Objective: The aim of this study was to translate new evidence about management of spinal metastases in a practical and reliable score for surgeons, radiation oncologists and oncologists, able to establish the need for surgery regardless the available technology and settings. Patients and Methods: Three main items were identified and graded: Neurological status (0–5 points), Stability of the spine according to the Spinal Instability Neoplastic Score (SINS) Score (0–5 points), and Epidural compression according to the Epidural Spinal Cord Compression (ESCC) scale (0–3 points). Patients were considered suitable for surgery with ASA score < 4 and ECOG score <3. A retrospective clinical validation of the NSE score was made on 145 patients that underwent surgical or non surgical treatment. Results: Agreement between the undertaken treatment and the score (88.3% of patients), resulted in a strong association with improvement or preservation of clinical status (neurological functions and mechanical pain) (p < 0.001) at 3 and 6 months. In the non-agreement group no association was recorded at the 3 and 6 months follow-up (p 0.486 and 0.343 for neurological functions, 0.063 and 0.858 for mechanical pain). Conclusion: Functional outcomes of the study group showed that the proposed NSE score could represent a practical and reliable tool to establish the need for surgery. Agreement between the score and the performed treatments resulted in better clinical outcomes, when compared with patients without agreement. Further validation is needed with a larger number of patients and to assess reproducibility among surgeons, radiation oncologists, and oncologists.

The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases

Cofano F.;Di Perna G.;Zenga F.;Baldassarre B.;Ajello M.;Marengo N.;Lanotte M.;Garbossa D.
2020-01-01

Abstract

Objective: The aim of this study was to translate new evidence about management of spinal metastases in a practical and reliable score for surgeons, radiation oncologists and oncologists, able to establish the need for surgery regardless the available technology and settings. Patients and Methods: Three main items were identified and graded: Neurological status (0–5 points), Stability of the spine according to the Spinal Instability Neoplastic Score (SINS) Score (0–5 points), and Epidural compression according to the Epidural Spinal Cord Compression (ESCC) scale (0–3 points). Patients were considered suitable for surgery with ASA score < 4 and ECOG score <3. A retrospective clinical validation of the NSE score was made on 145 patients that underwent surgical or non surgical treatment. Results: Agreement between the undertaken treatment and the score (88.3% of patients), resulted in a strong association with improvement or preservation of clinical status (neurological functions and mechanical pain) (p < 0.001) at 3 and 6 months. In the non-agreement group no association was recorded at the 3 and 6 months follow-up (p 0.486 and 0.343 for neurological functions, 0.063 and 0.858 for mechanical pain). Conclusion: Functional outcomes of the study group showed that the proposed NSE score could represent a practical and reliable tool to establish the need for surgery. Agreement between the score and the performed treatments resulted in better clinical outcomes, when compared with patients without agreement. Further validation is needed with a larger number of patients and to assess reproducibility among surgeons, radiation oncologists, and oncologists.
2020
195
105896
1
12
Metastases; NOMS framework; Oncology; Radiosurgery; Score; Spinal metastases; Surgical indication
Cofano F.; Di Perna G.; Zenga F.; Ducati A.; Baldassarre B.; Ajello M.; Marengo N.; Ceroni L.; Lanotte M.; Garbossa D.
File in questo prodotto:
File Dimensione Formato  
Clin Neurol Neurosurg 2020.pdf

Accesso riservato

Tipo di file: PDF EDITORIALE
Dimensione 5.73 MB
Formato Adobe PDF
5.73 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1758300
Citazioni
  • ???jsp.display-item.citation.pmc??? 7
  • Scopus 15
  • ???jsp.display-item.citation.isi??? 14
social impact