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Richard Assaker - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic Spine Metastasis from lung cancer
European Spine Journal, 2016Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, Melodieanne Karnoub, Mariehelene Vieillard, Patrick Devos, Alkis Bouras, Richard AssakerAbstract:Background: The management of Spine metastases is an increasing concern for Spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of Spine metastases, there is a lack of studies focusing on lung cancer alone. Purpose: To assess the effectiveness and safety of surgery in the management of symptomatic Spine metastases from lung cancer. Methods: We retrospectively reviewed all patients (n = 53) who underwent surgery for Spine Metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered "surgical success". Results: No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of Spine metastases (p = 0.0216). Conclusion: A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic Spine Metastasis from lung cancer
European Spine Journal, 2016Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, A Bouras, Melodieanne Karnoub, Mariehelene Vieillard, Patrick Devos, Richard AssakerAbstract:The management of Spine metastases is an increasing concern for Spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of Spine metastases, there is a lack of studies focusing on lung cancer alone. To assess the effectiveness and safety of surgery in the management of symptomatic Spine metastases from lung cancer. We retrospectively reviewed all patients (n = 53) who underwent surgery for Spine Metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered “surgical success”. No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of Spine metastases (p = 0.0216). A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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recent concepts in the management of thoracolumbar Spine Metastasis
Journal of Neurosurgical Sciences, 2013Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, A Bouras, Richard AssakerAbstract:As patient with cancer live longer, Spine Metastasis is a growing problem. Untreated, it can cause pain, instability and neurologic deficit, which can severely alter the patient's ability and quality of life. When the diagnosis is established, scoring systems help the physician to best define the objective of treatment by evaluating the life expectancy. Except in rare circumstances, treatment is palliative. Over the past 2 decades, remarkable evolution in surgical techniques provided to patients valuable therapeutic options to perform circumferential decompression and stabilization of the affected level. More recently, minimally invasive techniques allowed a significant reduction of morbidity. The parallel development of stereotactic radiosurgery offers new therapeutic options in particular for patients ineligible for surgery.
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minimally invasive decompression and stabilization for the management of thoracolumbar Spine Metastasis
Journal of Neurosurgery, 2012Co-Authors: Fahed Zairi, A Arikat, M Allaoui, Paulo Marinho, Richard AssakerAbstract:Object Spinal Metastasis with spinal cord involvement is a frequent complication in cancer patients. As the spinal compression frequently occurs ventrally, performing a simple posterior laminectomy alone is generally ineffective and dangerous. Many aggressive surgical strategies have been developed to improve outcomes for patients with metastatic Spine disease. These strategies are associated with high morbidity and complication rates, especially in patients with numerous neoplasm-associated comorbidities, which can limit their indication in patients with a limited life expectancy. The authors performed a prospective evaluation of minimally invasive decompression and stabilization for the palliative management of symptomatic thoracolumbar Spine Metastasis. Methods Ten patients with Metastasis to the thoracolumbar Spine and neurological compromise underwent minimally invasive transpedicular vertebrectomy and spinal cord decompression through a tubular expandable retractor. Percutaneous stabilization was al...
