Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Spine (Phila Pa 1976). 2023 Nov 15;48(22):1599-1605. doi: 10.1097/BRS.0000000000004512. Epub 2022 Oct 14.
Retrospective review.
The aim was to determine if preoperative spinal instability neoplastic scores (SINSs) and Tokuhashi prognostication scores differed in patients receiving surgical care before and during the coronavirus disease-2019 (COVID-19) pandemic.
The COVID-19 pandemic has caused delays in scheduling nonemergent surgeries. Delay in presentation and/or surgical treatment for oncology patients with metastatic spinal disease could result in progression of the disease, which can complicate surgical care and worsen patient outcomes.
Retrospective review of electronic medical records between March 1, 2019 and March 1, 2021 at a tertiary medical center was performed to identify patients who underwent surgery for metastatic spine disease. Primary spinal tumors were excluded. Patients were separated into two groups base on their surgery date: before the COVID-19 pandemic (March 1, 2019-February 29, 2020) and during the COVID-19 pandemic (March 1, 2020-March 1, 2021). Primary outcomes included SINS and Tokuhashi scores. A variety of statistical tests were performed to compare the groups.
Fifty-two patients who underwent surgery before the COVID-19 pandemic were compared to 41 patients who underwent surgery during the COVID-19 pandemic. There was a significant difference between the before and during groups with respect to SINS (9.31±2.39 vs . 11.00±2.74, P =0.002) and Tokuhashi scores (9.27±2.35 vs . 7.88±2.85, P =0.012). Linear regression demonstrated time of surgery (before or during COVID-19 restrictions) was a significant predictor of SINS (β=1.55, 95% CI: 0.42-2.62, P =0.005) and Tokuhashi scores (β=-1.41, 95% CI: -2.49 to -0.34, P =0.010).
Patients with metastatic spinal disease who underwent surgery during the COVID-19 pandemic had higher SINS, lower Tokuhashi scores and similar Skeletal Oncology Research Group scores compared to patients who underwent surgery before the pandemic. This suggests the pandemic has impacted the instability of disease at presentation in patients with spinal metastases, but has not impacted surgical prognosis, as there were no differences in Skeletal Oncology Research Group scores and the difference in Tokuhashi scores is most likely not clinically significant.
回顾性研究。
旨在确定在新冠疫情期间和之前，接受手术治疗的患者的术前脊柱不稳定肿瘤评分（SINS）和 Tokuhashi 预后评分是否存在差异。
新冠疫情导致非紧急手术的预约时间延迟。患有转移性脊柱疾病的肿瘤患者的就诊和/或手术治疗延迟，可能会导致疾病进展，从而使手术治疗复杂化并导致患者预后恶化。
在一家三级医疗中心，对 2019 年 3 月 1 日至 2021 年 3 月 1 日期间的电子病历进行回顾性分析，以确定接受转移性脊柱疾病手术的患者。排除原发性脊柱肿瘤。根据手术日期将患者分为两组：疫情前（2019 年 3 月 1 日-2 月 29 日）和疫情期间（2020 年 3 月 1 日-2021 年 3 月 1 日）。主要结果包括 SINS 和 Tokuhashi 评分。对两组进行了各种统计检验。
将 52 例在新冠疫情前接受手术的患者与 41 例在新冠疫情期间接受手术的患者进行了比较。术前组和术后组的 SINS（9.31±2.39 vs. 11.00±2.74，P=0.002）和 Tokuhashi 评分（9.27±2.35 vs. 7.88±2.85，P=0.012）有显著差异。线性回归显示手术时间（在新冠疫情限制之前或之后）是 SINS（β=1.55，95%CI：0.42-2.62，P=0.005）和 Tokuhashi 评分（β=-1.41，95%CI：-2.49 至-0.34，P=0.010）的显著预测因素。
与疫情前接受手术的患者相比，在新冠疫情期间接受手术的转移性脊柱疾病患者的 SINS 更高、Tokuhashi 评分更低、骨骼肿瘤研究组评分相似。这表明大流行影响了脊柱转移患者疾病的初始不稳定性，但并未影响手术预后，因为骨骼肿瘤研究组评分无差异，且 Tokuhashi 评分的差异很可能无临床意义。
