Shifting Paradigms in the Treatment of Metastatic Spine Disease
- 1 October 2009
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 34 (Supplement), S101-S107
- https://doi.org/10.1097/brs.0b013e3181bac4b2
Abstract
Systematic review and evidence appraisal. To evaluate the optimal treatment for patients with spinal cord compression secondary to solid metastases and in patients with solitary renal metastases, without spinal cord compression. Focused Medline and OVID database searches were conducted using relevant keywords. Only clinical articles that evaluated specific end points of interest were included in the literature review. The quality of evidence provided by each article was assessed using the ATS guidelines. The expert opinion was synthesized based on the evidence and rated as strong or weak, depending on the quality of the supporting literature. Twelve surgical and 7 radiation clinical series were identified that evaluated post-treatment ambulation in patients with metastatic spinal cord compression. Only 1 surgical article met the criteria for moderate quality evidence while the remaining surgical and radiation articles presented very low quality of evidence. All articles that evaluated treatment of solitary renal metastases presented very low quality of evidence. A strong recommendation is made for patients with high-grade cord compression due to solid tumor metastases to undergo surgical decompression with stabilization followed by radiation therapy. A weak recommendation is made for patients with solitary renal metastases without spinal cord compression to undergo spinal stereotactic radiosurgery.Keywords
This publication has 37 references indexed in Scilit:
- An Official ATS Statement: Grading the Quality of Evidence and Strength of Recommendations in ATS Guidelines and RecommendationsAmerican Journal of Respiratory and Critical Care Medicine, 2006
- A Revised Scoring System for Preoperative Evaluation of Metastatic Spine Tumor PrognosisSpine, 2005
- Surgical Strategy for Spinal MetastasesSpine, 2001
- Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: Final results from a prospective trialInternational Journal of Radiation Oncology*Biology*Physics, 1995
- Surgical Decompression of Anterior and Posterior Malignant Epidural Tumors Compressing the Spinal Cord: A Prospective StudyNeurosurgery, 1985
- Anterolateral decompression for metastatic epidural spinal cord tumorsJournal of Neurosurgery, 1985
- Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spineJournal of Neurosurgery, 1984
- Vertebral body resection in the treatment of cancer involving the spineCancer, 1984
- Anterior decompression of the spine for metastatic epidural cord compression: A promising avenue of therapy?Annals of Neurology, 1982
- Epidural spinal cord compression from metastatic tumor: Results with a new treatment protocolAnnals of Neurology, 1980