研究中，我们旨在比较脊柱转移瘤中间 SINS 为 7-12 的患者中保守组与手术组的初始状态和治疗结果。此外，我们评估了初始接受保守治疗的患者转为手术的时间，并确定了与转为手术相关的因素。
2013 年 5 月至 2017 年 12 月，对 SINS 为 7-12 的脊柱转移瘤患者进行随访，随访时间超过 12 个月的患者纳入本研究。排除初始诊断时存在神经功能缺损或脊髓压迫迹象的患者。最终，79 例患者（初始保守组 47 例，初始手术组 32 例）纳入本研究。对两组患者的体力状况、Tomita 评分和 Tokuhashi 评分进行评估。评估 SINS 各组成部分、Bilsky 分级和肿瘤放射敏感性，以确定与转为手术相关的因素。
平均随访时间为 20.9 个月（范围 12-46 个月）。两组患者的人口统计学变量、原发癌类型和体力状况无显著差异。然而，初始手术组的 Tomita 评分较低（ = 0.006）。根据体力状况和椎体高度塌陷的变化评估的 1 年治疗结果显示，初始手术组的恶化趋势较轻。初始保守组在第 1 年的手术转化率为 33%，之后转化率的发生率变化不大。当椎体塌陷小于 50%或肿瘤位于半刚性区域（T3-T10）时，手术的需求显著增加（分别为 = 0.039 和 = 0.042）。
初始保守治疗的患者在第 1 年转为手术的比例约为 33%。当肿瘤位于 T3-T10 且椎体塌陷小于 50%时，手术可能是比保守治疗更好的选择。