Fahed Zairi - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic Spine Metastasis from lung cancer
European Spine Journal, 2016Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, Melodieanne Karnoub, Mariehelene Vieillard, Patrick Devos, Alkis Bouras, Richard AssakerAbstract:Background: The management of Spine metastases is an increasing concern for Spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of Spine metastases, there is a lack of studies focusing on lung cancer alone. Purpose: To assess the effectiveness and safety of surgery in the management of symptomatic Spine metastases from lung cancer. Methods: We retrospectively reviewed all patients (n = 53) who underwent surgery for Spine Metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered "surgical success". Results: No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of Spine metastases (p = 0.0216). Conclusion: A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic Spine Metastasis from lung cancer
European Spine Journal, 2016Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, A Bouras, Melodieanne Karnoub, Mariehelene Vieillard, Patrick Devos, Richard AssakerAbstract:The management of Spine metastases is an increasing concern for Spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of Spine metastases, there is a lack of studies focusing on lung cancer alone. To assess the effectiveness and safety of surgery in the management of symptomatic Spine metastases from lung cancer. We retrospectively reviewed all patients (n = 53) who underwent surgery for Spine Metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered “surgical success”. No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of Spine metastases (p = 0.0216). A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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recent concepts in the management of thoracolumbar Spine Metastasis
Journal of Neurosurgical Sciences, 2013Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, A Bouras, Richard AssakerAbstract:As patient with cancer live longer, Spine Metastasis is a growing problem. Untreated, it can cause pain, instability and neurologic deficit, which can severely alter the patient's ability and quality of life. When the diagnosis is established, scoring systems help the physician to best define the objective of treatment by evaluating the life expectancy. Except in rare circumstances, treatment is palliative. Over the past 2 decades, remarkable evolution in surgical techniques provided to patients valuable therapeutic options to perform circumferential decompression and stabilization of the affected level. More recently, minimally invasive techniques allowed a significant reduction of morbidity. The parallel development of stereotactic radiosurgery offers new therapeutic options in particular for patients ineligible for surgery.
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minimally invasive decompression and stabilization for the management of thoracolumbar Spine Metastasis
Journal of Neurosurgery, 2012Co-Authors: Fahed Zairi, A Arikat, M Allaoui, Paulo Marinho, Richard AssakerAbstract:Object Spinal Metastasis with spinal cord involvement is a frequent complication in cancer patients. As the spinal compression frequently occurs ventrally, performing a simple posterior laminectomy alone is generally ineffective and dangerous. Many aggressive surgical strategies have been developed to improve outcomes for patients with metastatic Spine disease. These strategies are associated with high morbidity and complication rates, especially in patients with numerous neoplasm-associated comorbidities, which can limit their indication in patients with a limited life expectancy. The authors performed a prospective evaluation of minimally invasive decompression and stabilization for the palliative management of symptomatic thoracolumbar Spine Metastasis. Methods Ten patients with Metastasis to the thoracolumbar Spine and neurological compromise underwent minimally invasive transpedicular vertebrectomy and spinal cord decompression through a tubular expandable retractor. Percutaneous stabilization was al...
Woong Sub Koom - One of the best experts on this subject based on the ideXlab platform.
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variation in practice patterns of korean radiation oncologists for Spine Metastasis between 2009 and 2014
Cancer Research and Treatment, 2016Co-Authors: Hee Chul Park, Yong Chan Ahn, Woong Sub Koom, Yoonsun Chung, Si Yeol SongAbstract:Purpose The Korean Society of Radiation Oncologists (KOSRO) conducted the Patterns of Care Study (PCS) of radiotherapy (RT) for Spine metastases in 2009. The current study was conducted to investigate current practice patterns and compare them with the results of the PCS. Materials and methods The survey questionnaire was composed of 10 questions regarding general information and seven questions for each of two clinical scenarios. Results Fifty-four members of the KOSRO answered at least one question on the web-based questionnaire. The yearly number of patients treated who underwent palliative Spine RT was greater than 200 in 14 (25.9%), 51 to 100 in 13 (24.1%), and 31 to 50 in 11 respondents (20.4%). Scenario 1 described a patient presenting with cord compressive Spine Metastasis in multiple bones and liver Metastasis from non-small cell lung cancer. Thirty gray (Gy) in 10 fractions was chosen by 35 respondents (64.8%). Scenario 2 described a case of a single Spine Metastasis without progression after targeted therapy. Thirty Gy in 10 fractions was chosen by 19 respondents (35.2%), and a single fraction or less than four fractions of stereotactic ablative radiotherapy (SABR) were selected by 18 respondents (33.3%). When compared with the 2009 PCS, practice patterns of Korean radiation oncologists had not changed significantly over 5 years, except that SABR emerged as a new treatment modality in the selected population. Conclusion The 2014 PCS demonstrated that multiple fraction RT is still preferred in a considerable proportion of Korean radiation oncologists.
