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Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)

BACKGROUND: The cervicothoracic junction (CTJ) site accounts for approximately 10% of all spinal metastases. The complex anatomical and biomechanical features increase the difficulty in surgical treatment of the CTJ metastases. However, few studies in the literature on surgical treatment for spinal...

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Autores principales: Li, Zemin, Long, Houqing, Guo, Rui, Xu, Jinghui, Wang, Xiaobo, Cheng, Xing, Huang, Yangliang, Li, Fobao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791728/
https://www.ncbi.nlm.nih.gov/pubmed/29382354
http://dx.doi.org/10.1186/s13018-018-0732-2
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author Li, Zemin
Long, Houqing
Guo, Rui
Xu, Jinghui
Wang, Xiaobo
Cheng, Xing
Huang, Yangliang
Li, Fobao
author_facet Li, Zemin
Long, Houqing
Guo, Rui
Xu, Jinghui
Wang, Xiaobo
Cheng, Xing
Huang, Yangliang
Li, Fobao
author_sort Li, Zemin
collection PubMed
description BACKGROUND: The cervicothoracic junction (CTJ) site accounts for approximately 10% of all spinal metastases. The complex anatomical and biomechanical features increase the difficulty in surgical treatment of the CTJ metastases. However, few studies in the literature on surgical treatment for spinal metastases are focusing on this special area. The aim of this study was to evaluate the surgical outcome of patients with CTJ metastases and analyze the prognostic factor for the postoperative survival. METHODS: Total of 34 patients with CTJ metastases who underwent surgery in our department were retrospectively analyzed. We evaluated records for the details of medical history, treatment, surgery, radiographic imaging, and follow-up. Outcomes were assessed by overall survival as well as modified Tokuhashi score, SINS, Frankel grade, visual analog scale (VAS), and Karnofsky Performance Status (KPS). RESULTS: The entire patients’ median survival time was 12.4 months (range, 3.5–36.2 months). Pain improved in 32 patients (94.12%), and the postoperative VAS scores were significantly improved compared with preoperative data. Majority of patients (71%) maintained or improved their Frankel scores 1 year after surgery. KPS scores improved in 13 patients (38%), remained stable in 19 (56%), and worsened in 2 (6%) postoperatively. Notably, patients with neurological deficit that did not improve after surgery had significantly worse median survival than those who had either no deficit or who improved after surgery. There were no instrumentation failures in this study. CONCLUSIONS: Surgical treatment is effective for patients of CTJ metastases, with a tolerable rate of complications. Remained or regained ambulatory status predicted overall survival. Thus, prompt and aggressive decompressive surgery is recommended for CTJ metastases patients with neurological impairment.
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spelling pubmed-57917282018-02-12 Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ) Li, Zemin Long, Houqing Guo, Rui Xu, Jinghui Wang, Xiaobo Cheng, Xing Huang, Yangliang Li, Fobao J Orthop Surg Res Research Article BACKGROUND: The cervicothoracic junction (CTJ) site accounts for approximately 10% of all spinal metastases. The complex anatomical and biomechanical features increase the difficulty in surgical treatment of the CTJ metastases. However, few studies in the literature on surgical treatment for spinal metastases are focusing on this special area. The aim of this study was to evaluate the surgical outcome of patients with CTJ metastases and analyze the prognostic factor for the postoperative survival. METHODS: Total of 34 patients with CTJ metastases who underwent surgery in our department were retrospectively analyzed. We evaluated records for the details of medical history, treatment, surgery, radiographic imaging, and follow-up. Outcomes were assessed by overall survival as well as modified Tokuhashi score, SINS, Frankel grade, visual analog scale (VAS), and Karnofsky Performance Status (KPS). RESULTS: The entire patients’ median survival time was 12.4 months (range, 3.5–36.2 months). Pain improved in 32 patients (94.12%), and the postoperative VAS scores were significantly improved compared with preoperative data. Majority of patients (71%) maintained or improved their Frankel scores 1 year after surgery. KPS scores improved in 13 patients (38%), remained stable in 19 (56%), and worsened in 2 (6%) postoperatively. Notably, patients with neurological deficit that did not improve after surgery had significantly worse median survival than those who had either no deficit or who improved after surgery. There were no instrumentation failures in this study. CONCLUSIONS: Surgical treatment is effective for patients of CTJ metastases, with a tolerable rate of complications. Remained or regained ambulatory status predicted overall survival. Thus, prompt and aggressive decompressive surgery is recommended for CTJ metastases patients with neurological impairment. BioMed Central 2018-01-30 /pmc/articles/PMC5791728/ /pubmed/29382354 http://dx.doi.org/10.1186/s13018-018-0732-2 Text en © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Li, Zemin
Long, Houqing
Guo, Rui
Xu, Jinghui
Wang, Xiaobo
Cheng, Xing
Huang, Yangliang
Li, Fobao
Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
title Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
title_full Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
title_fullStr Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
title_full_unstemmed Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
title_short Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
title_sort surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (ctj)
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791728/
https://www.ncbi.nlm.nih.gov/pubmed/29382354
http://dx.doi.org/10.1186/s13018-018-0732-2
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