Lenschow Moritz, Lenz Maximilian, von Spreckelsen Niklas, Ossmann Julian, Meyer Johanna, Keßling Julia, Nadjiri Lukas, Telentschak Sergej, Zarghooni Kourosh, Knöll Peter, Perrech Moritz, Celik Eren, Scheyerer Max, Neuschmelting Volker
Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany.
Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany.
Cancers (Basel). 2022 Apr 27;14(9):2193. doi: 10.3390/cancers14092193.
Background: Adequate assessment of spinal instability using the spinal instability neoplastic score (SINS) frequently guides surgical therapy in spinal epidural osseous metastases and subsequently influences neurological outcome. However, how to surgically manage ‘impending instability’ at SINS 7−12 most appropriately remains uncertain. This study aimed to evaluate the necessity of spinal instrumentation in patients with SINS 7−12 with regards to neurological outcome. Methods: We screened 683 patients with spinal epidural metastases treated at our interdisciplinary spine center. The preoperative SINS was assessed to determine spinal instability and neurological status was defined using the Frankel score. Patients were dichotomized according to being treated by instrumentation surgery and neurological outcomes were compared. Additionally, a subgroup analysis of groups with SINS of 7−9 and 10−12 was performed. Results: Of 331 patients with a SINS of 7−12, 76.1% underwent spinal instrumentation. Neurological outcome did not differ significantly between instrumented and non-instrumented patients (p = 0.612). Spinal instrumentation was performed more frequently in SINS 10−12 than in SINS 7−9 (p < 0.001). The subgroup analysis showed no significant differences in neurological outcome between instrumented and non-instrumented patients in either SINS 7−9 (p = 0.278) or SINS 10−12 (p = 0.577). Complications occurred more frequently in instrumented than in non-instrumented patients (p = 0.016). Conclusions: Our data suggest that a SINS of 7−12 alone might not warrant the increased surgical risks of additional spinal instrumentation.
使用脊柱不稳定肿瘤评分（SINS）对脊柱不稳定进行充分评估常常能指导脊柱硬膜外骨转移瘤的手术治疗，并随后影响神经功能结局。然而，如何最恰当地手术处理SINS评分在7至12分的“即将发生的不稳定”情况仍不明确。本研究旨在评估SINS评分在7至12分的患者中进行脊柱内固定对于神经功能结局的必要性。方法：我们筛查了在我们的跨学科脊柱中心接受治疗的683例脊柱硬膜外转移瘤患者。评估术前SINS以确定脊柱不稳定情况，并使用Frankel评分定义神经功能状态。根据是否接受内固定手术将患者分为两组，并比较神经功能结局。此外，对SINS评分为7至9分和10至12分的组进行了亚组分析。结果：在331例SINS评分为7至12分的患者中，76.1%接受了脊柱内固定术。接受内固定和未接受内固定的患者之间神经功能结局无显著差异（p = 0.612）。SINS评分为10至12分的患者比SINS评分为7至9分的患者更频繁地接受脊柱内固定术（p < 0.001）。亚组分析显示，在SINS评分为7至9分（p = 0.278）或10至12分（p = 0.577）的患者中，接受内固定和未接受内固定的患者之间神经功能结局均无显著差异。接受内固定的患者比未接受内固定的患者并发症发生率更高（p = 0.016）。结论：我们的数据表明，仅SINS评分为7至12分可能并不足以证明额外进行脊柱内固定会增加手术风险是合理的。