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Variation in Practice Patterns of Korean Radiation Oncologists for Spine Metastasis between 2009 and 2014
Cancer Research and Treatment, 2015Co-Authors: Jeong Il Yu, Hee Chul Park, Woong Sub Koom, Yoonsun Chung, Si Yeol SongAbstract:The Korean Society of Radiation Oncologists (KOSRO) conducted the Patterns of Care Study (PCS) of radiotherapy (RT) for Spine metastases in 2009. The current study was conducted to investigate current practice patterns and compare them with the results of the PCS.The survey questionnaire was composed of 10 questions regarding general information and seven questions for each of two clinical scenarios.Fifty-four members of the KOSRO answered at least one question on the web-based questionnaire. The yearly number of patients treated who underwent palliative Spine RT was greater than 200 in 14 (25.9%), 51 to 100 in 13 (24.1%), and 31 to 50 in 11 respondents (20.4%). Scenario 1 described a patient presenting with cord compressive Spine Metastasis in multiple bones and liver Metastasis from non-small cell lung cancer. Thirty gray (Gy) in 10 fractions was chosen by 35 respondents (64.8%). Scenario 2 described a case of a single Spine Metastasis without progression after targeted therapy. Thirty Gy in 10 fractions was chosen by 19 respondents (35.2%), and a single fraction or less than four fractions of stereotactic ablative radiotherapy (SABR) were selected by 18 respondents (33.3%). When compared with the 2009 PCS, practice patterns of Korean radiation oncologists had not changed significantly over 5 years, except that SABR emerged as a new treatment modality in the selected population.The 2014 PCS demonstrated that multiple fraction RT is still preferred in a considerable proportion of Korean radiation oncologists.
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vertebral compression fractures after Spine irradiation using conventional fractionation in patients with metastatic colorectal cancer
Radiation oncology journal, 2014Co-Authors: W J Rhee, Kyung Hwan Kim, Jee Suk Chang, Hyunju Kim, Seohee Choi, Woong Sub KoomAbstract:PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with Spine Metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated Spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved Spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the Spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
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stereotactic body radiotherapy with helical tomotherapy for pain palliation in Spine Metastasis
Technology in Cancer Research & Treatment, 2013Co-Authors: Myoung Soo Kim, Ki Chang Keum, Jihye Cha, Ju Hye Kim, Jinsil Seong, Chang Geol Lee, Ki Chang Nam, Woong Sub KoomAbstract:To evaluate the pain response, local tumor control and toxicity of stereotactic body radiotherapy (SBRT) with helical tomotherapy (HT) in the patients with Spine Metastasis. From May 2009 to June 2010, 22 patients with 31 lesions were treated by SBRT. Dose scheme were 24 Gy in 3 fractions (87.1%), 30 Gy in 5 fractions (9.7%), and 16 Gy in a single fraction (3.2%). Pain was assessed using a numerical rating scale. Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED). The response criteria of International Bone Metastases Consensus Group (IBMCG) was used. The median follow-up duration was 10 months (range 3-23 months). After SBRT the mean pain score decreased significantly (4.32 before SBRT, 0.71 at 3 months). However, median OMED didn't decrease until 3 months after SBRT (Median OMED; 34.5 mg before SBRT, 45 mg at 3 months). Pain response rate and pain progression-free survival rate at 3 month was 96.8 and 93.5%, respectively. Local progression-free survival rate at 3 month was 93.5%. There was no severe acute toxicity. SBRT with HT is a safe and effective treatment modality for local tumor control and pain palliation associated with Spine Metastasis.
Kristin J Redmond - One of the best experts on this subject based on the ideXlab platform.
