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Survival rate and neurological outcome after operation for advanced spinal metastasis (Tomita's classification > or type 4)

 Young Min Kwon  ;  Keun Su Kim  ;  Sung Uk Kuh  ;  Dong Kyu Chin  ;  Byung Ho Jin  ;  Yong Eun Cho 
 YONSEI MEDICAL JOURNAL, Vol.50(5) : 689-696, 2009 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Child ; Combined Modality Therapy ; Diagnostic Techniques, Neurological ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies ; Spinal Neoplasms/mortality ; Spinal Neoplasms/secondary* ; Spinal Neoplasms/surgery ; Survival Rate
Bone neoplasm ; decision making ; metastasis ; prognosis
PURPOSE: We investigated whether primary malignancy entities and the extent of tumor resection have an effect on the survival rate and neurological improvement in patients with spinal metastases that extend beyond the vertebral compartment (Tomita's classification > or = type 4). MATERIALS AND METHODS: We retrospectively reviewed 87 patients with advanced spinal metastasis who underwent surgery. They were divided into groups 1 and 2 according to whether they responded to adjuvant therapy or not, respectively. They were subdivided according to the extent of tumor resection: group 1, gross total resection (G1GT); group 1, subtotal resection (G1ST); group 2, gross total resection (G2GT); and group 2, subtotal resection (G2ST). The origin of the tumor, survival rate, extent of resection, and neurological improvement were analyzed. RESULTS: Group 1 had a better survival rate than group 2. The G1GT subgroup showed a better prognosis than the G1ST subgroup. In group 2, the extent of tumor resection (G2GT vs. G2ST) did not affect survival rate. In all subgroups, neurological status improved one month after surgery, however, the G2ST subgroup had worsened at the last follow-up. There was no local recurrence at the last follow-up in the G1GT subgroup. Four out of 13 patients in the G2GT subgroup showed a local recurrence of spinal tumors and progressive worsening of neurological status. CONCLUSION: In patients with spinal metastases (Tomita's classification > or = type 4), individuals who underwent gross total resection of tumors that responded to adjuvant therapy showed a higher survival rate than those who underwent subtotal resection. For tumors not responding to adjuvant therapy, we suggest palliative surgical decompression.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kuh, Sung Uk(구성욱) ORCID logo https://orcid.org/0000-0003-2566-3209
Kwon, Young Min(권영민)
Kim, Keun Su(김근수) ORCID logo https://orcid.org/0000-0002-3384-5638
Cho, Yong Eun(조용은) ORCID logo https://orcid.org/0000-0001-9815-2720
Chin, Dong Kyu(진동규) ORCID logo https://orcid.org/0000-0002-9835-9294
Jin, Byung Ho(진병호)
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