Abstract
Introduction
Spinal metastases occur in 20% of the cancer patients being of those only 5–10% develop spinal cord compression. The basic surgical principle of the treatment is palliative due to multicentric and advanced stage when metastases are found in the bone. In this context, select an appropriate patient for surgery is challenging, because this is based on clinical conditional, clinical presentation and oncological status. Since the SINS classification has been published in 2010, it has become an important tool for surgical standpoint to define which type of tumor's fracture is potential or unstable and facilitates the communication between oncological team. Herein, the aim of this paper is to evaluate the association between SINS score and VAS preoperatively, ASIA pre and postoperatively, the relation between SINS and specific kind of tumors, VAS pre and postoperative, and overall survival.
Material and Methods
This study is a prospective cohort. The authors analyzed 79 patients who presented with spinal metastatic disease (excluding 15 hematological cases and 10 cases that the data were lost) and that underwent spinal surgery decompression. The criteria for surgery were clinical condition, oncological status, the SINS score and/or spinal cord compression. The data was collected from June, 2012 to March, 2015. The SINS (Spinal Instability for Neoplastic Score), VAS (Visual Analogue Scale) pre and postoperatively (0–3 months) after surgery), ASIA (American Spinal Cord Injury Association) scale pre and post operatively (0–3 months) data was collected. The authors analyzed the association between SINS score and VAS preoperatively, ASIA preoperatively and postoperatively, SINS and specific types of disease, VAS pre and postoperatively and the overall survival after surgery. The Pearson test association, chi-square test and Kaplan-Meyer curve were applied.
Results
Utilizing Pearson association test we found 70.7% of patients with VAS (9–10), had a SINS score (13–18) against one with VAS (0–4) had SINS (7–12) p = 0.02. An analysis of ASIA preoperatively and post operatively (3 months), we found 59.57% (28 patients) ASIA B-D became postoperatively ASIA E, 36.17% (17 patients) showed no change; 71.43%(5 patients) ASIA A became ASIA B-D, it was correlated with p < 0.001. Comparison with higher SINS (13–18) with breast and lung spinal metastases showed 73.68%(18 patients) and 85.71%(8 patients) respectively, p = 0.03 (weak correlation. From 69 patients preoperatively VAS (9–10) and 8 patients VAS (5–8) all of them became VAS (0–4) making the statistical analysis not possible. The global overall survival was 10.78 months. ASIA E patients were 12.38 months IC 95%((9.05–15.65), and ASIA A were 2.75 IC 95%(0.745–4.75).
Conclusion
The utilization of the SINS score to determine instability is reliable and related to increase of the pain at the VAS preoperatively; the surgery improves neurological function (ASIA) statistically significant and VAS postoperatively without statistical significance. It was found that there was a weak relation between higher SINS and breast cancer patients who present spinal cord compression in our series. Based on our patients overall survival we conclude that surgery is an important tool for patients who present clinical conditions and spinal instability.