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normal tissue complication probability of vertebral compression fracture after stereotactic body radiotherapy for de novo Spine Metastasis
Radiotherapy and Oncology, 2020Co-Authors: Xuguang Chen, Chengcheng Gui, J Grimm, Ellen Huang, Lawrence Kleinberg, Daniel M Sciubba, Majid Khan, Kristin J RedmondAbstract:Abstract Objective Stereotactic body radiotherapy (SBRT) for Spine metastases is associated with post-treatment vertebral compression fracture (VCF). The purpose of this study is to identify clinical and radiation planning characteristics that predict post-SBRT VCF through a novel normal tissue complication probability (NTCP) analysis. Methods Patients with de novo Spine metastases treated with SBRT between 2009 and 2018 at a single institution were included. Those who had surgical stabilization or radiation to the same site prior to SBRT were excluded. VCF was defined as new development or progression of existing vertebral body height loss not attributable to tumor growth. Probit NTCP models were constructed and fitted using a maximum likelihood approach. A multivariate proportional hazard model was used to estimate time to VCF using the Fine and Gray method. Results Three hundred and two vertebral segments from 193 patients were treated with a median dose of 24 Gy in 3 fractions (range 15–30 Gy in 1–5 fractions). With a median follow up of 13.9 months, local control was 89.3% at 1 year. A total of 26 SBRT-induced VCFs were observed, with 1 and 2-year cumulative incidences of 4.6% and 6.7%. NTCP modeling demonstrated a steep response of VCF risk to the dose to 80% and 50% volume of the planning target volume (PTV D80% and D50%), but not maximum dose or dose to 1 cc or 10% of PTV. D80% of 25 Gy and D50% of 28 Gy in 3 fractions corresponded to 10% VCF risk. On multivariate analysis, lower body mass index (HR 0.90 per unit increase, p = 0.04), total spinal instability neoplastic score (SINS, HR 2.44 unstable vs stable, p = 0.04), and PTV D80% (HR 1.11 for every Gy increase, p = 0.003) were associated with increased VCF risk. Conclusions SBRT provides excellent tumor control for spinal metastases and is associated with low rate of VCF in our cohort. NTCP modeling suggests that the larger volume of Spine receiving lower doses are more closely associated with post-SBRT VCF than high dose regions. Under current target delineation methods, common SBRT regimens such as 24 Gy in 2 fractions or 27 Gy in 3 fractions may be inherently associated with VCF risk of 10% or greater. Consensus contouring guidelines should be reevaluated to minimize the volume of irradiated Spine in light of these new data.
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neuroimaging and stereotactic body radiation therapy sbrt for Spine Metastasis
Topics in Magnetic Resonance Imaging, 2019Co-Authors: Majid Khan, Chengcheng Gui, Rahul Garg, Young Lee, Arjun Sahgal, Mahmud Mossabasha, Nina A Mayr, Kristin J RedmondAbstract:Historically, management options for spinal metastases include surgery for stabilization and decompression and/or external beam radiation therapy (EBRT). EBRT is palliative in nature, as it lacks accurate targeting such that the prescribed radiation doses must be limited in order to maintain safety. Modern advancement in imaging and radiotherapy technology have facilitated the development of stereotactic body radiation therapy (SBRT), which provides increased targeted precision for radiation delivery to tumors resulting in lower overall toxicity, particularly to regional structures such as the spinal cord and esophagus, while delivering higher, more effective, and radically ablative radiation doses.Over the past decade, SBRT has been increasingly utilized as a method of treating spinal metastases either as the primary modality or following surgical intervention in both de novo and reirradiation setting. Numerous studies suggest that SBRT is associated with an 80% to 90% rate of 1-year local control across clinical scenarios. For example, studies of SBRT as the primary treatment modality suggest long-term local control rate of 80% to 95% for spinal metastases. Similarly, SBRT in the adjuvant setting following surgery is associated with local control rates ranging from 70% to 100%. Furthermore, because SBRT allows for lower dose to the spinal cord, it has also been used in patients who have had prior radiation therapy, with studies showing 66% to 93% local control in this scenario.
Paulo Marinho - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic Spine Metastasis from lung cancer
European Spine Journal, 2016Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, Melodieanne Karnoub, Mariehelene Vieillard, Patrick Devos, Alkis Bouras, Richard AssakerAbstract:Background: The management of Spine metastases is an increasing concern for Spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of Spine metastases, there is a lack of studies focusing on lung cancer alone. Purpose: To assess the effectiveness and safety of surgery in the management of symptomatic Spine metastases from lung cancer. Methods: We retrospectively reviewed all patients (n = 53) who underwent surgery for Spine Metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered "surgical success". Results: No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of Spine metastases (p = 0.0216). Conclusion: A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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evaluation of the relevance of surgery in a retrospective case series of patients who underwent the surgical treatment of a symptomatic Spine Metastasis from lung cancer
European Spine Journal, 2016Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, A Bouras, Melodieanne Karnoub, Mariehelene Vieillard, Patrick Devos, Richard AssakerAbstract:The management of Spine metastases is an increasing concern for Spine surgeons. When considering surgery, it is crucial to ensure that its iatrogenic effects will not exceed its potential benefits, particularly in frail patients with short life expectancy. Among all prognostic factors, the primary site of cancer is the most important, lung cancer being the poorest. Although surgery has shown its effectiveness in the management of Spine metastases, there is a lack of studies focusing on lung cancer alone. To assess the effectiveness and safety of surgery in the management of symptomatic Spine metastases from lung cancer. We retrospectively reviewed all patients (n = 53) who underwent surgery for Spine Metastasis from lung cancer at the Lille University Hospital between January 2005 and December 2011. Patients for whom surgery was effective to restore or preserve ambulation, to relieve pain, and to ensure stability without severe complication were considered “surgical success”. No patient was lost to follow-up and vital status data were available for all patients. The median survival was 2.1 months and was not influenced by the surgical success (p = 0.1766). We reported seven major complications in seven patients, including three epidural haematoma, two massive pulmonary embolisms and two deaths from cardiopulmonary failure. The surgical success rate was 49 % and on univariate analysis, the factors that have influenced the postoperative outcome were the KPS (p < 0.001), the Frankel grade (p = 0.0217) and the delay between the cancer diagnosis and the occurrence of Spine metastases (p = 0.0216). A strict patient selection is required to limit the iatrogenic effect of surgery, which may alter the quality of life of these frail patients with limited life expectancy.
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recent concepts in the management of thoracolumbar Spine Metastasis
Journal of Neurosurgical Sciences, 2013Co-Authors: Fahed Zairi, M Allaoui, Paulo Marinho, A Bouras, Richard AssakerAbstract:As patient with cancer live longer, Spine Metastasis is a growing problem. Untreated, it can cause pain, instability and neurologic deficit, which can severely alter the patient's ability and quality of life. When the diagnosis is established, scoring systems help the physician to best define the objective of treatment by evaluating the life expectancy. Except in rare circumstances, treatment is palliative. Over the past 2 decades, remarkable evolution in surgical techniques provided to patients valuable therapeutic options to perform circumferential decompression and stabilization of the affected level. More recently, minimally invasive techniques allowed a significant reduction of morbidity. The parallel development of stereotactic radiosurgery offers new therapeutic options in particular for patients ineligible for surgery.
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minimally invasive decompression and stabilization for the management of thoracolumbar Spine Metastasis
Journal of Neurosurgery, 2012Co-Authors: Fahed Zairi, A Arikat, M Allaoui, Paulo Marinho, Richard AssakerAbstract:Object Spinal Metastasis with spinal cord involvement is a frequent complication in cancer patients. As the spinal compression frequently occurs ventrally, performing a simple posterior laminectomy alone is generally ineffective and dangerous. Many aggressive surgical strategies have been developed to improve outcomes for patients with metastatic Spine disease. These strategies are associated with high morbidity and complication rates, especially in patients with numerous neoplasm-associated comorbidities, which can limit their indication in patients with a limited life expectancy. The authors performed a prospective evaluation of minimally invasive decompression and stabilization for the palliative management of symptomatic thoracolumbar Spine Metastasis. Methods Ten patients with Metastasis to the thoracolumbar Spine and neurological compromise underwent minimally invasive transpedicular vertebrectomy and spinal cord decompression through a tubular expandable retractor. Percutaneous stabilization was al...